A nurse is collecting data from a client who is at 18 weeks of gestation and tells the nurse that she felt light flutering in her stomach the previous day. The nurse should use which of the following terms to document this finding?

This statement by the client indicates a need for further teaching, as it shows that the client does not understand the importance of regular physical activity for managing gestational diabetes. Physical activity can help lower blood glucose levels, improve insulin sensitivity, and prevent excessive weight gain during pregnancy. The client should aim for at least 30 minutes of moderate-intensity exercise on most days of the week, unless contraindicated by medical or obstetric complications.

The other statements by the client indicate that the client understands the key aspects of gestational diabetes management.

"I should limit my carbohydrates to 50% of caloric intake.” This statement is correct, as the client should follow a balanced diet that provides adequate nutrition for herself and her fetus, while controlling blood glucose levels. Carbohydrates are the main source of glucose and should be limited to 50% of caloric intake, distributed evenly throughout the day, and preferably from complex sources such as whole grains, fruits, and vegetables.

"I will take my glyburide daily with breakfast.” This statement is correct, as the client should take her prescribed oral hypoglycemic medication as directed by her provider. Glyburide is a sulfonylurea that stimulates insulin secretion and lowers blood glucose levels. It is usually taken once or twice a day with meals, depending on the dose and blood glucose response.

d. "I know I am at increased risk to develop type 2 diabetes." This statement is correct, as the client should be aware of the long-term implications of gestational diabetes. Gestational diabetes is a condition where the body becomes resistant to insulin during pregnancy, resulting in high blood glucose levels. It usually resolves after delivery, but it increases the risk of developing type 2 diabetes later in life. The client should monitor her blood glucose levels regularly, maintain a healthy weight, and have screening tests for diabetes every 1 to 3 years.

c. Excessive uterine enlargement

A hydatidiform mole is a type of gestational trophoblastic disease, where the placenta develops abnormally into a mass of cysts that resemble grape-like clusters. A hydatidiform mole can cause excessive uterine enlargement, as the uterus grows larger than expected for the gestational age. The nurse should measure the fundal height and compare it with the expected value based on the last menstrual period or ultrasound.

The other findings are not associated with a hydatidiform mole and may indicate other conditions.

Whitish vaginal discharge is not a sign of a hydatidiform mole, but it may be normal in pregnancy due to increased cervical mucus production. However, if the discharge is foul-smelling, yellow, green, or bloody, it may indicate an infection or a complication such as preterm labor or placental abruption.

Fetal heart rate irregularities are not a sign of a hydatidiform mole, but they may indicate fetal distress or congenital anomalies. A hydatidiform mole usually does not have a viable fetus, and fetal heart tones are absent or very faint. The nurse should use a Doppler device or a fetal monitor to assess the fetal heart rate and rhythm.

d. Rapidly dropping human chorionic gonadotropin (hCG) levels are not a sign of a hydatidiform mole, but they may indicate a spontaneous abortion or an ectopic pregnancy. A hydatidiform mole usually causes very high hCG levels, as the abnormal placental tissue secretes large amounts of this hormone. The nurse should perform a urine or blood test to measure the hCG levels and monitor them for chan