A nurse is caring for a client who reports a recent episode of painful sores on the perineum, muscle aches, and chills for about 2 weeks.
The client currently denies pain but reports sitting is uncomfortable at times.
The client denies dysuria and reports mild vaginal itching.
What should the nurse anticipate?

Choice D rationale

Unilateral, cramp-like abdominal pain. This is a common symptom of an ectopic pregnancy. The pain usually starts on one side of the abdomen after the early stages of pregnancy and may be accompanied by spotting or vaginal bleeding.

Choice A rationale

Large amount of vaginal bleeding. While vaginal bleeding can occur in an ectopic pregnancy, it’s usually light to moderate, not large. Heavy vaginal bleeding is more commonly associated with miscarriage or other conditions.

Choice B rationale

Severe nausea and vomiting. While some women with an ectopic pregnancy may experience nausea and vomiting, these symptoms are common in early pregnancy and are not specific to ectopic pregnancy.

Choice C rationale

Uterine enlargement greater than expected for gestational age. This is not a typical symptom of an ectopic pregnancy. In fact, because the pregnancy is not in the uterus, the size of the uterus may be smaller than expected for the gestational age.

Based on your last menstrual period (LMP) of May 4, 2022, your estimated date of delivery (EDD) would be around February 11, 2023."

Rationale:

• Calculating the Estimated Date of Delivery (EDD): The EDD can be calculated using Naegele's Rule, which is a standard method used to estimate the due date. The rule involves subtracting three months from the first day of the last menstrual period (LMP), adding seven days, and adjusting the year if necessary.

• Application of Naegele’s Rule:

  • Start with the first day of the LMP: May 4, 2022.
  • Subtract three months: February 4, 2022.
  • Add seven days: February 11, 2022.
  • Since the year needs to be adjusted, the EDD is February 11, 2023.

Key Points:

• Naegele’s Rule is commonly used but assumes a 28-day menstrual cycle and ovulation on the 14th day. Variations in cycle length can affect the accuracy.