Which intervention would a nurse recommend to a pregnant client experiencing breast tenderness?

Human chorionic gonadotropin (hCG)is a glycoprotein hormone produced by trophoblasts after implantation. It maintains the corpus luteum, stimulates progesteronesecretion, and peaks at 8–12 weeks gestation, reaching levels of 50,000–100,000 mIU/mL (normal non-pregnant <5 mIU/mL). High hCGconcentrations stimulate the chemoreceptor trigger zone, causing nauseaand vomiting. Elevated levels occur in molar pregnancy and multiple gestations.

Rationale for correct answers

2.hCG is the primary hormone responsible for nausea and vomiting in early pregnancy. Its peak around the end of the first trimester coincides with maximal morning sickness severity. Its stimulation of the chemoreceptor trigger zone and delayed gastric emptying explains the symptoms described.

Rationale for incorrect answers

1.Progesterone causes smooth muscle relaxation, decreased lower esophageal sphincter tone, and reduced gastrointestinal motility, which can contribute to bloating and constipation, not the primary mechanism for nausea and vomiting.

3.Estrogen is elevated in pregnancy and may have some role in enhancing sensitivity to odors, but its primary functions include uterine growth, increased blood flow, and breast tissue development. It does not directly stimulate the vomiting center.

4.Relaxin is secreted by the corpus luteum and placenta and functions mainly to relax pelvic ligaments and soften the cervix in preparation for delivery. It does not act on the gastrointestinal tract or central emetic pathways.

Take home points

• hCG is the main hormone responsible for nausea and vomiting in early pregnancy.
• Progesterone mainly causes constipation and reflux due to smooth muscle relaxation.
• Estrogen contributes to vascular changes and uterine growth, not emesis.
• Relaxin softens pelvic ligaments and cervix, unrelated to nausea.

1.Consuming small, frequent meals helps by preventing gastric overdistension and reducing nausea. Empty stomachs and large meals worsen symptoms, so this dietary adjustment is first-line management.

2.Avoiding strong odors is effective because heightened olfactory sensitivity in pregnancy exacerbates nausea. Avoidance of triggers reduces vomiting episodes.

4.Using ginger-based remedies has proven antiemetic properties by modulating serotonin receptors in the gastrointestinal tract. Clinical studies show ginger reduces nausea severity without adverse fetal effects.

Rationale for incorrect answers

3.Eating large, high-fat meals worsens gastric emptying time, increases nausea, and is contraindicated. High-fat foods are harder to digest and increase reflux risk, which aggravates vomiting.

5.Limiting fluid intake is harmful, as dehydration worsens nausea and increases the risk of hypovolemia. Recommended strategy is sipping fluids between meals to maintain hydration and reduce gastric overfilling.

Take home points

• Nausea and vomiting in pregnancy are linked to high hCG and estrogen levels.
• Small, frequent meals and avoiding triggers reduce symptoms effectively.
• Ginger is safe and evidence-supported as a natural antiemetic.
• Large, fatty meals and fluid restriction worsen symptoms and are contraindicated.