Rationale for correct choices Hydatidiform mole: The client’s findings are consistent with a molar pregnancy. Key indicators include an intrauterine mass with cystic vesicles on ultrasound, absence of a fetus, elevated fundal height (28 cm at approximately 4 months gestation), and symptoms such as nausea/vomiting and dark brown vaginal discharge. Elevated blood pressure and anemia further support this diagnosis due to trophoblastic disease. Prepare the client for suction curettage: Suction curettage (D&C) is the primary treatment to evacuate abnormal trophoblastic tissue from the uterus. It helps prevent complications such as hemorrhage and progression to gestational trophoblastic neoplasia. Discuss weekly pregnancy hormone level monitoring: Serial monitoring of human chorionic gonadotropin (hCG) levels is essential to ensure complete resolution of trophoblastic tissue and to detect persistent disease or malignancy early. Vaginal bleeding: Bleeding is a common complication due to abnormal placental tissue and uterine evacuation. Monitoring helps detect hemorrhage or retained products. Blood pressure: Hypertension can occur with molar pregnancy due to excessive hCG levels and trophoblastic proliferation; monitoring helps detect complications such as preeclampsia-like symptoms. Rationale for incorrect choices Ectopic pregnancy: This typically presents with unilateral pelvic pain and absence of intrauterine pregnancy on ultrasound, not a uterine mass with cystic vesicles. Abruptio placentae: Would present with painful vaginal bleeding and a tender, rigid uterus in later pregnancy, not cystic vesicles or absent fetus. Placenta previa: Characterized by painless bright red bleeding and a low-lying placenta, not uterine mass or elevated fundal height discrepancies. Prepare the client for an emergency cesarean birth: There is no viable fetus present, and ultrasound confirms absence of fetal structures. Administer terbutaline: Used for uterine relaxation in preterm labor, which is not applicable here. Cervical dilation: Not a key indicator in molar pregnancy; cervix is not the primary focus of pathology. Uterus for hypertonicity: Not typical; the uterus may be enlarged but not characteristically hypertonic. Unilateral pelvic pain: More consistent with ectopic pregnancy, not molar pregnancy.