The nurse assesses a pregnant client for cardiac complications. Which maternal report should prompt the nurse to further investigate potential cardiac complications in pregnancy?

Choice A reason: Weight gain and dependent edema of the ankles are common physiological occurrences during pregnancy due to increased hydrostatic pressure in the lower extremities and hormonal changes. While these can occur in heart failure, they are generally considered normal findings in an otherwise healthy pregnancy. Choice B reason: Heartburn and indigestion, or pyrosis, are frequent complaints in pregnancy resulting from the hormone progesterone relaxing the lower esophageal sphincter and the growing uterus displacing the stomach. These gastrointestinal symptoms are not typically indicative of underlying cardiac pathology or hemodynamic instability during gestation. Choice C reason: Fatigue and the need for increased rest are expected during pregnancy due to the high metabolic demands of the developing fetus and significant hormonal shifts. General lethargy is common, especially in the first and third trimesters, and does not specifically signal a cardiovascular complication. Choice D reason: While mild dyspnea can occur, significant shortness of breath during routine activities, such as climbing stairs, can indicate a decreased cardiac reserve. During pregnancy, blood volume increases by 40% to 50%, and an inability of the heart to handle this increased preload suggests potential cardiac dysfunction.