A nurse is collecting data from a client who requests a prescription for a diaphragm.
Which of the following findings should the nurse identify as a contraindication to the client’s use of a diaphragm?

Choice A, 42022:
This option incorrectly counts the elective abortion as a term birth. Elective abortions, regardless of gestational age, are not considered term births in the GTPAL system. They are classified under abortions (A).

Including the elective abortion as a term birth would overestimate the client's parity, leading to inaccurate assessment of her reproductive history.

Choice B, 20022:
This option incorrectly excludes the elective abortion from the GTPAL calculation. Elective abortions are considered pregnancies and are included in the gravida (G) count.
Omitting the elective abortion would underestimate the client's overall pregnancy history and potentially overlook relevant factors related to her reproductive health.

Choice D, 20222:
This option incorrectly counts the spontaneous abortion as a preterm birth. Spontaneous abortions that occur before 20 weeks of gestation are not classified as preterm births in the GTPAL system. They are categorized as abortions (A).
Classifying the spontaneous abortion as a preterm birth would misrepresent the client's obstetric history and potentially lead to inappropriate care decisions.

Choice C, 40122:
This option accurately reflects the client's parity based on the GTPAL system:
Gravida (G): 4 (total pregnancies, including elective abortion, spontaneous abortion, twin birth, and current pregnancy) Term (T): 0 (no previous term births)
Preterm (P): 1 (twin birth at 36 weeks, considered preterm as it occurred before 37 weeks) Abortions (A): 2 (elective abortion and spontaneous abortion)
Living children (L): 2 (twins from the previous pregnancy)

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.