A pregnant client tells the nurse that her LMP was 3 months ago and began on October 20. Using Naegele's rule, calculate the client's estimated date of delivery.

Answer format E.g. "October 20"

Choice A rationale

Maintaining a folic acid intake of 4 mcg per day is not sufficient. The recommended dose for pregnant women is 400-800 mcg to help prevent neural tube defects, but it is not specifically related to reducing the risk of preterm labor.

Choice B rationale

Increasing fluid intake to 8-10 (8 oz) glasses per day is recommended as it helps to maintain hydration, which is crucial in preventing preterm labor. Dehydration can cause uterine contractions, which can lead to preterm labor.

Choice C rationale

Consuming the recommended daily allowance of vitamin C (85 mg) is important for immune function and overall health but does not directly affect the risk of preterm labor.

Choice D rationale

Increasing caloric intake by 500 calories per day is typically recommended for breastfeeding mothers, not for preventing preterm labor during pregnancy. Proper nutrition is important, but overconsumption can lead to excessive weight gain.

Choice A rationale

During pregnancy, the body’s production of red blood cells usually increases to meet the increased demands of the growing fetus. Therefore, a drop in hematocrit is not typically due to insufficient red blood cell production.

Choice B rationale

While iron is essential during pregnancy, a reduction in hematocrit levels at 16 weeks' gestation is primarily due to increased plasma volume, rather than iron deficiency. Nutritional counseling may still be beneficial but isn't the primary explanation for this change.

Choice C rationale

A hematocrit level of 34% at 16 weeks is generally not considered indicative of a severe problem. Instead, it is a physiological response to increased plasma volume, known as dilutional anemia of pregnancy.

Choice D rationale

The primary reason for a lower hematocrit count during pregnancy is the increase in blood plasma volume, leading to dilutional anemia. This is a normal adaptation to pregnancy that ensures adequate blood flow to the fetus.