# 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. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617266&lang=en > language: en > subject: Ante/Intra/Postpartum and Newborn Care > category: HPM ## Question 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. 1 Give Rh immune globulin today because of the two past miscarriages. 2 Record the obstetric history as G5 T1 P1 A2 L3. 3 Record the estimated date of birth as 2026-10-19 by Naegele's rule. 4 Plan Rh immune globulin at 28 weeks if antibody screen is negative. 5 Anticipate an ultrasound now to confirm the estimated birth date. 6 Record the obstetric history as G5 T1 P2 A2 L3. ## Explanation The twin delivery counts as one preterm birth, so the history is G5 T1 P1 A2 L3. Naegele's rule assumes a 28-day cycle, so with 35-day cycles 2026-10-19 would be about a week too early; a first-trimester ultrasound is the accurate way to confirm the date. The past miscarriages were already covered with Rh immune globulin, so the next routine dose is at about 28 weeks if the client remains unsensitized. ## In-depth explanation 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. References 1StatPearls: Gravidity and ParityA multiple birth counts as one parous event; G/TPAL definitions 2ACOG Committee Opinion: Methods for Estimating the Due DateFirst-trimester ultrasound is the most accurate dating method; Naegele's rule assumes a 28-day cycle 3ACOG Practice Bulletin: Prevention of Rh D AlloimmunizationRh D immune globulin is given at about 28 weeks to unsensitized Rh-negative clients and after sensitizing events ## Clinical scenario Scenario An Rh-negative client with 35-day cycles, a preterm twin birth, and two treated miscarriages is seen at the first prenatal visit. ## Key concepts - **GTPAL** — Notation for gravida, term births, preterm births, abortions/miscarriages, and living children. - **Naegele's rule** — Estimated date of birth = first day of LMP + 7 days - 3 months + 1 year, assuming a 28-day cycle. - **Rh immune globulin** — Anti-D antibody given to Rh-negative clients to prevent sensitization to Rh-positive fetal blood. ## Related questions - [A nurse is providing preconception counseling to a 28-year-old woman planning a pregnancy …](https://mymerci.kr/pages/nclex_q.php?qn_id=364076&lang=en) - [A 28-year-old client at 6 weeks gestation, gravida 1 para 0, presents to the prenatal clin…](https://mymerci.kr/pages/nclex_q.php?qn_id=368130&lang=en) - [Stage 2 — Analyze cues. 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