A nurse is calculating the estimated date of birth using Nagele’s rule for a client who is pregnant and whose last menstrual cycle started June 21. What is the estimated date of delivery in the next year?

Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and dehydration during pregnancy. The client's laboratory results show signs consistent with dehydration and electrolyte imbalances, such as a low potassium level (3.3 mEq/L) and an elevated blood urea nitrogen (BUN) level (28 mg/dL).

Additionally, the presence of ketones in the urine (not explicitly mentioned in the provided laboratory results but commonly associated with hyperemesis gravidarum) indicates that the body is breaking down fat for energy due to inadequate oral intake and dehydration.

These findings suggest that the client is experiencing significant fluid and electrolyte disturbances, which are commonly seen in hyperemesis gravidarum. Therefore, the client is at risk of developing hyperemesis gravidarum based on the laboratory results indicating dehydration and electrolyte imbalances.

Choice A rationale
Maternal cytomegalovirus (CMV) infection is a serious health concern as it is associated with severe birth defects like sensori-neural hearing loss, impairment of cognitive development, and cerebral palsy. It is acquired by contact with body fluids and by vertical transmission from mother to fetus. Transmission can occur via the saliva and urine of the newborn, which is why this is the correct answer.
Choice B rationale
CMV does not require airborne precautions. It is not an airborne disease; it is spread through close, direct contact with a person infected with the virus.
Choice C rationale
CMV does not cause visible lesions on the mother’s genitalia. This is a characteristic of other sexually transmitted infections, not CMV2.
Choice D rationale
Mothers do not receive prophylactic treatment with acyclovir prior to delivery to prevent CMV2. Acyclovir is an antiviral medication used to treat herpes simplex virus infections, not CMV2.