A nurse is caring for a client who is at 23 weeks of gestation and has been unable to control her gestational diabetes mellitus with oral hypoglycemic therapy, diet and exercise. The nurse should anticipate a prescription from the provider for which of the following medications for the client?

A. Letrozole: Letrozole is an aromatase inhibitor used for ovulation induction in clients with infertility. It is not used to manage gestational diabetes and would have no role in glucose regulation during pregnancy.

B. Lactulose: Lactulose is a laxative commonly used to treat constipation or hepatic encephalopathy. It has no glucose-lowering effects and is not appropriate for managing gestational diabetes mellitus.

C. Insulin: Insulin is the treatment of choice for gestational diabetes when diet, exercise, and oral agents fail to control blood glucose. It does not cross the placenta and allows precise glucose management, making it safe and effective during pregnancy.

D. Metoprolol: Metoprolol is a beta-blocker used to treat hypertension or certain cardiac conditions. It is not indicated for gestational diabetes and may affect glucose metabolism, especially at higher doses.

A. The client requires a rubella vaccination at this time: Rubella is a live attenuated virus vaccine and is contraindicated during pregnancy. Administering it during gestation poses a risk of congenital rubella syndrome. The client must wait until after delivery for vaccination. Therefore, immunization now is inappropriate and unsafe.

B. The client requires a rubella immunization following delivery: A negative rubella titer indicates that the client is not immune to rubella and is at risk for infection. Rubella infection during pregnancy can cause serious fetal anomalies. The vaccine should be administered postpartum before discharge. This ensures immunity for future pregnancies.

C. The client is immune to the rubella virus: Immunity is confirmed by a positive rubella titer, not a negative one. A negative result shows susceptibility and lack of protective antibodies. Therefore, this interpretation is incorrect. The client is not immune and needs vaccination after delivery.

D. The client is not experiencing a rubella infection at this time: While a negative titer may imply no current infection, it primarily reflects a lack of immunity. It does not provide diagnostic information about active or recent infection. The main concern here is the absence of antibodies. Thus, this choice misinterprets the titer result.