The nurse is calculating the estimated date of confinement (EDC) using Nagele's rule for a client whose last menstrual period started on December 1. Which date is most accurate?

Choice A rationale:
Bronchoscopy is not the essential test for diagnosing cystic fibrosis. Bronchoscopy is a procedure that allows the healthcare provider to visualize the airways and lungs but is not the primary test for cystic fibrosis diagnosis. Cystic fibrosis is primarily diagnosed through genetic testing and sweat chloride testing.
Choice B rationale:
Serum calcium levels are not specific to cystic fibrosis diagnosis. Serum calcium levels are typically used to assess calcium balance in the body and are not directly related to cystic fibrosis diagnosis.
Choice C rationale:
Urine creatinine levels are not specific to cystic fibrosis diagnosis. Urine creatinine levels are often used to assess kidney function and muscle breakdown but are not diagnostic for cystic fibrosis.
Choice D rationale:
Sweat chloride test is essential in establishing the diagnosis of cystic fibrosis. Cystic fibrosis is characterized by the abnormal transport of chloride across cell membranes, leading to salty sweat. The sweat chloride test measures the amount of chloride in the sweat and is a key diagnostic test for cystic fibrosis. Values above a certain threshold (typically 60 mmol/L) are suggestive of cystic fibrosis.

Choice A rationale:

Nasal congestion and occasional epistaxis (nosebleeds) are common symptoms during pregnancy due to elevated levels of estrogen. Increased estrogen causes mucosal blood vessels to become engorged and more fragile, leading to nasal congestion and occasional nosebleeds. This is a normal respiratory change in pregnancy and not necessarily a cause for concern.

Choice B rationale:

While cardiovascular changes are common in pregnancy, nosebleeds alone are not indicative of abnormal cardiovascular changes unless they are accompanied by other symptoms. The given scenario does not provide enough information to support this choice.

Choice C rationale:

There is no evidence provided to suggest domestic violence (Choice C) as the cause of the woman's symptoms. Additionally, this choice lacks a physiological basis for the symptoms described.

Choice D rationale:

Intranasal cocaine use (Choice D) can indeed cause nasal congestion and frequent nosebleeds. However, the scenario does not provide any information to support this choice, and assuming drug use without evidence is not appropriate.