A nurse is attending to an antepartum client whose lab results show a negative rubella titer.
What is the correct interpretation of this data?
The client is immune to the rubella virus.
The client needs a rubella vaccination immediately.
The client should receive a rubella immunization post-delivery.
The client is not currently infected with the rubella virus.
The Correct Answer is C
Choice A rationale
A negative rubella titer indicates that the client does not have immunity to the rubella virus. Therefore, the statement that the client is immune to the rubella virus is incorrect.
Choice B rationale
While it is true that a person with a negative rubella titer needs a rubella vaccination, it is not recommended to administer the vaccine immediately during pregnancy due to the potential risks to the fetus. Therefore, this statement is not correct in this context.
Choice C rationale
The correct interpretation of a negative rubella titer in an antepartum client is that the client should receive a rubella immunization post-delivery. This is because rubella can cause serious complications if contracted during pregnancy, including congenital rubella syndrome in the newborn. Vaccination post-delivery will protect the client in future pregnancies.
Choice D rationale
A negative rubella titer does not provide information about whether the client is currently infected with the rubella virus. It only indicates that the client does not have immunity to the virus. Therefore, this statement is not a correct interpretation of the data.
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Correct Answer is D
Explanation
Choice A rationale
Bleeding or spotting can accompany implantation. This is a common occurrence and does not necessarily indicate a problem with the pregnancy. It happens when the fertilized egg attaches to the lining of the uterus. Some women may mistake this bleeding for a light period, but it’s a sign of pregnancy.
Choice B rationale
Fertilization typically takes place in the outer third of the fallopian tube. After ovulation, the egg travels down the fallopian tube towards the uterus. If sperm are present in the fallopian tube at this time, fertilization can occur. This is a normal part of the reproductive process.
Choice C rationale
Sperm can remain viable in the woman’s reproductive tract for 2 to 3 days. This means that intercourse does not have to coincide exactly with ovulation in order to achieve pregnancy. The sperm can survive long enough to fertilize the egg when it is released.
Choice D rationale
The statement “Implantation occurs between 2 and 3 weeks after conception” is incorrect and requires intervention by the nurse. Implantation actually occurs about 6-10 days after ovulation, which is less than 2 weeks after conception.
Correct Answer is C
Explanation
Choice A rationale
A negative rubella titer indicates that the client does not have immunity to the rubella virus. Therefore, the statement that the client is immune to the rubella virus is incorrect.
Choice B rationale
While it is true that a person with a negative rubella titer needs a rubella vaccination, it is not recommended to administer the vaccine immediately during pregnancy due to the potential risks to the fetus. Therefore, this statement is not correct in this context.
Choice C rationale
The correct interpretation of a negative rubella titer in an antepartum client is that the client should receive a rubella immunization post-delivery. This is because rubella can cause serious complications if contracted during pregnancy, including congenital rubella syndrome in the newborn. Vaccination post-delivery will protect the client in future pregnancies.
Choice D rationale
A negative rubella titer does not provide information about whether the client is currently infected with the rubella virus. It only indicates that the client does not have immunity to the virus. Therefore, this statement is not a correct interpretation of the data.
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