A nurse in a prenatal clinic is determining a client's estimated date of delivery using Naegele's rule. The first day of her last menstrual period was May 8. Which of the following dates should the nurse tell the client is her estimated date of delivery?

Choice A:

While rupture of fetal membranes is a potential risk with placenta previa, it's not the primary reason to avoid a pelvic exam. If the membranes are already ruptured, a pelvic exam may be necessary to assess cervical dilation and fetal station.

However, in the absence of ruptured membranes, the risk of profound bleeding outweighs the benefits of a pelvic exam in women with placenta previa.

Choice C:

Preterm labor is a potential complication of placenta previa, but it's not directly caused by a pelvic exam. If preterm labor is suspected, a pelvic exam may be necessary to assess cervical dilation and fetal station.

However, in the absence of preterm labor signs, a pelvic exam is not routinely recommended in women with placenta previa due to the risk of bleeding.

Choice D:

Infection is a potential risk with any invasive procedure, including a pelvic exam. However, it's not a major concern in women with placenta previa compared to the risk of bleeding.

Proper sterile technique during the exam can significantly reduce the risk of infection.

Choice B:

Profound bleeding is the most significant risk associated with a pelvic exam in women with placenta previa. The placenta is located abnormally low in the uterus, covering or partially covering the cervix. Any manipulation of the cervix, such as during a pelvic exam, can disrupt the placenta's attachment and cause significant bleeding.

This bleeding can be life-threatening for both the mother and the fetus. Therefore, it's crucial to avoid pelvic exams in women with placenta previa unless there's a compelling clinical reason to perform one.

Rationale for Choice A:
A pelvic exam is required if you want birth control pills. This response is not therapeutic because it dismisses the client's feelings and does not address her concerns. It focuses on the policy or requirement rather than the client's emotional needs. It could make the client feel like her anxiety is not justified or that she has no choice in the matter.

Rationale for Choice B:
Don't worry, I will stay in there with you for the exam. While this response may be intended to provide reassurance, it does not fully address the client's underlying concerns. It offers a solution without first exploring the specific reasons for the client's anxiety. It could also make the client feel dependent on the nurse's presence for comfort, rather than empowering her to manage her own anxiety.

Rationale for Choice C:
All you need to do is relax during the exam. This response is not therapeutic because it minimizes the client's feelings and suggests that she can simply control her anxiety by relaxing. It does not acknowledge the validity of her concerns or provide any guidance on how to manage those concerns. It could make the client feel like her anxiety is her fault or that she is not coping well.

Rationale for Choice D:
Tell me more about your concerns. This is the most therapeutic response because it encourages the client to express her feelings and concerns openly. It validates the client's experience and demonstrates active listening and empathy. It provides an opportunity for the nurse to gather more information about the specific reasons for the client's anxiety and to tailor interventions accordingly. It also empowers the client by allowing her to share her thoughts and take control of the conversation.