A nurse is teaching a client who is at 15 weeks of gestation and is to undergo an amniocentesis. The nurse should explain that the purpose of this test is to identify which of the following conditions? (Select all that apply.)

Explanation:

A. A client who is at 38 weeks of gestation and reports a cough and fever.

The client at 38 weeks of gestation with a cough and fever presents with symptoms that could indicate a potential infection, such as respiratory or urinary tract infection, which can be serious during pregnancy. Infections in late pregnancy can also increase the risk of complications for both the mother and the baby. Therefore, assessing this client first is crucial to evaluate and address any potential infection and prevent complications.

B. A client who is at 28 weeks of gestation and reports painless vaginal bleeding.

Painless vaginal bleeding can be a concern, especially in the second or third trimester, as it may indicate conditions such as placenta previa or placental abruption. However, since this client's bleeding is painless, it may not be an immediate emergency compared to the potential infection in option A.

C. A client who is at 14 weeks of gestation and reports nausea and vomiting.

Nausea and vomiting, commonly known as morning sickness, are common during early pregnancy. While these symptoms can be uncomfortable, they are typically not urgent unless they lead to dehydration or other complications, which would require assessment but may not be as urgent as a potential infection in option A.

D. A client who has missed a period and reports vaginal spotting.

Vaginal spotting can occur in early pregnancy and may or may not be concerning depending on the amount and frequency. Since this client has missed a period, it suggests early pregnancy, and spotting can be relatively common in early pregnancy without indicating a significant problem. However, assessment is still needed to rule out any potential complications.

Explanation:

A. Excessive uterine enlargement

This choice is correct because a hydatidiform mole can cause rapid and excessive growth of the uterus due to the abnormal proliferation of placental tissue. This can lead to the uterus being larger than expected for the gestational age.

B. Profuse, clear vaginal discharge

This choice is not typically associated with a hydatidiform mole. While vaginal discharge can occur during pregnancy, a profuse and clear discharge is not specifically characteristic of a hydatidiform mole. Other causes, such as normal vaginal secretions or infections, could lead to such discharge.

C. Rapid decline in human chorionic gonadotropin (hCG) levels

This choice is not typical of a hydatidiform mole. In fact, one of the hallmarks of a molar pregnancy is an abnormally high level of hCG. The hCG levels may continue to rise instead of declining rapidly.

D. Irregular fetal heart rate

This choice is not associated with a hydatidiform mole because a molar pregnancy does not involve a viable fetus with a heartbeat. Instead, it is characterized by the abnormal growth of placental tissue, which can cause symptoms related to uterine enlargement and complications such as bleeding or preeclampsia, but not an irregular fetal heart rate.