The nurse caring for a pregnant patient knows that her health teaching regarding fetal circulation has been effective when the patient reports that she has been sleeping ­­_______

A. Subjective report of quickening at 18 weeks gestation in a multiparous client: Quickening, or maternal perception of fetal movement, is considered a presumptive sign of pregnancy because it is subjective and can be influenced by gastrointestinal activity or abdominal muscle contractions.

B. A positive serum hCG level and Goodell’s sign on pelvic exam: Both findings are classified as probable signs of pregnancy. While hCG indicates hormonal changes and Goodell’s sign reflects cervical softening, these findings may also occur due to other hormonal conditions.

C. Visualization of the gestational sac by ultrasound at 5 weeks gestation: The presence of a gestational sac alone is an early probable sign but not diagnostic of a viable pregnancy. A definitive, or positive, sign requires visualization of an embryo or detection of fetal cardiac activity on ultrasound.

D. Fetal heart tones auscultated by Doppler at 11 weeks gestation: Detection of fetal heart tones is a clinically positive sign of pregnancy, confirming the presence of a living fetus. This finding provides objective evidence of fetal life and distinguishes true pregnancy from other physiologic or hormonal changes.

A. Notify the healthcare provider, as this finding may be associated with congenital anomalies: Two arteries and one vein represent the normal anatomy of the umbilical cord. Notification is unnecessary unless only one artery (a single umbilical artery) is present, which could indicate possible congenital anomalies.

B. Document the finding as normal and continue with routine newborn care: The normal umbilical cord structure consists of two arteries that carry deoxygenated blood from the fetus and one vein that returns oxygenated blood to the fetus. This finding confirms a normal cord and requires no additional interventions beyond standard care.

C. Apply warm compresses to the cord to promote circulation: The umbilical cord no longer functions in circulation after birth. Applying warm compresses would serve no purpose and could introduce unnecessary risk of infection or injury to the cord stump.

D. Document the finding as abnormal and continue with routine newborn care: Labeling a normal finding as abnormal could lead to confusion in medical records and unnecessary evaluations. Proper documentation should accurately reflect the expected normal anatomy of two arteries and one vein.