The nurse is calculating the estimated date of confinement (EDC) using Nagele's rule for a client whose last menstrual period started on December 1. Which date is most accurate?

Choice A rationale:
Pulmonary stenosis is characterized by a systolic ejection murmur best heard at the upper left sternal border. It does not typically produce a continuous machinery-like murmur. Pulmonary stenosis results from narrowing at the pulmonary valve, obstructing blood flow from the right ventricle to the pulmonary artery.
Choice B rationale:
A continuous machinery-like murmur is characteristic of patent ductus arteriosus (PDA). PDA is a congenital heart defect where the ductus arteriosus, a fetal blood vessel that should close after birth, remains open, allowing continuous blood flow between the aorta and pulmonary artery. This murmur is often best heard in the left infraclavicular region.
Choice C rationale:
Ventricular septal defect (VSD) typically produces a harsh holosystolic murmur heard best at the lower left sternal border. VSD is a hole in the septum separating the ventricles, allowing blood to flow from the higher-pressure left ventricle to the lower-pressure right ventricle.
Choice D rationale:
Coarctation of the aorta causes a murmur due to increased blood flow across the aortic valve. However, this murmur is not continuous and is usually systolic and best heard in the back over the left scapula.

Choice A rationale:

An Apgar score of 10 at 1 minute after birth indicates that the infant is in excellent condition, adjusting well to extrauterine life, and requires no further testing or interventions at that moment. The Apgar score assesses the baby's heart rate, respiratory effort, muscle tone, reflexes, and color, with a maximum score of 10. An Apgar score of 10 suggests that the baby is pink, has a heart rate above 100 beats per minute, exhibits strong cries, has active motion, and demonstrates good muscle tone.

Choice B rationale:

An Apgar score of 10 does not indicate severe distress requiring resuscitation. A low Apgar score (typically below 7) at 1 minute may prompt further evaluation and interventions to support the baby's transition to extrauterine life.

Choice C rationale:

While a high Apgar score is reassuring, it does not predict a future free of neurologic problems. The Apgar score assesses the baby's current condition and provides a snapshot of their overall well-being at birth.

Choice D rationale:

Although the Apgar score is assessed at 1 and 5 minutes after birth, a score of 10 at 1 minute suggests that the baby is doing well at that moment. However, the baby should still be assessed again at 5 minutes to ensure continued stability and appropriate interventions if necessary.