The nurse is calculating the estimated date of confinement (EDC) using Nagele's rule for a client whose last menstrual period started on February 13th. Which date is most accurate?

The correct answer is d. Amenorrhea.

Choice A: Chadwick’s sign is a non-specific, early sign of pregnancy that is typically characterized by a bluish discoloration of the cervix, vagina, and vulva. The Chadwick sign can typically be observed as early as six to eight weeks after conception, and commonly disappears shortly after birth. However, it’s not a definitive indication of pregnancy, and the absence of it on physical exam does not exclude a potential pregnancy.

Choice B: Hegar’s sign is a non-specific indication of pregnancy that is characterized by the compressibility and softening of the cervical isthmus (i.e., the portion of the cervix between the uterus and the vaginal portion of the cervix). It typically presents between the fourth and sixth week of pregnancy and may be present until the 12th week of pregnancy. However, the Hegar sign is not a definitive indication of pregnancy, and the absence of it does not exclude a potential pregnancy.

Choice C: A positive pregnancy test By 10 weeks, a home pregnancy test would almost certainly show a positive result if the woman is pregnant. This is because the hormone human chorionic gonadotropin (hCG), which is produced by the placenta after implantation of the embryo into the uterine wall, would be present in high enough levels to be detected by the test. However, a positive pregnancy test is not a presumptive sign of pregnancy, but rather a probable one.

Choice D: Amenorrhea, or the absence of menstrual periods, is often considered the most presumptive sign of pregnancy. This is because it’s one of the first noticeable signs of pregnancy for many women. By 10 weeks of gestation, the woman would likely have missed two menstrual periods if she usually has regular cycles. However, while amenorrhea is a common early sign of pregnancy, it can also be caused by various other conditions or factors such as stress, significant weight loss or gain, or certain medical conditions. Therefore, a missed period should be followed up with a pregnancy test to confirm pregnancy.

Choice A reason: She will not be unable to conceive in the future, as ectopic pregnancy does not necessarily affect her fertility. However, she may have a higher risk of having another ectopic pregnancy or infertility if the fallopian tube is damaged or removed.

Choice B reason: A D&C (dilation and curettage) will not be performed to remove the products of conception, as this procedure is used to empty the uterus, not the fallopian tube. The treatment for ectopic pregnancy may include medication, surgery, or expectant management, depending on the location, size, and viability of the pregnancy.

Choice C reason: Bed rest and analgesics are not the recommended treatment for ectopic pregnancy, as they do not address the underlying cause or prevent complications. Ectopic pregnancy is a medical emergency that requires prompt intervention to prevent rupture, bleeding, and shock.

Choice D reason: Hemorrhage is the major concern for ectopic pregnancy, as the pregnancy can rupture the fallopian tube and cause severe bleeding into the abdominal cavity. This can lead to hypovolemic shock, which is a life-threatening condition.