A nurse is caring for a 30-year-old female client who is at 20 weeks of gestation in the labor and delivery unit. Exhibits Upon reviewing the client’s medical record, the nurse determines that the client is at risk for developing dropdown and dropdown.

Upon reviewing the client’s medical record, the nurse determines that the client is at risk for developing choriocarcinoma and thyrotoxicosis. Rationale for correct answers Choriocarcinoma is a malignant form of gestational trophoblastic disease (GTD) that arises from a molar pregnancy, as evidenced by grape-like vesicles seen on ultrasound and excessively elevated beta-hCG (normal in pregnancy: up to 100,000 mIU/mL by late first trimester). This condition can lead to metastases if not diagnosed and treated promptly. Thyrotoxicosis occurs due to excess beta-hCG, which stimulates thyroid hormone production. This is supported by the slightly elevated free T4 levels, a common feature of molar pregnancy-related hyperthyroidism. Rationale for incorrect Response 1 options Preterm labor: The client is at 20 weeks with no contractions noted, and cervical changes are not reported. Placenta previa: Characterized by painless bright red bleeding later in pregnancy; this client has dark brown discharge consistent with molar pregnancy. Cardiac arrhythmia: No evidence of electrolyte abnormalities or arrhythmogenic conditions such as hyperkalemia. Rationale for incorrect Response 2 options Preeclampsia: Normal blood pressure (≥140/90 mm Hg would be concerning); no proteinuria. Urinary tract infection: No leukocytes, nitrites, or dysuria reported. Hypoglycemia: Normal serum glucose levels; vomiting history does not indicate hypoglycemia.