A client with preeclampsia is admitted to the hospital. The client's laboratory results indicate a lactate dehydrogenase (LDH) level of 525 U/L and uric acid of 5.8 mg/dL. Which intervention should the nurse anticipate?

Choice A rationale

Expulsion of the products of conception is a form of spontaneous abortion. The most immediate risk to the client is postpartum hemorrhage. The nurse must assess for uterine bleeding and firmness of the fundus, which indicates the uterus is contracting and clamping down blood vessels. A soft or boggy uterus is a sign of uterine atony and increases the risk of hemorrhage.

Choice B rationale

Providing emotional support is a crucial nursing intervention, but it is not the most important in the immediate aftermath of a spontaneous abortion. The client's physical stability and safety are the highest priority. Once the nurse has addressed the immediate physiological needs and ensured the client is stable, then emotional support can be provided.

Choice C rationale

Notifying the healthcare provider is an important step, but it follows the initial assessment of the client's physical status. The nurse must first gather essential information regarding the client's bleeding and fundal tone to provide a complete report. This ensures that the provider can make informed decisions about further interventions.

Choice D rationale

Removing the expelled material is part of providing hygienic care and comfort to the client. While important, it is not the most critical intervention. The immediate life-threatening risk is postpartum hemorrhage, which is addressed by assessing uterine bleeding and fundal firmness. Physical stability takes precedence over environmental cleanup.

Choice A rationale: Culturing vaginal secretions is primarily used for identifying infections like bacterial vaginosis or sexually transmitted infections, which are not consistent with the clinical presentation here. The brownish discharge is more likely due to necrotic tissue from proliferative trophoblastic growth than an infectious process. In gestational trophoblastic disease, vaginal bleeding results from abnormal trophoblast invasion and degeneration rather than microbial activity, thus making cultures less diagnostically relevant in this context.

Choice B rationale: While glucose in the urine can signal gestational diabetes, this patient’s presentation is not consistent with hyperglycemia-related symptoms such as polyuria or excessive thirst. Gestational trophoblastic disease is characterized by exaggerated pregnancy symptoms, including hyperemesis gravidarum due to elevated hCG levels, not insulin resistance. The greatly enlarged uterus and lack of fetal heart tones suggest molar pregnancy rather than a metabolic disturbance, making this lab test low priority for confirming diagnosis.

Choice C rationale: Hematocrit values help assess anemia or hemoconcentration but are non-specific in the diagnosis of gestational trophoblastic disease. While bleeding may affect hematocrit, the mild nature of the bleeding here does not support significant blood loss. Additionally, hematocrit changes lag behind acute events and do not correlate well with uterine size or nausea severity. The hypertensive reading suggests trophoblastic proliferation stimulating preeclampsia-like symptoms, which cannot be clarified through hematocrit alone.

Choice D rationale: Human chorionic gonadotropin (hCG) levels are crucial for confirming gestational trophoblastic disease, as they are markedly elevated due to hyperproliferation of trophoblastic cells. Normal hCG levels at 10 weeks range between 44,000–210,000 mIU/mL. In hydatidiform mole, levels often exceed these thresholds dramatically. hCG drives trophoblast proliferation and correlates with uterine size and severity of symptoms like nausea. This value helps differentiate between viable pregnancy and molar or neoplastic gestation