A nurse is caring for a client in the first trimester of pregnancy and discovers that the client lacks immunity to rubella based on her blood work. When is the recommended time for administering rubella immunization?

A. "Placenta previa usually results in a higher risk of maternal hypertension, while abruptio placentae is commonly associated with a low-risk pregnancy.
This is incorrect because abruptio placentae, not placenta previa, is associated with maternal hypertension (e.g., preeclampsia, chronic hypertension). Placenta previa is not related to blood pressure issues.

B. "Placenta previa is characterized by sudden onset of severe abdominal pain and uterine tenderness, while abruptio placentae is associated with painless bleeding."
This is incorrect because placenta previa presents with painless, bright red vaginal bleeding, while abruptio placentae causes sudden, severe abdominal pain, uterine tenderness, and possibly dark red bleeding.

C. "Placenta previa typically presents with severe pain and contractions, whereas abruptio placentae involves painless bleeding without contractions."
This is incorrect because placenta previa does not cause pain or contractions. In contrast, abruptio placentae often presents with painful contractions and uterine hypertonicity.

D. "Placenta previa involves the placenta partially or completely covering the cervix, whereas abruptio placentae involves the premature separation of the placenta from the uterine wall."
Placenta previa occurs when the placenta covers the cervix (partial or complete), leading to bleeding. Abruptio placentae occurs when the placenta prematurely separates from the uterine wall, which can lead to hemorrhage and fetal distress.

Priority concerns:

Liver function tests: The client has elevated ALT (75 U/L), AST (78 U/L), alkaline phosphatase (184 U/L), and LDH (250 U/L), which are consistent with liver involvement in preeclampsia with severe features. This suggests hepatic dysfunction and possible progression to HELLP syndrome.

Blood pressure: The client’s BP is 168/100 mmHg, which meets the criteria for severe preeclampsia (≥160/110 mmHg). Uncontrolled hypertension increases the risk of stroke, placental abruption, and progression to eclampsia.

Headache: The persistent headache could indicate severe preeclampsia with neurological involvement due to cerebral vasospasm and increased risk of stroke or seizure. A headache that does not resolve with usual measures is a warning sign, and magnesium sulfate should be considered for seizure prophylaxis.

Not a Priority Concern

Heartburn is a common symptom in pregnancy due to gastric reflux and increased progesterone levels, which relax the lower esophageal sphincter. While it can be uncomfortable, it is not immediately life-threatening.

Gestational age: The client is at 37 weeks’ gestation, which is considered early term but not preterm. While gestational age is important for delivery planning, it is not the most immediate concern compared to the client’s hypertensive crisis.

Cardiac assessment: The apical pulse is 77 bpm, regular, and lungs are clear, indicating that there is no immediate cardiac or respiratory compromise.