A client at 37 weeks is scheduled to undergo a contraction stress test (CST) after receiving a 6/8 on the biophysical profile (BPP). The nurse notes the client has a history of which is a contraindication for the CST.

Choice A rationale

Rhogam, an immunoglobulin, is administered to Rh-negative pregnant women to prevent the development of antibodies against Rh-positive fetal blood cells. It works by destroying any fetal red blood cells that may have entered the maternal circulation, thereby preventing the mother's immune system from becoming sensitized. Since the patient is Rh-positive, her body will not produce antibodies against her own Rh-positive red blood cells or an Rh-positive fetus, making Rhogam administration unnecessary.

Choice B rationale

Administration of Rhogam at 28 weeks of gestation is the standard prophylactic protocol for Rh-negative pregnant women. This timing is chosen because it's a period of peak risk for fetomaternal hemorrhage. This choice is incorrect for this patient because she is Rh-positive, and thus is not at risk for Rh isoimmunization, making the medication unnecessary.

Choice C rationale

Administering Rhogam during labor is a reactive measure taken when an Rh-negative mother is giving birth to an Rh-positive baby. The goal is to prevent sensitization from the blood mixing during delivery. This choice is incorrect for this patient since she is Rh-positive and does not require the medication at all, regardless of the baby's Rh status.

Choice D rationale

The beginning of the second trimester is not a standard administration time for prophylactic Rhogam. The typical timing for routine administration is around 28 weeks of gestation. This choice is incorrect for this patient because she is Rh-positive, and therefore does not need Rhogam at any point during her pregnancy. *.

Choice C rationale

An increase in vaginal discharge or leaking of fluid is an important symptom to report. A sudden increase in watery discharge or a gush of fluid could indicate premature rupture of membranes (PROM), which places both the mother and fetus at risk for infection and premature birth. Reporting this allows for prompt evaluation and appropriate medical intervention to prevent complications.

Choice A rationale

A weight gain of one pound per week during the second and third trimesters is within the normal range. The recommended weight gain is typically 0.5 to 1 pound per week for a woman with a normal BMI. A sudden, rapid weight gain (more than 2 pounds in a week) could be a sign of preeclampsia, which is what the client should be instructed to report.

Choice B rationale

While urinary frequency is normal during pregnancy, especially in the first and third trimesters due to hormonal changes and uterine pressure on the bladder, the client should be instructed to report burning. Burning upon urination is a key symptom of a urinary tract infection (UTI), which is common in pregnancy and can lead to more serious complications like pyelonephritis if left untreated.

Choice D rationale

Severe nausea and vomiting (hyperemesis gravidarum) can lead to dehydration and electrolyte imbalances. Waiting for it to last more than seven days before reporting it is inappropriate. The client should be instructed to report severe nausea and vomiting if it prevents her from keeping fluids down, as this can lead to dehydration and malnutrition, requiring immediate medical attention and potential hospitalization.