A client is admitted to the labor and birth unit at 32 weeks' gestation with gestational hypertension. Which of the following assessment findings may be signs that the client is developing preeclampsia?

A. Eliciting the Moro reflex to wake the baby is unsafe and unnecessary. This method involves startling the infant, which can cause distress and may result in injury to the nipple, infant’s gums, or palate. It does not address the correct technique for breaking suction safely.

B. Pulling the breast or nipple directly from the baby’s mouth can lead to significant nipple trauma, including cracking, bleeding, and pain, and may also injure the infant’s mouth. This method is considered unsafe and is strongly discouraged in breastfeeding education.

C. Breaking the suction by gently inserting a clean finger into the corner of the infant’s mouth is the recommended technique. This action releases the latch safely, prevents nipple trauma, and allows the infant to unlatch without discomfort. It ensures that both the mother and baby remain safe during breastfeeding, and it supports proper feeding practices.

D. Relying on a popping sound as an indicator of safe breast removal is unreliable and can be misleading. Attempting to remove the breast based on sound alone may result in abrupt or forceful removal, causing pain or injury to the mother’s nipple and the infant’s oral tissues.

A. Genital warts are caused by human papillomavirus (HPV) infection. They usually present as painless, cauliflower-like lesions on the external genitalia. Genital warts do not cause cyclical pelvic pain, progressively worsening dysmenorrhea, dyspareunia, irregular bleeding, or infertility, making this an unlikely cause of the client’s symptoms.

B. Pregnancy does not account for chronic, long-term pelvic pain or progressive worsening over several years. Additionally, pregnancy is not a chronic condition and cannot explain the client’s secondary infertility or irregular vaginal bleeding over multiple menstrual cycles.

C. Endometriosis occurs when endometrial tissue grows outside the uterine cavity, most commonly on the ovaries, fallopian tubes, or peritoneum. It is characterized by progressive dysmenorrhea with pain during menstruation that worsens over time, persistent or cyclic pelvic pain often severe, dyspareunia or pain during sexual intercourse, irregular bleeding such as spotting or heavy periods, and infertility due to adhesions and altered pelvic anatomy that can impede conception. The client’s long history of progressively worsening pain, dyspareunia, irregular bleeding, and difficulty conceiving strongly supports endometriosis as the most likely diagnosis.

D. Premenstrual syndrome (PMS) involves physical and emotional symptoms, such as mood swings, bloating, breast tenderness, and mild cramps, that occur 1–2 weeks before menstruation. PMS does not cause severe, progressively worsening pelvic pain, dyspareunia, chronic irregular bleeding, or infertility.