The nurse is caring for a school-age child with delays in physical, social, and intellectual development from a prolonged illness and hospitalizations. Which action should the nurse take to promote the child's sense of industry?

Choice A rationale: Culturing vaginal secretions is primarily used for identifying infections like bacterial vaginosis or sexually transmitted infections, which are not consistent with the clinical presentation here. The brownish discharge is more likely due to necrotic tissue from proliferative trophoblastic growth than an infectious process. In gestational trophoblastic disease, vaginal bleeding results from abnormal trophoblast invasion and degeneration rather than microbial activity, thus making cultures less diagnostically relevant in this context.

Choice B rationale: While glucose in the urine can signal gestational diabetes, this patient’s presentation is not consistent with hyperglycemia-related symptoms such as polyuria or excessive thirst. Gestational trophoblastic disease is characterized by exaggerated pregnancy symptoms, including hyperemesis gravidarum due to elevated hCG levels, not insulin resistance. The greatly enlarged uterus and lack of fetal heart tones suggest molar pregnancy rather than a metabolic disturbance, making this lab test low priority for confirming diagnosis.

Choice C rationale: Hematocrit values help assess anemia or hemoconcentration but are non-specific in the diagnosis of gestational trophoblastic disease. While bleeding may affect hematocrit, the mild nature of the bleeding here does not support significant blood loss. Additionally, hematocrit changes lag behind acute events and do not correlate well with uterine size or nausea severity. The hypertensive reading suggests trophoblastic proliferation stimulating preeclampsia-like symptoms, which cannot be clarified through hematocrit alone.

Choice D rationale: Human chorionic gonadotropin (hCG) levels are crucial for confirming gestational trophoblastic disease, as they are markedly elevated due to hyperproliferation of trophoblastic cells. Normal hCG levels at 10 weeks range between 44,000–210,000 mIU/mL. In hydatidiform mole, levels often exceed these thresholds dramatically. hCG drives trophoblast proliferation and correlates with uterine size and severity of symptoms like nausea. This value helps differentiate between viable pregnancy and molar or neoplastic gestation

Choice A rationale

A finger stick blood glucose is not a standard screening tool for preeclampsia. While clients with gestational diabetes can have an increased risk, an elevated blood pressure is the key indicator in this clinical scenario. The primary pathophysiology of preeclampsia does not involve glucose metabolism, making this a low-yield and inappropriate initial action.

Choice B rationale

Observing for the strength and time of contractions is relevant for assessing labor progression, but it is not the most appropriate initial action for an elevated blood pressure in a client with a history of preeclampsia. The priority is to investigate the cause of the hypertension and screen for the hallmark signs of the condition, such as proteinuria.

Choice C rationale

An elevated blood pressure of 155/90 mm Hg in a client with a history of preeclampsia is a critical finding. The next step is to collect a urine specimen to test for proteinuria, which, along with the hypertension, is a diagnostic criterion for preeclampsia. This is a crucial and immediate action to assess the client's current clinical status and guide further management.

Choice D rationale

While severe headaches can be a symptom of preeclampsia, inquiring about a history of migraines is not the most appropriate first step. The priority is to objectively assess the client for the definitive signs of preeclampsia, which include hypertension and proteinuria. While subjective symptoms are important, a urine specimen provides objective, diagnostic data.