A nurse in a prenatal clinic is determining a client's estimated date of delivery using Naegele's rule. The first day of her last menstrual period was May 8. Which of the following dates should the nurse tell the client is her estimated date of delivery?

Choice A rationale:

Tachycardia, or a fast heart rate, is not a common finding in severe preeclampsia. While some women with preeclampsia may experience a slight increase in heart rate, it is not typically a significant or defining feature of the condition. In fact, some women with severe preeclampsia may even experience a slightly decreased heart rate due to increased vagal tone.

Choice B rationale:
Hypotension, or low blood pressure, is also not a typical finding in severe preeclampsia. Blood pressure is often elevated in preeclampsia, and it is one of the key diagnostic criteria. Hypotension would be a concerning finding in a woman with preeclampsia, as it could indicate a serious complication such as placental abruption or HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelet count).

Choice C rationale:
Polyuria, or excessive urination, is not a characteristic finding of severe preeclampsia. In fact, many women with preeclampsia experience oliguria, or decreased urine output, due to decreased kidney function. This is because preeclampsia can cause damage to the blood vessels in the kidneys, impairing their ability to filter blood and produce urine.

Choice D rationale:
Headache is a common and often severe symptom of severe preeclampsia. It is thought to be caused by increased pressure within the brain due to swelling and vasoconstriction of the blood vessels. Headaches in preeclampsia can be very intense and may be accompanied by other symptoms such as blurred vision, nausea, and vomiting. They are often a sign that the preeclampsia is worsening and that delivery may be necessary.

The correct answer is choice b. Quickening occurs between the fourth and fifth months of pregnancy.

Choice A rationale:

Quickening does not start soon after implantation. Implantation occurs around 6-10 days after fertilization, but quickening, which is the first feeling of fetal movements, typically happens much later in pregnancy.

Choice B rationale:

This is the correct answer. Quickening usually occurs between 16 to 20 weeks of pregnancy, which corresponds to the fourth and fifth months.

Choice C rationale:

Quickening does not start during the last trimester. By the last trimester, fetal movements are usually strong and frequent, and the mother has been feeling them for several months.

Choice D rationale:

Quickening does not occur between the second and third month of pregnancy. At this stage, the fetus is still too small for its movements to be felt by the mother.