A client attends a first prenatal visit 9 weeks after the first day of the last menstrual period (LMP), which was 2026-01-12. Cycles are regular but occur every 35 days. Obstetric history: one term singleton birth; one birth of twins at 35 weeks, both living; and two miscarriages at 7 and 9 weeks, each followed by Rh immune globulin. Records show blood type O, Rh-negative; today's antibody screen is pending. Which actions should the nurse include? Select all that apply.

Quick answer
G5 T1 P1 A2 L3, a dating ultrasound now, and Rh immune globulin at 28 weeks if the antibody screen is negative.

Why this is correct
Parity counts births, not babies, so the twin birth is P1 while both twins count toward L3. The 35-day cycle means ovulation occurs about 7 days later than Naegele's rule assumes, so the rule gives a date that is too early; first-trimester ultrasound is the most accurate dating method. Each miscarriage was already followed by Rh immune globulin, so nothing is due today; the routine antenatal dose is at about 28 weeks for an unsensitized Rh-negative client.

Easy analogy or mental picture
TPAL counts deliveries like car trips, not passengers. Naegele's rule is a ruler cut for a 28-day cycle; with a 35-day cycle, the ruler is 7 days short.

Memory hook
Twins = 1 in P, 2 in L. Naegele only fits 28-day cycles. Rh-negative + unsensitized = RhIG at 28 weeks and after sensitizing events.

NCLEX decision rule
Before accepting a calculated date or a scheduled treatment in an option, check the stem for the detail that changes it (cycle length, prior doses).

Why the other choices are wrong
Recording P2 is the classic error of counting each twin as a separate birth. The date 2026-10-19 is a correct Naegele calculation, which makes it convincing, but the rule assumes a 28-day cycle and this client's 35-day cycles push the true date about a week later. Giving Rh immune globulin today reflects correct concern for an Rh-negative client with prior pregnancy losses, but each loss was already treated and there is no new sensitizing event now.