A nurse is reinforcing teaching about immunizations to a client who is pregnant. Which of the following immunizations should the nurse identity as contraindicated during pregnancy?

A. The client has a sudden increase in energy: A sudden increase in energy in a client with major depressive disorder can indicate an elevated risk for suicidal behavior, especially if the client previously had low motivation or lethargy. This change is an urgent safety concern and should be reported immediately.

B. The client reports a change in sleeping patterns: Changes in sleep are common in depression and with antidepressant therapy. While important to monitor, they are not as immediately life-threatening as sudden energy changes that could precede suicidal actions.

C. The client is withdrawn and uncommunicative: Social withdrawal is a common symptom of depression. While concerning, it does not require the same urgent response as a sudden increase in energy that could indicate imminent risk.

D. The client neglects personal hygiene: Poor self-care is typical in depression and should be addressed in ongoing care, but it does not present the same immediate risk as potential suicidal behavior.

A. "I will need to take my medications for a total of 6 weeks.": TB treatment requires a prolonged course, typically 6 months, not 6 weeks. This statement reflects a misunderstanding of the duration of therapy and could lead to incomplete treatment and drug resistance.

B. “I am no longer contagious.": Clients with active tuberculosis remain contagious until they have received adequate treatment and follow-up testing confirms noninfectious status. Early discharge does not automatically mean the client is no longer a transmission risk.

C. "I will need to have someone observe me when I take my medication.": Directly Observed Therapy (DOT) is recommended to ensure adherence to TB medications, which helps prevent drug resistance and treatment failure. Understanding the importance of DOT indicates comprehension of infection control and treatment compliance.

D. "I can expect my contact lenses to turn red or orange.": Rifampin can discolor body fluids, including tears, causing contact lenses to appear red or orange. Recognizing this harmless side effect demonstrates the client’s understanding of medication effects.

E. "I should notify my provider if I start taking new over-the-counter or prescription medications.": TB medications have multiple drug interactions, and the client must inform the provider of any new medications to prevent adverse effects or reduced drug efficacy.

F. "I can continue my current alcohol intake.": Alcohol use is contraindicated with TB medications because it increases the risk of hepatotoxicity, particularly with isoniazid, rifampin, and pyrazinamide. Continuing alcohol would compromise treatment safety.

G. "I will need to have a repeat Mantoux test in 4 weeks.": Follow-up testing is not required once TB is confirmed by sputum culture. The Mantoux test is used for diagnosis, not monitoring treatment response.