A nurse should include which of the following information?

The correct answer is choice b. Quickening occurs between the fourth and fifth months of pregnancy.

Choice A rationale:

Quickening does not start soon after implantation. Implantation occurs around 6-10 days after fertilization, but quickening, which is the first feeling of fetal movements, typically happens much later in pregnancy.

Choice B rationale:

This is the correct answer. Quickening usually occurs between 16 to 20 weeks of pregnancy, which corresponds to the fourth and fifth months.

Choice C rationale:

Quickening does not start during the last trimester. By the last trimester, fetal movements are usually strong and frequent, and the mother has been feeling them for several months.

Choice D rationale:

Quickening does not occur between the second and third month of pregnancy. At this stage, the fetus is still too small for its movements to be felt by the mother.

Rationale for Choice A: Whitish vaginal discharge
While whitish vaginal discharge can occur in some cases of hydatidiform mole, it's not a specific or sensitive finding for this condition.
It can also be present in various other gynecological conditions, including normal pregnancy, infections, and hormonal imbalances.
Therefore, relying on whitish vaginal discharge alone for monitoring a potential hydatidiform mole could lead to misdiagnosis or delayed diagnosis.

Rationale for Choice B: Excessive uterine enlargement
Excessive uterine enlargement is a common sign of hydatidiform mole, but it's not always present and might not be detected early in the condition.
The uterus might not be significantly enlarged in early stages, and other factors like multiple pregnancies or uterine fibroids could also contribute to uterine enlargement.
Solely relying on uterine enlargement could miss cases of hydatidiform mole that haven't progressed to a noticeable degree.

Rationale for Choice C: Fetal heart rate irregularities
Fetal heart rate irregularities are not relevant in hydatidiform mole because there is no viable fetus present. Hydatidiform moles are characterized by abnormal growth of placental tissue without a normal fetus developing. Monitoring for fetal heart rate would be inappropriate and misleading in this context.

Rationale for Choice D: Rapidly changing hCG levels
This is the most accurate and reliable finding to monitor for in a suspected hydatidiform mole.
hCG is a hormone produced by the placenta, and it's typically elevated in pregnancy. However, in hydatidiform mole, hCG levels are often abnormally high and rise rapidly.
Serial hCG measurements can accurately detect and track the progression of a hydatidiform mole, even in its early stages. It's considered the gold standard for diagnosis and monitoring of this condition.