A nurse is reviewing the laboratory results for a client who has Cushing's disease. The nurse should expect the client to have an increase in which of the following laboratory values?

Rationale for correct choices

• Spontaneous abortion: The client is presenting at 10 weeks gestation with moderate, bright red vaginal bleeding and a history of risk factors including type 1 diabetes mellitus and recurrent infections. The open cervix on examination indicates that the pregnancy may not be viable and suggests impending or ongoing miscarriage.

• Cervical dilation: Cervical dilation is a key clinical sign of spontaneous abortion, as it indicates that the body is preparing to expel the pregnancy. The presence of an open cervix in conjunction with vaginal bleeding and cramping directly supports the risk for miscarriage. Monitoring cervical changes helps the healthcare team assess the progression and urgency of intervention.

Rationale for incorrect choices

• Molar pregnancy: Molar pregnancy typically presents with markedly elevated hCG levels, larger-than-expected uterine size, and absence of a viable embryo. Although the client has an elevated hCG, the level is not excessively high, and there is no indication of vesicular tissue or characteristic ultrasound findings, making molar pregnancy unlikely.

• Ectopic pregnancy: Ectopic pregnancy generally presents with unilateral abdominal pain, shoulder pain, and sometimes hypotension or signs of internal bleeding. The client’s bleeding is bright red, moderate, and accompanied by cervical dilation, which is not typical for an ectopic pregnancy. No abdominal mass or unilateral tenderness is reported, reducing the likelihood of this diagnosis.

• Lower abdominal cramping: While cramping is a symptom associated with miscarriage, it alone is not sufficient evidence to determine the risk for spontaneous abortion. Cervical dilation is a more definitive clinical sign indicating that the miscarriage may be occurring or imminent.

• hCG levels: The client’s hCG level of 30,000 IU/L is within the expected range for 10 weeks gestation and does not specifically indicate miscarriage. Unlike cervical dilation, hCG levels alone cannot confirm the risk for spontaneous abortion.

Rationale:

A. "Using this machine increases my risk of overdose.": PCA pumps are designed with safety features, including dose limits and lockout intervals, which reduce the risk of overdose. Understanding this helps the client recognize that PCA is a safe method for self-administered pain control when used correctly.

B. “I can get pain medication any time as long as I press the button”: The client can only receive medication according to the programmed dose and lockout interval. Pressing the button repeatedly will not override the safety mechanism, so this reflects a misunderstanding of how PCA pumps function.

C. "My partner can press my pain medication button for me if I am sleeping": PCA pumps are intended for self-administration only. Allowing someone else to press the button (a practice called “PCA by proxy”) can cause overdose and is unsafe, especially if the client is sleeping or sedated.

D. "I will receive a limited amount of pain medication when I press the button.": PCA pumps deliver a preset dose with a lockout interval to prevent overdose. This statement shows the client understands the safety mechanisms in place, indicating correct comprehension of PCA use.