A nurse is calculating the estimated date of delivery for a patient who reports that the first day of her last menstrual period was August 10. Using Nägele’s Rule, what is the patient’s estimated date of delivery?

Choice A rationale: A positive Coombs test indicates that the newborn has antibodies against his own red blood cells, which can lead to hemolytic disease of the newborn. This condition can cause severe anemia and jaundice, which can lead to complications such as kernicterus if not treated promptly.

Choice B rationale: The newborn’s glucose level is within the normal range (40 to 60 mg/dL), so this finding does not require immediate follow-up.

Choice C rationale: The yellow color of the sclera indicates jaundice, which can be a sign of hyperbilirubinemia. This condition can lead to complications such as kernicterus if bilirubin levels become too high.

Choice D rationale: The absence of meconium stool in a 36-hour-old newborn is unusual, as most newborns pass meconium within the first 24 to 48 hours after birth. This could indicate a problem such as meconium ileus or Hirschsprung disease, which would require further evaluation.

Choice E rationale: The head assessment finding of caput succedaneum is a common and typically harmless condition in newborns caused by pressure on the head during delivery. It does not require immediate follow-up.

Choice F rationale: The newborn’s heart rate is slightly elevated (normal range for a newborn is 120-160 beats per minute). This could be a response to factors such as fever, pain, or distress, and should be reported to the provider.

Choice G rationale: The newborn’s respiratory rate is also elevated (normal range for a newborn is 30-60 breaths per minute). This could be a sign of respiratory distress and should be reported to the provider.

Choice H rationale: Dry mucous membranes can be a sign of dehydration, which can occur if the newborn is not feeding well or is losing too much fluid, for example, through excessive sweating due to fever. This should be reported to the provider.

Choice A rationale
Bronchopulmonary dysplasia is a chronic lung disease that affects newborns and infants, but it is not a complication of forceps-assisted birth. It’s more common in premature babies who have been treated with oxygen and positive-pressure ventilation.
Choice B rationale
Polycythemia, a condition characterized by an increased number of red blood cells, is not a complication of forceps-assisted birth. It can occur due to various reasons, including high altitude and certain genetic disorders.
Choice C rationale
Facial palsy can occur as a complication of forceps-assisted birth. The pressure exerted by the forceps can cause damage to the facial nerve, leading to temporary or permanent facial weakness or paralysis.
Choice D rationale
Hypoglycemia, or low blood sugar, is not a complication of forceps-assisted birth. It’s more commonly seen in babies of mothers with diabetes, premature babies, and babies who are small for their gestational age.