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:
Pulmonary stenosis is characterized by a systolic ejection murmur best heard at the upper left sternal border. It does not typically produce a continuous machinery-like murmur. Pulmonary stenosis results from narrowing at the pulmonary valve, obstructing blood flow from the right ventricle to the pulmonary artery.
Choice B rationale:
A continuous machinery-like murmur is characteristic of patent ductus arteriosus (PDA). PDA is a congenital heart defect where the ductus arteriosus, a fetal blood vessel that should close after birth, remains open, allowing continuous blood flow between the aorta and pulmonary artery. This murmur is often best heard in the left infraclavicular region.
Choice C rationale:
Ventricular septal defect (VSD) typically produces a harsh holosystolic murmur heard best at the lower left sternal border. VSD is a hole in the septum separating the ventricles, allowing blood to flow from the higher-pressure left ventricle to the lower-pressure right ventricle.
Choice D rationale:
Coarctation of the aorta causes a murmur due to increased blood flow across the aortic valve. However, this murmur is not continuous and is usually systolic and best heard in the back over the left scapula.

Choice A rationale:

A respiratory rate of 10 bpm (breaths per minute) is significantly below the normal range for an adult but is within the normal range for a newborn. Since the question does not specify the client's age, this information is insufficient to identify it as a complication of magnesium sulfate administration.

Choice B rationale:

A blood pressure of 148/94 is elevated and could be a complication of magnesium sulfate administration. Magnesium sulfate is used to manage pregnancy-induced hypertension, so if the blood pressure remains high or increases further, it could indicate an inadequate response to the treatment or a potential complication.

Choice C rationale:

Deep tendon reflexes of +2 are within the normal range and are not indicative of a complication related to magnesium sulfate administration. In fact, magnesium sulfate can cause muscle weakness and decreased deep tendon reflexes, so an absence of reflexes or extremely diminished reflexes might be a cause for concern.

Choice D rationale:

A urine output of 70 ml/hour is within the normal range for an adult, but without additional information, it is not indicative of a complication related to magnesium sulfate administration. Monitoring urine output is essential to assess renal function and fluid balance, but in this context, it does not provide specific information about the effects of magnesium sulfate.