A nurse in a prenatal clinic is caring for a client who asks what her estimated date of delivery will be if her last menstrual period was May 4, 2022.
Which of the following is the appropriate response by the nurse?

Choice A rationale

While bile does play a role in digestion, it is not retained in the liver. Instead, it is produced by the liver and stored in the gallbladder. When food enters the small intestine, the gallbladder releases bile to aid in the digestion of fats. However, this process is not directly related to heartburn during pregnancy.

Choice B rationale

During pregnancy, the body produces large amounts of the hormones progesterone and relaxin. These hormones tend to relax smooth muscle tissues throughout the body, including those in the gastrointestinal (GI) tract. As a result, food sometimes moves more slowly through the system, resulting in indigestion issues of all kinds, from that bloated, gassy feeling to heartburn. This is the correct answer because increased progesterone production does indeed cause decreased motility of smooth muscle, which can lead to heartburn.

Choice C rationale

While estrogen levels do increase during pregnancy, they do not directly cause an increase in the secretion of hydrochloric acid. Instead, the relaxation of the lower esophageal sphincter due to pregnancy hormones can allow stomach acid to flow back up into the esophagus, causing heartburn.

Choice D rationale

While it is true that the growing uterus can displace the stomach, especially in later stages of pregnancy, this is not the primary cause of heartburn. Heartburn is primarily caused by the relaxation of the lower esophageal sphincter, allowing stomach acid to flow back up into the esophagus.

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.