A pregnant client at 28 weeks of gestation, who is receiving Rho(D) immune globulin for her Rh-negative status, asks the nurse if she will need another dose later.
What is the most appropriate response from the nurse?

Choice A rationale

A fetal heart rate of 160 beats per minute is at the upper limit of the normal range (110-160 beats per minute) and could indicate fetal stress or maternal fever. While moderate variability is a positive sign of fetal well-being, the elevated heart rate warrants further investigation and does not solely indicate optimal fetal status.

Choice B rationale

A fetal heart rate consistently below 120 beats per minute indicates bradycardia, which can be a sign of fetal distress or hypoxia. The absence of accelerations, which are transient increases in FHR, further suggests a lack of fetal reserve and is not indicative of well-being.

Choice C rationale

The presence of late decelerations, which are decreases in FHR that begin after the peak of a uterine contraction and return to baseline after the contraction ends, is a pattern associated with uteroplacental insufficiency. This indicates that the fetus is not receiving adequate oxygen during contractions and is a sign of fetal distress, not well-being.

Choice D rationale

Increased fetal movement between contractions is often a reassuring sign of fetal well-being. It indicates that the fetus has adequate oxygenation and is active. While a decrease or absence of fetal movement can be concerning, increased movement suggests the fetus is healthy and responsive.

Choice A rationale

Rho(D) immune globulin provides passive immunity against the Rh D antigen. The effects of a single dose administered at 28 weeks typically last for about 12 weeks, which generally covers the remainder of the pregnancy. However, it does not provide lifelong protection.

Choice B rationale

While Rh-negative mothers receive Rho(D) immune globulin after events like bleeding or trauma that could lead to fetal-maternal hemorrhage, the standard protocol also includes a prophylactic dose at around 28 weeks gestation regardless of such events.

Choice C rationale

If the baby is Rh-positive, fetal red blood cells may enter the mother's circulation during delivery. To prevent the mother from developing Rh antibodies that could affect future Rh-positive pregnancies, another dose of Rho(D) immune globulin is necessary within 72 hours postpartum.

Choice D rationale

Rho(D) immune globulin given at 28 weeks primarily protects the current pregnancy. While it helps prevent sensitization that could affect future pregnancies, the 72-hour postpartum dose is specifically timed to address potential exposure to fetal Rh-positive blood during delivery of an Rh-positive infant.