A nurse is caring for a client who is in the active phase of the first stage of labor. When monitoring the uterine contractions, which of the following findings should the nurse report to the provider?

Choice A reason: Irregular fetal heart rate is not an expected finding in a client with a hydatidiform mole, as it can indicate fetal arrhythmia, distress, or demise. A client with a hydatidiform mole may have no fetal heart tones, as the pregnancy is nonviable and consists of abnormal trophoblastic tissue.

Choice B reason: Rapid decline in human chorionic gonadotropin (hCG) levels is not an expected finding in a client with a hydatidiform mole, as it can indicate a normal or abnormal termination of pregnancy. A client with a hydatidiform mole may have markedly elevated hCG levels, as the trophoblastic tissue secretes excessive amounts of the hormone.

Choice C reason: Profuse, clear vaginal discharge is not an expected finding in a client with a hydatidiform mole, as it can indicate a normal or abnormal cervical mucus production. A client with a hydatidiform mole may have vaginal bleeding, which is often dark brown or bright red, and may contain grape-like vesicles.

Choice D reason: Excessive uterine enlargement is an expected finding in a client with a hydatidiform mole, as it reflects the rapid growth of the trophoblastic tissue and the accumulation of fluid-filled vesicles. A client with a hydatidiform mole may have a uterus that is larger than expected for the gestational age, and may experience uterine cramping or pain.

Choice A reason: Dipstick value of 3+ for protein in her urine is a sign of significant proteinuria, which is one of the diagnostic criteria for preeclampsia, along with hypertension. Proteinuria indicates renal damage and impaired glomerular filtration, which can lead to complications, such as oliguria, eclampsia, or HELLP syndrome.

Choice B reason: Pitting pedal edema at the end of the day is a common and expected finding in pregnancy, as it results from the increased blood volume, venous pressure, and fluid retention. Edema is not a reliable indicator of preeclampsia, unless it is severe, generalized, or sudden.

Choice C reason: Weight gain of 0.5 kg during the past 2 weeks is a normal and expected finding in pregnancy, as it reflects the growth and development of the fetus, placenta, and maternal tissues. Weight gain is not a reliable indicator of preeclampsia, unless it is excessive, rapid, or associated with edema.

Choice D reason: Blood pressure (BP) increase to 138/86 mm Hg is a mild elevation that may indicate gestational hypertension, but not preeclampsia, unless it is accompanied by proteinuria or other signs of organ dysfunction. The diagnostic threshold for preeclampsia is a BP of 140/90 mm Hg or higher on two occasions at least four hours apart.