A patient who is pregnant asks the nurse for her due date. The patient's last menstrual period began on January 10th. What is the patient's due date based on Naegele's rule?

A. Patent ductus arteriosus, foramen ovale, aortic arch is incorrect because the aortic arch is a normal part of the circulatory system and does not close after birth. A patent ductus arteriosus is abnormal if it remains open after birth.

B. Foramen ovale, ductus arteriosus, coronary sinus is incorrect because the coronary sinus is a normal cardiac structure that collects venous blood from the myocardium into the right atrium; it does not close after birth.

C. Pulmonary artery, ductus venosus, tricuspid valve is incorrect because the pulmonary artery and tricuspid valve are normal heart structures, not fetal shunts. Only the ductus venosus among these closes after birth.

D. Foramen ovale, ductus arteriosus, ductus venosus is correct because these three fetal shunts bypass the lungs and liver: the foramen ovale allows blood to flow from the right atrium to the left atrium, bypassing the lungs; the ductus arteriosus connects the pulmonary artery to the aorta, diverting blood from the lungs; and the ductus venosus shunts oxygenated blood from the umbilical vein directly to the inferior vena cava, bypassing the liver. These structures normally close after birth as the newborn transitions to pulmonary and hepatic circulation.

A. Painful, enlarged lymph nodes is incorrect because in Hodgkin disease, the lymph node enlargement is usually painless. Painful nodes are more commonly associated with infections or inflammatory conditions, where the immune response triggers tenderness and discomfort. In Hodgkin disease, the cancerous lymphocytes infiltrate the nodes without causing acute inflammatory pain.

B. Enlarged, firm, nontender lymph nodes is correct. The classic presentation of Hodgkin disease is the presence of firm, rubbery, nontender lymphadenopathy, most often in the cervical, supraclavicular, or mediastinal regions. The nodes are typically mobile early in the disease but may become fixed as the disease progresses. This type of lymphadenopathy is usually gradual and persistent, often discovered incidentally by the patient or during a routine exam. The nontender nature is a key distinguishing feature from infectious lymphadenopathy.

C. Petechiae is incorrect because petechiae result from thrombocytopenia or coagulation disorders, not Hodgkin disease. While advanced Hodgkin lymphoma may eventually affect the bone marrow and platelet production, petechiae are not an early or common manifestation.

D. Bone and joint pain is incorrect because this is not a typical presenting symptom of Hodgkin disease. Bone involvement may occur only in advanced stages, usually with other systemic symptoms.