The nurse is calculating the estimated date of confinement (EDC) using Nagele's rule for a client whose last menstrual period started on February 13th. Which date is most accurate?

Choice A reason: Eating three larger meals a day is not recommended for hyperemesis gravidarum, as it may increase the nausea and vomiting. Instead, the nurse should advise the woman to eat small, frequent meals throughout the day.

Choice B reason: Ice cream may stay down better than other foods, as it is cold, bland, and soothing. The nurse should encourage the woman to try foods that are appealing to her and avoid foods that trigger nausea.

Choice C reason: Eating what sounds good to the woman even if her meals are not well-balanced is acceptable for hyperemesis gravidarum, as the priority is to maintain hydration and nutrition. The nurse should reassure the woman that she can resume a balanced diet once her symptoms improve.

Choice D reason: Avoiding ginger tea or sweet drinks is not necessary for hyperemesis gravidarum, as some women may find them helpful in reducing nausea. The nurse should suggest the woman to experiment with different beverages and see what works for her.

Choice E reason: Eating a high-protein snack at bedtime is beneficial for hyperemesis gravidarum, as it can prevent low blood sugar levels and morning sickness. The nurse should recommend the woman to have a protein-rich food, such as cheese, yogurt, nuts, or eggs, before going to bed.

The correct answer is: B. 3-1-1-0-3.

Choice A reason:

This option suggests the woman has been pregnant four times, which is incorrect. She has had three pregnancies: one set of twins (counted as one pregnancy) and two singletons.

Choice B reason:

This is the correct option. The woman has had three pregnancies (Gravida = 3), one full-term delivery (Term = 1), one preterm delivery (the twins, Preterm = 1), no abortions (Abortions = 0), and three living children (Living = 3).

Choice C reason:

This option incorrectly suggests two preterm deliveries and one abortion, neither of which is indicated in the woman's history.

Choice D reason:

This option incorrectly suggests two preterm deliveries (the twins are counted as one preterm delivery) and does not accurately reflect the woman's history.

GTPAL stands for Gravida (total number of pregnancies), Term births (deliveries after 37 weeks), Preterm births (deliveries between 20-36 weeks), Abortions (losses before 20 weeks), and Living children. Normal ranges: Term (≥37 weeks), Preterm (20-36 weeks)