For a woman at 42 weeks gestation, which finding would require more assessment by the nurse?

A. Weight gain of 4 pounds in a month. A weight gain of 4 pounds in a month is within the expected range for pregnancy, especially in the third trimester. While rapid or excessive weight gain could indicate fluid retention and worsening heart failure, this amount alone is not immediately concerning.

B. Dyspnea with walking. Dyspnea on exertion in a pregnant woman with congestive heart disease is a serious concern. It may indicate pulmonary congestion, worsening heart failure, or reduced cardiac output. Any increasing shortness of breath, especially with minimal activity, should be reported immediately to prevent complications like pulmonary edema or decompensated heart failure.

C. Presence of striae gravidarum. Striae gravidarum (stretch marks) are a normal skin change in pregnancy due to rapid growth and stretching of the skin. They are not related to congestive heart disease and do not require reporting.

D. Patellar reflexes of +2. A +2 deep tendon reflex (DTR) is normal and does not indicate worsening cardiac status. Reflex abnormalities are more relevant in conditions such as preeclampsia, where hyperreflexia can signal worsening disease, but they are not a concern in heart disease.

A. Fetal heart rate of 118 beats/min. A fetal heart rate of 118 bpm is within the normal range of 110-160 bpm and does not necessarily indicate fetal distress. While continuous monitoring is important in post-term pregnancies, this finding alone does not require urgent assessment.

B. One fetal movement noted in a two-hour assessment by the mother. Decreased fetal movement is a concerning sign that requires further assessment. At 42 weeks gestation, the aging placenta may lead to reduced oxygen and nutrient supply, increasing the risk of fetal compromise. Normally, at least 10 movements should be felt within two hours. A significant decrease in movement could indicate fetal distress or hypoxia, requiring immediate evaluation with a non-stress test (NST) or biophysical profile (BPP).

C. Cervix dilated 2 cm and 50% effaced. A partially dilated and effaced cervix is expected in a post-term pregnancy and does not indicate fetal distress. It suggests that labor may be approaching but does not require additional urgent assessment.

D. Score of 8 on the biophysical profile. A biophysical profile (BPP) score of 8 out of 10 is reassuring and indicates normal fetal well-being. If the score were 4 or lower, it would require immediate intervention, but a score of 8 suggests adequate oxygenation and fetal health.