The office nurse is teaching a gravida 1 para 0 client at 8 weeks gestation about signs and symptoms she may experience during early pregnancy. The nurse instructs the client to call the provider for which symptoms? (Select all that apply)

Choice A rationale Fetal movement, or quickening, typically begins between 16 and 20 weeks of gestation for a primigravida. At 8 weeks gestation, the fetus is only about 1.6 centimeters long and weighs approximately 1 gram, making its movements imperceptible to the mother. Therefore, a report of decreased fetal movement at this early stage is not a clinically valid concern or a reason to contact the provider as the sensation has not yet been established. Choice B rationale Vaginal bleeding during the first trimester can indicate serious complications such as a threatened, inevitable, or incomplete abortion, or an ectopic pregnancy. Any spotting or frank bleeding requires immediate medical evaluation to determine fetal viability and maternal safety. While some light implantation bleeding can occur very early, bleeding at 8 weeks is considered abnormal and potentially life-threatening to the pregnancy, necessitating a prompt ultrasound and physical assessment by a healthcare provider. Choice C rationale An increase in thin, milky, mild-smelling vaginal discharge, known as leukorrhea, is a normal physiological finding during pregnancy due to increased estrogen levels and pelvic vascularity. Unless the discharge is accompanied by a foul odor, itching, or significant color changes indicating an infection like candidiasis or bacterial vaginosis, it is not a reason for concern. The nurse should reassure the client that this is a protective mechanism to maintain vaginal flora and health. Choice D rationale Breast tenderness is one of the earliest presumptive signs of pregnancy, occurring as early as 3 to 4 weeks gestation. It results from the rapid hypertrophy of mammary glandular tissue and increased vascularity driven by rising levels of estrogen and progesterone. While uncomfortable, it is a normal physiological adaptation as the body prepares for future lactation. It does not require a call to the provider unless accompanied by localized redness, heat, or systemic fever. Choice E rationale Low abdominal pain or cramping at 8 weeks gestation can be a warning sign of an impending miscarriage or an ectopic pregnancy, which is a surgical emergency. While some mild stretching of the round ligaments can occur, sharp or persistent pain is not considered a normal discomfort of early pregnancy. This symptom requires immediate investigation to rule out pathology and ensure that the gestational sac is correctly implanted within the uterine cavity rather than the fallopian tubes.