A pregnant woman undergoes a triple/quadruple screen at 16 to 18 weeks' gestation. What would the nurse suspect if the woman's alpha-fetoprotein (AFP) level is decreased?

Choice A Reason: Nausea is a common presumptive sign of pregnancy, especially in the first trimester. It is caused by hormonal changes and may be accompanied by vomiting.

Choice B Reason: Abdominal enlargement is another presumptive sign of pregnancy, as the uterus grows to accommodate the developing fetus. It may be noticeable as early as 12 weeks of gestation.

Choice C Reason: A positive pregnancy test is a presumptive sign of pregnancy, as it detects the presence of human chorionic gonadotropin (hCG), a hormone produced by the placenta. However, it is not a definitive sign, as it may be affected by other factors such as medications, tumors, or false positives.

Choice D Reason: Braxton Hicks contractions are not a presumptive sign of pregnancy, but a probable sign. They are irregular and painless contractions of the uterus that occur throughout pregnancy, but become more frequent and noticeable in the third trimester. They are also known as false labor contractions.

Choice E Reason: Amenorrhea, or the absence of menstrual periods, is a presumptive sign of pregnancy, as it indicates that ovulation has ceased. However, it is not a definitive sign, as it may be caused by other factors such as stress, illness, or hormonal imbalances.

Choice A Reason: This is incorrect because hemoconcentration by hypertension is a condition where the blood volume decreases and the blood pressure increases, leading to a higher hemoglobin level. A normal hemoglobin level for a pregnant woman in her second trimester is 10.5 to 14 g/dL. A hemoglobin level of 11 g/dL is within the normal range, not indicative of hemoconcentration.

Choice B Reason: This is incorrect because a multiple gestation pregnancy is a pregnancy with more than one fetus, such as twins or triplets. A multiple gestation pregnancy can cause a lower hemoglobin level due to increased blood volume and increased demand for iron. A hemoglobin level of 11 g/dL is not suggestive of a multiple gestation pregnancy.

Choice C Reason: This is incorrect because greater-than-expected weight gain is not directly related to the hemoglobin level. Weight gain during pregnancy depends on various factors such as pre-pregnancy weight, nutrition, physical activity, and genetics. A hemoglobin level of 11 g/dL does not reflect the weight status of the pregnant client.

Choice D Reason: This is correct because iron-deficiency anemia is a common type of anemia that occurs when the body does not have enough iron to produce enough red blood cells. Iron-deficiency anemia can cause a low hemoglobin level and affect the oxygen delivery to the tissues and the fetus. A hemoglobin level of 11 g/dL may indicate iron-deficiency anemia, especially if the client has other symptoms such as fatigue, weakness, pale skin, or cravings for non-food items. The nurse should confirm the diagnosis with further tests and recommend iron supplements and dietary changes to treat the condition.