In caring for a client with hyperemesis gravidarum, which finding should the nurse anticipate?

In a client with hyperemesis gravidarum, it is common to anticipate the presence of moderate urine ketones. Hyperemesis gravidarum is characterized by severe nausea and vomiting during pregnancy, which can lead to insufficient caloric intake and dehydration. As a result, the body begins to utilize fat stores for energy, leading to ketone production. When the liver breaks down fat, it releases ketones into the bloodstream, which can be excreted in urine. Thus, the presence of moderate amounts of urine ketones is indicative of the body's response to prolonged fasting and significant weight loss associated with this condition.

The other findings do not align with the typical manifestations of hyperemesis gravidarum. For instance, a significantly elevated blood pressure may suggest other complications unrelated to hyperemesis, while large amounts of urine protein could indicate conditions like preeclampsia, which is not typical in hyperemesis gravidarum. Similarly, an elevated pulse rate could be a response to dehydration, but it does not directly reflect the metabolic state characterized by the presence of ketones. This makes the anticipation of positive urine ketones the most relevant and likely finding in managing a client with hyperemesis gravidarum.