Which physical assessment data should the practical nurse (PN) consider a normal finding for a primigravida client who is 12 hours postpartum?

Choice A rationale

The last day of the last normal menstrual period would not accurately establish the estimated date of birth because calculations for gestational age commence from the onset of the cycle. Conception typically occurs around two weeks after the first day, so using the last day would lead to an underestimation of gestational age.

Choice B rationale

The average duration of menstrual periods, while providing insight into cycle regularity, does not offer the precise temporal marker needed for gestational age calculation. Nägele's rule specifically requires the first day of the last menstrual period, not the length of bleeding, to accurately estimate the delivery date.

Choice C rationale

The average frequency of menstrual periods, though indicating cycle regularity or irregularity, is not the specific data point required for estimating the delivery date. Nägele's rule relies on a fixed reference point, which is the beginning of the last menstrual cycle, not the intervals between cycles.

Choice D rationale

The first day of the last normal menstrual period (LMP) is crucial for accurately assigning an estimated date of birth (EDB) using Nägele's rule. This calculation adds 7 days to the LMP and subtracts 3 months, providing a standardized method for determining gestational age and anticipated delivery.

Choice A rationale

Administering oxygen and suctioning are appropriate for respiratory distress, but turning the newborn from supine to prone every 2 hours does not prevent aspiration in tracheoesophageal fistula and may increase the risk of aspiration or worsen respiratory compromise by allowing refluxed gastric contents to enter the airway.

Choice B rationale

Offering sterile water per nipple is contraindicated in suspected tracheoesophageal fistula because it poses a significant aspiration risk, as the water will likely enter the trachea. Placing the infant in a prone position does not mitigate this aspiration risk during feeding.

Choice C rationale

Inserting an orogastric tube is appropriate, but giving feedings via gavage before confirmation is dangerous due to the risk of aspiration into the lungs if a fistula is present. Confirmation via x-ray is crucial to ensure the tube is correctly placed and feeding is safe.

Choice D rationale

Keeping the infant NPO (nothing by mouth) prevents aspiration of fluids or food into the respiratory tract, which is a major complication of tracheoesophageal fistula. Elevating the head of the crib to 30 degrees uses gravity to minimize gastroesophageal reflux and further reduce the risk of aspiration.