# A nurse is assessing a 32-year-old gravida 3, para 2 client at 10 weeks gestation who presents with vaginal bleeding and severe nausea and vomiting. Which assessment finding would be most characteristic of a hydatidiform mole? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542898 > language: ko > subject: Maternal Newborn Health ## 문제 A nurse is assessing a 32-year-old gravida 3, para 2 client at 10 weeks gestation who presents with vaginal bleeding and severe nausea and vomiting. Which assessment finding would be most characteristic of a hydatidiform mole? A 28-year-old primigravida at 12 weeks gestation presents to the emergency department with complaints of severe nausea, vomiting, and vaginal spotting that started 2 days ago. She reports that her morning sickness has been much worse than what her friends experienced during their pregnancies. ## 보기 1. Fundal height equal to expected for gestational age 2. Fundal height measuring larger than expected for gestational age **✔ 정답** 3. Fundal height smaller than expected for gestational age 4. Fundal height not assessed due to bleeding **정답: 2** ## 해설 Hydatidiform mole is characterized by fundal height larger than expected for gestational age due to rapid uterine growth from proliferating trophoblastic tissue. Other findings like fetal heart tones or normal vital signs are not characteristic. ## 심화 해설 Clinical Context This question tests your ability to recognize the classic clinical presentation of a hydatidiform mole (molar pregnancy), a form of gestational trophoblastic disease (GTD). The client's presentation of first-trimester vaginal bleeding accompanied by severe nausea and vomiting (hyperemesis) should immediately raise your index of suspicion for a molar pregnancy. The severe nausea is linked to markedly elevated levels of beta-human chorionic gonadotropin (β-hCG), which is a hallmark of this condition. In a complete hydatidiform mole (CHM), there is abnormal, rapid proliferation of trophoblastic tissue. This excessive tissue growth causes the uterus to enlarge at a rate faster than expected for the gestational age. Therefore, a fundal height measurement that is larger than expected for dates is a highly characteristic assessment finding. This is a key point of differentiation from a threatened or spontaneous abortion, where the fundal height is typically equal to or smaller than expected for gestational age. The provided literature confirms that uterine enlargement is a typical clinical presentation of CHM, driven by the abnormal trophoblastic proliferation and significantly elevated β-hCG levels [3]. Pathophysiology Connection To understand why the uterus is larger, follow the underlying mechanism. In a complete mole, an "empty" egg (devoid of maternal DNA) is fertilized, leading to a paternal-only genetic makeup. This triggers unchecked growth of the cytotrophoblast and syncytiotrophoblast layers. The chorionic villi become edematous and distended, forming grape-like vesicles that fill the uterine cavity more rapidly than a normal fetus and amniotic sac would. This rapid tissue expansion, rather than fetal growth, is what causes the fundal height to exceed the expected measurement for the 10-week gestation date. The excessive β-hCG produced by the hyperplastic trophoblast directly stimulates the chemoreceptor trigger zone, explaining the severe nausea and vomiting [3]. Analysis of Options - **Option 1 (Fundal height equal to expected):** This finding is typical of a normal intrauterine pregnancy or a missed abortion. It is not characteristic of a rapidly proliferating molar pregnancy. - **Option 2 (Fundal height measuring larger than expected):** This is the correct answer. The excessive growth of trophoblastic tissue causes the uterus to be larger than dates, a classic sign of a hydatidiform mole [3]. - **Option 3 (Fundal height smaller than expected):** This finding might suggest an error in dating, a fetal growth restriction, or an intrauterine fetal demise. It is inconsistent with the pathophysiology of a complete mole. - **Option 4 (Fundal height not assessed due to bleeding):** While caution is always used, vaginal bleeding is not a contraindication for a gentle abdominal assessment of fundal height. This assessment provides critical diagnostic information and should not be omitted solely because bleeding is present. Clinical Reasoning and Safety From an NCLEX-RN safety perspective, recognizing a fundal height greater than dates in a patient with first-trimester bleeding and hyperemesis is a critical clinical judgment. It directs the nurse to prioritize notifying the healthcare provider for immediate diagnostic evaluation, including a quantitative β-hCG level and pelvic ultrasound. The β-hCG level in a molar pregnancy is often dramatically elevated, well above the normal range for the gestational age [3]. A delay in diagnosis can lead to serious complications, including hemorrhage, preeclampsia before 20 weeks, and the rare but serious progression to invasive mole or choriocarcinoma . The nurse's accurate physical assessment is the first step in triggering this essential diagnostic cascade. References (research sources) - [3]Case Report: Complete hydatidiform mole mimicking spondyloarthritis: a probable paraneoplastic rheumatologic syndrome.Case reportGao Z, Zhang Q, Ma Z. (2026) · DOI: 10.3389/fimmu.2026.1866294 ## 임상 시나리오 Clinical Snapshot: Hydatidiform Mole Assessment A 32-year-old G3P2 at 10 weeks gestation presents with first-trimester vaginal bleeding and severe nausea and vomiting. You suspect a hydatidiform mole. Key Assessment Findings - **Fundal Height:** Larger than expected for 10 weeks (e.g., 14-16 cm). The uterus is often soft and boggy on palpation. - **Vaginal Bleeding:** Dark brown or bright red, often described as a "prune juice" appearance. May be accompanied by passage of grape-like vesicles. - **Hyperemesis:** Severe, persistent nausea and vomiting due to markedly elevated beta-hCG levels. - **Vital Signs:** May reveal tachycardia and orthostatic hypotension if dehydration from hyperemesis is significant. - **Pelvic Exam:** The uterus feels larger than dates, and bilateral theca lutein cysts may be palpable as adnexal masses in up to 50% of cases. Immediate Nursing Actions - **Stabilize the Client:** Initiate IV access with a large-bore catheter. Administer IV fluids for dehydration. Monitor for signs of hemorrhage. - **Prepare for Ultrasound:** A pelvic ultrasound is the diagnostic test of choice. Expect findings of a "snowstorm" pattern with no identifiable fetal parts in a complete mole. - **Send Labs:** Obtain a quantitative beta-hCG level (will be markedly elevated, often >100,000 mIU/mL), CBC, type and screen, and coagulation profile. - **Emotional Support:** Provide clear, empathetic communication. The client is experiencing a pregnancy loss and faces a potential malignancy risk. - **Anticipate Evacuation:** Prepare the client for suction dilation and curettage (D&C), the definitive treatment. Rh immune globulin should be administered if the client is Rh-negative. Post-Treatment Monitoring After molar evacuation, serial quantitative beta-hCG levels must be monitored weekly until undetectable for three consecutive weeks, then monthly for 6-12 months to detect malignant transformation (gestational trophoblastic neoplasia). Advise the client to avoid pregnancy during this monitoring period. ## 핵심 개념 - **Hydatidiform Mole** — A form of gestational trophoblastic disease characterized by abnormal proliferation of trophoblastic tissue, often presenting with a uterus larger than gestational age, vaginal bleeding, and hyperemesis. - **Fundal Height** — The distance from the pubic symphysis to the top of the uterine fundus, measured in centimeters, which typically correlates with weeks of gestation after 20 weeks. - **Hyperemesis Gravidarum** — Severe, persistent nausea and vomiting during pregnancy that can lead to dehydration, weight loss, and electrolyte imbalances, often associated with high beta-hCG levels. - **beta-hCG** — Beta-human chorionic gonadotropin, a hormone produced by trophoblastic cells; levels are markedly elevated in molar pregnancies and are used for diagnosis and monitoring. - **Gestational Trophoblastic Disease** — A spectrum of pregnancy-related disorders arising from abnormal proliferation of trophoblastic cells, including complete and partial hydatidiform moles. ## 같은 주제 문제 - [A 28-year-old woman at 12 weeks gestation presents to the clinic with severe nausea, vomit…](https://mymerci.kr/pages/nclex_q.php?qn_id=542896) - [A 28-year-old woman at 12 weeks gestation presents to the emergency department with severe…](https://mymerci.kr/pages/nclex_q.php?qn_id=542897) - [A 28-year-old woman at 12 weeks gestation is diagnosed with a complete hydatidiform mole. …](https://mymerci.kr/pages/nclex_q.php?qn_id=542899) - [A nurse is caring for a 32-year-old client diagnosed with a complete hydatidiform mole who…](https://mymerci.kr/pages/nclex_q.php?qn_id=542900) - [A nurse is caring for a client diagnosed with a complete hydatidiform mole who underwent s…](https://mymerci.kr/pages/nclex_q.php?qn_id=542901) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._