A nurse is using Naegele's rule to calculate the estimated due date of a client who reports that the first day of their last menstrual cycle was July 21st.
Which of the following should the nurse document as the client's expected due date?

Choice A rationale

Bilirubin monitoring is critical for jaundice due to hemolysis, often seen in ABO incompatibility or cephalohematoma. While Large for Gestational Age (LGA) infants can have polycythemia, hypoglycemia is a more immediate and life-threatening risk that requires priority monitoring in the first hours of life. The normal total bilirubin range is typically less than 5 mg/dL in the first 24 hours.

Choice B rationale

LGA infants are often born to mothers with uncontrolled or gestational diabetes, leading to fetal hyperinsulinism. After birth, the maternal glucose supply is cut off, and the high insulin levels persist, causing a rapid and profound drop in the newborn's blood glucose, hence hypoglycemia is a major concern. The normal newborn glucose range is 40 to 60 mg/dL and should be monitored.

Choice C rationale

White blood cell (WBC) count is primarily monitored to detect neonatal sepsis or infection. While all newborns are at risk, the LGA classification does not inherently place them at a higher, unique risk for infection compared to the immediate metabolic derangement risks like hypoglycemia. The normal WBC count range is 9,000 to 30,000 cells/mm.

Choice D rationale

Arterial Blood Gases (ABGs) are used to assess the newborn's respiratory status and acid-base balance, particularly in respiratory distress syndrome or persistent pulmonary hypertension. While LGA infants can experience birth trauma or meconium aspiration, ABG monitoring is not routine unless significant respiratory symptoms are present.

Choice A rationale

A nonreactive nonstress test (NST), defined by having fewer than two accelerations of at least 15 beats per minute (BPM) above baseline, lasting at least 15 seconds, within a 20-minute window, indicates potential fetal compromise or sleep state, leading to a maximum score of 0 on this component, thus not indicating well-being.

Choice B rationale

The biophysical profile (BPP) scores fetal movement with a maximum of 2 points for three or more discrete body or limb movements within a 30-minute period. The finding of four limb movements clearly meets this criterion and earns the full 2 points, reflecting an intact central nervous system and adequate fetal oxygenation, which is a sign of fetal well-being.

Choice C rationale

The BPP criterion for fetal breathing movements requires at least one episode of sustained movements for 30 seconds within the 30-minute observation period to score 2 points. The finding of 20 seconds is insufficient to meet this 30-second threshold, resulting in a score of 0 points for this component and thus not indicating full well-being.

Choice D rationale

The amniotic fluid index (AFI) measures the sum of the deepest vertical pockets of amniotic fluid in the four quadrants of the uterus. An AFI of 1 cm is significantly below the normal range of 5 cm to 25 cm, indicating oligohydramnios (low fluid). This finding scores 0 points on the BPP and suggests potential chronic fetal compromise or renal issues.