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

Hemorrhagic shock results from significant blood loss, leading to decreased circulating blood volume and subsequent hypotension. Therefore, hypertension is not expected; instead, the nurse should anticipate hypotension as a classic sign, indicating the body's compensatory mechanisms are failing to maintain adequate perfusion. Systolic blood pressure below 90 mmHg is a common indicator of shock.

Choice B rationale

Initial compensatory mechanisms in shock, driven by the sympathetic nervous system, usually include tachypnea (increased respiratory rate) to enhance oxygenation and address resulting metabolic acidosis. Bradypnea (abnormally slow respiratory rate, normal 12-20 breaths/min) is a late and ominous sign, reflecting profound central nervous system depression and circulatory failure.

Choice C rationale

Tachycardia (heart rate >100 beats/min) is an early and compensatory sign of hemorrhagic shock, triggered by the release of catecholamines (epinephrine, norepinephrine). The sympathetic nervous system increases the heart rate and contractility to compensate for the reduced stroke volume caused by the hypovolemia and maintain cardiac output and tissue perfusion.

Choice D rationale

Hemorrhagic shock causes a severe reduction in renal blood flow due to vasoconstriction and low systemic pressure. This results in oliguria (urine output <30 mL/hr) or anuria, not polyuria. Decreased urine output is a critical indicator of inadequate perfusion to the kidneys and is a classic finding in progressing shock.

Choice A rationale

Migraine with aura is considered a Category 4 contraindication (unacceptable health risk) for the use of combined hormonal contraceptives (CHCs), including oral contraceptives. The estrogen component in CHCs increases the risk of ischemic stroke, and this risk is substantially amplified in clients who experience migraine headaches with focal neurological symptoms (aura), necessitating the selection of an alternative birth control method.

Choice B rationale

Hypotension (low blood pressure) is typically not a contraindication for oral contraceptive use. In fact, some studies suggest a potential, though often clinically insignificant, increase in blood pressure with CHC use due to a potential increase in circulating angiotensinogen, the precursor to the vasoconstrictive hormone angiotensin II. The use of CHCs is not restricted based on hypotension.

Choice C rationale

Dysmenorrhea (painful menstruation) is often significantly improved or resolved by the use of combined oral contraceptives (COCs). COCs work by suppressing ovulation and thinning the endometrial lining, which typically reduces prostaglandin production, thus decreasing the cramping and pain associated with the menstrual cycle, making it an indication, not a contraindication.

Choice D rationale

A history of ovarian cysts is generally not a contraindication for combined oral contraceptive use, provided the cysts were non-malignant and resolved or are benign. In fact, COCs can be used to treat or prevent the recurrence of functional ovarian cysts by suppressing the hormonal stimulation of the ovaries that leads to their formation, making it a potential therapeutic benefit.