A nurse is calculating the estimated date of birth using Nagele’s rule for a client who is pregnant and whose last menstrual cycle started June 21. What is the estimated date of delivery in the next year?

Choice A rationale
Performing a fundal massage is not the appropriate action for a client with placenta previa who is experiencing a large amount of vaginal bleeding. Fundal massage is typically used to stimulate contractions and reduce postpartum hemorrhage after the delivery of the placenta. However, in the case of placenta previa, where the placenta is covering the cervix, a fundal massage could potentially cause more harm and increase bleeding.
Choice B rationale
Assessing for abdominal tenderness is not the most immediate action for a nurse to take when a client with placenta previa is exhibiting a large amount of vaginal bleeding. While abdominal tenderness could indicate a complication such as placental abruption, the primary concern with placenta previa is the risk of severe bleeding that can endanger both the mother and the baby.
Choice C rationale
Obtaining serial hemoglobin and hematocrit is the correct action in this situation. These laboratory tests are important for monitoring the client’s blood loss and determining the need for a possible blood transfusion. With a large amount of vaginal bleeding, the client is at risk for anemia and hypovolemic shock, so close monitoring of blood levels is crucial.

Choice C rationale

Monitoring vital signs closely is an important part of care for any client, but it is not the most specific action a nurse should take for a client with placenta previa who is experiencing a large amount of vaginal bleeding. Vital sign changes could indicate worsening of the client’s condition, but these changes often occur late in the progression of blood loss. Therefore, while important, it is not the most immediate action to take.

Choice A rationale
While applying a spermicidal cream or jelly to the diaphragm is recommended to increase its effectiveness, the use of a vaginal lubricant is not typically recommended.
Choice B rationale
Washing the diaphragm with mild soap and warm water is recommended after each use. However, using detergent soap may cause irritation and is not typically recommended.
Choice C rationale

The diaphragm can be inserted up to 6 hours before intercourse. This allows for flexibility and spontaneity.
Choice D rationale
The diaphragm should be left in place for at least 6 hours after intercourse, not 2 to 4 hours. This is to ensure that all sperm are killed by the spermicide.