A nurse is reviewing documentation for a newly admitted pregnant client. Which of the following findings constitutes a clinically positive sign of pregnancy. confirming the presence of a fetus rather than indicating a probable or presumptive state?

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.