A pregnant client tells the nurse that her LMP was 3 months ago and began on October 20. Using Naegele's rule, calculate the client's estimated date of delivery.

Answer format E.g. "October 20"

Choice A rationale

Rubella vaccination is contraindicated during pregnancy due to the risk of congenital rubella syndrome in the fetus. It should be administered postpartum if the client is non-immune.

Choice B rationale

Preterm labor is a concern at 28 weeks' gestation. Educating the client on signs and symptoms can help in early detection and management, potentially improving outcomes for both mother and baby.

Choice C rationale

Rh-negative mothers with a negative antibody screen should receive Rhogam at 28 weeks to prevent Rh sensitization. This is crucial to avoid hemolytic disease of the newborn in future pregnancies.

Choice D rationale

A positive urine analysis for leukocytes indicates a possible urinary tract infection. A clean catch urine culture is needed to identify the causative organism and guide appropriate antibiotic therapy.

Choice E rationale

The glucose challenge test result of 120 at 26 weeks is within normal limits, but a 3-hour diagnostic glucose tolerance test may be ordered if there's a high index of suspicion for gestational diabetes or other risk factors.

Choice F rationale

A blood transfusion is not indicated as the hemoglobin/hematocrit levels (11.0 mg/dl and 35%) are within acceptable limits for pregnancy.

Choice A rationale

Heartburn is common due to the relaxation of the lower esophageal sphincter caused by progesterone, but quickening (the first movement of the fetus felt by the mother) typically occurs earlier in pregnancy, around 18-20 weeks.

Choice B rationale

Nausea and vomiting are more common in the first trimester due to hormonal changes, particularly increased levels of hCG. These symptoms often decrease as pregnancy progresses.

Choice C rationale

A stuffy nose and bleeding gums can occur due to increased blood volume and hormonal changes affecting mucous membranes, but these are more noticeable in the earlier stages of pregnancy.

Choice D rationale

Constipation and hemorrhoids are common in the third trimester. The growing uterus can put pressure on the rectum and intestines, slowing down bowel movements and increasing the risk of hemorrhoids.