A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

To calculate the estimated date of delivery using Angele’s Rule, you start with the first day of the last menstrual period (LMP), subtract three months, and then add seven days.

For this client:

First day of last menstrual period (LMP): August 10

Subtract three months: August - 3 months = May

Add seven days: May + 7 days = May 17

So, the client's estimated date of delivery is May 17.

Therefore, the correct answer is:

C. May 17

Explanation

Choice A Reason:

Obtaining a specimen for a Kleihauer-Betke test is incorrect. The Kleihauer-Betke test is used to determine the fetal-maternal hemorrhage in cases of Rh-negative mothers, particularly after delivery. However, in the immediate postpartum period with uterine atony and significant bleeding, the priority is to control bleeding and stabilize the patient's condition. Obtaining a Kleihauer-Betke test can be done later if indicated, but it is not the immediate action for managing uterine atony.

Choice B Reason:

Administering betamethasone IM is incorrect. Betamethasone is a corticosteroid commonly used to promote fetal lung maturity when preterm birth is anticipated. It is not indicated for managing uterine atony or postpartum hemorrhage.

Choice C Reason:

Avoiding performing sterile vaginal examinations is incorrect. Sterile vaginal examinations may be necessary to assess the extent of cervical dilation, evaluate the presence of any retained products of conception, or assist with the placement of interventions such as uterine massage or administration of medications. However, avoiding or minimizing vaginal examinations alone does not address the underlying cause of uterine atony or control postpartum hemorrhage. Therefore, it is not the most appropriate immediate action.

Choice D Reason:

Anticipating a prescription for misoprostol is correct. Uterine atony, characterized by the inability of the uterus to contract effectively after childbirth, is a significant cause of postpartum hemorrhage. Misoprostol, a prostaglandin E1 analogue, is commonly used to manage uterine atony and prevent or control postpartum hemorrhage. It helps to stimulate uterine contractions and reduce bleeding by promoting uterine muscle tone.