A nurse is caring for a client at 34 weeks gestation.

Medical History: The client has a history of gestational diabetes and mild hypertension.

Diagnostic Results: The latest ultrasound shows normal fetal growth and development. Blood sugar levels have been slightly elevated in the past week.

Vital Signs: Blood pressure has been steadily increasing over the past few hours. Heart rate and temperature remain within normal limits.

Complete the diagram by selecting the condition the client is most likely experiencing? Two actions the nurse should take to address that condition and two parameters the nurse should monitor to assess the client’s progress

The correct answers are Choices D

Choice A rationale: Constipation is a common symptom during pregnancy due to hormonal changes and the pressure of the growing uterus on the intestines. It generally does not warrant immediate reporting to the provider unless it is severe or accompanied by other concerning symptoms.

Choice B rationale: Low back pain is also a typical complaint during pregnancy, especially in the third trimester. It is often due to the additional weight and changes in posture. While it can be uncomfortable, it is usually not an urgent concern unless it is severe or associated with other symptoms.

Choice C rationale: Leukorrhea, or increased vaginal discharge, is common during pregnancy and is generally not a cause for concern. It helps protect the birth canal from infection and is typically not something that requires immediate reporting unless it is accompanied by itching, foul odor, or unusual color.

Choice D rationale: Blurred vision is a potential sign of preeclampsia, a serious condition that can develop during pregnancy and pose risks to both the mother and baby. This symptom warrants immediate reporting to the provider for further evaluation.

Choice A: Severe nausea and vomiting

While nausea and vomiting can be common in early pregnancy, including ectopic pregnancies, they are not specific indicators of an ectopic pregnancy.

Approximately 70-80% of pregnant women experience nausea and vomiting, regardless of the location of the pregnancy. Hence, the presence of severe nausea and vomiting alone would not definitively point towards an ectopic pregnancy.

Choice B: Uterine enlargement greater than expected for gestational age

In an ectopic pregnancy, the fertilized egg implants outside the uterus, typically in the fallopian tube. This means the uterus would not be expected to enlarge as it would in a normal intrauterine pregnancy. In fact, uterine size might be smaller than expected for gestational age in cases of ectopic pregnancy.

Choice C: Copious vaginal bleeding

While vaginal bleeding can occur in ectopic pregnancies, it's not always present and is not the most common initial symptom. When bleeding does occur, it's often lighter than a normal menstrual period and may be brown or dark in color.

Copious vaginal bleeding is more likely to occur in cases of miscarriage or other pregnancy complications.

Choice D: Pelvic pain

Pelvic pain is the most common and characteristic symptom of an ectopic pregnancy.

The pain is often described as sharp, stabbing, or cramping, and it may be localized to one side of the abdomen. The pain can be intermittent or constant, and it may worsen with activity or movement.

The pain is caused by the stretching of the fallopian tube as the ectopic pregnancy grows. In some cases, the pain can be severe enough to cause nausea and vomiting.

Therefore, pelvic pain is the most reliable finding that the nurse should expect in a client with a possible ectopic pregnancy at 8 weeks of gestation.