A nurse is reinforcing teaching about nutrition with a client who is pregnant and has hyperemesis gravidarum at home.
Which of the following statements indicates that the client understands the teaching?

Choice A rationale:

Copious vaginal bleeding Rationale: Copious vaginal bleeding, especially if it's heavy and associated with pain, can be a sign of a miscarriage or other significant complications during pregnancy. While some bleeding can be normal in early pregnancy (implantation bleeding), copious bleeding is not expected and should prompt immediate medical attention. However, it is not a typical finding for an ectopic pregnancy.

Choice B rationale:

Pelvic pain Rationale: Pelvic pain is a concerning symptom in a client with a possible ectopic pregnancy. Ectopic pregnancies occur when the fertilized egg implants outside the uterus, often in the fallopian tube. As the embryo grows, it can cause the tube to rupture, leading to severe abdominal pain and internal bleeding. Pelvic pain is a hallmark symptom of an ectopic pregnancy and should be reported to the provider immediately.

Choice C rationale:

Uterine enlargement greater than expected for gestational age Rationale: Uterine enlargement is expected during pregnancy as the uterus accommodates the growing fetus. However, in the case of an ectopic pregnancy, the fertilized egg implants outside the uterus, typically in the fallopian tube. Therefore, uterine enlargement greater than expected for gestational age would not be a typical finding. This choice is not correct for an ectopic pregnancy.

Choice D rationale:

Severe nausea and vomiting Rationale: Severe nausea and vomiting can be associated with pregnancy-related conditions like hyperemesis gravidarum, but it is not a typical finding in ectopic pregnancies. Ectopic pregnancies are more likely to present with pelvic pain and may progress to severe abdominal pain if the fallopian tube ruptures. .

Choice A rationale:

"Tell me more about your concerns" is an appropriate therapeutic response by the nurse. It encourages the client to express her worries and fears about the pelvic examination. Open-ended questions like this one allow the nurse to better understand the client's specific concerns, which can help in addressing them effectively.

Choice B rationale:

"All you need to do is relax during the exam" may come across as dismissive and may not address the client's anxiety effectively. It's important to acknowledge the client's feelings and offer support rather than making the situation seem overly simplistic.

Choice C rationale:

"Don't worry. I will stay in there with you for the exam" might make the client feel like she has no control over the situation and can be invasive. While offering support is important, it's essential to respect the client's autonomy and provide emotional support through active listening and communication.

Choice D rationale:

"A pelvic exam is required if you want birth control pills" is not an appropriate response to the client's anxiety about the pelvic exam. This response does not address the client's concerns and may not provide the necessary emotional support or information she needs.