The nurse is caring for a pregnant client during the first prenatal visit.
Prior to obtaining prenatal lab work the client asks the nurse, "Why do I need a rubella screening? I was already vaccinated.”. What explanation by the nurse is most accurate?

Choice A rationale

Consuming adequate calories as determined by a dietitian is a primary goal for discharging a client with anorexia nervosa. This indicates that the client is compliant with the nutritional rehabilitation plan and is capable of maintaining a caloric intake sufficient for metabolic needs. Stabilization of eating patterns and the ability to self-regulate intake without purging or restriction are essential benchmarks. It reflects an improvement in the behavioral aspects of the eating disorder and physiological stability.

Choice B rationale

A body mass index (BMI) of 15 is significantly below the healthy range (18.5 to 24.9 kg/m) and indicates that the client remains severely underweight and malnourished. Discharging a client with such a low BMI would be unsafe as they remain at high risk for cardiac arrhythmias, electrolyte imbalances, and organ failure. Clinical guidelines usually require a higher BMI, typically at least 17 or more, along with weight stability, before considering a transition to outpatient care.

Choice C rationale

Dependency on a parent for basic needs indicates a lack of developmental autonomy and poor coping mechanisms, which are often underlying psychological issues in anorexia nervosa. Discharge readiness requires the client to demonstrate age-appropriate independence and the ability to manage self-care. Continued dependency suggests that the psychological triggers and family dynamics contributing to the disorder have not been adequately addressed. The client needs to show functional improvement and emotional resilience before leaving an intensive treatment environment.

Choice D rationale

The statement regarding not being perfect indicates a positive shift in the cognitive distortions and perfectionism frequently associated with anorexia nervosa. Acknowledging that perfection is unattainable suggests that the client is developing healthier thought patterns and reducing the internal pressure that drives restrictive eating. Cognitive behavioral progress is a critical metric for discharge, as it reduces the likelihood of relapse. This shift in mindset shows the client is engaging effectively with psychotherapy and emotional processing.

Choice E rationale

A blood pressure of 108/74 mm Hg is within the normal range (systolic 90 to 120 and diastolic 60 to 80), indicating cardiovascular stability. Clients with active anorexia nervosa often suffer from bradycardia and hypotension due to starvation and reduced metabolic rate. Achieving a stable, normal blood pressure suggests that the client’s autonomic nervous system and fluid volume are recovering. This physiological normalization is a necessary prerequisite for discharge to ensure the client can safely transition to a lower level of care.

Choice A rationale

Cocaine is a potent vasoconstrictor that causes a rapid increase in maternal blood pressure and significant uterine artery constriction. This sudden vascular compromise can lead to premature separation of the placenta from the uterine wall, known as placenta abruption. This condition is a life-threatening emergency for both the mother and the fetus due to the risk of severe hemorrhage and impaired fetal oxygenation caused by the drug's sympathetic nervous system stimulation.

Choice B rationale

Erythroblastosis fetalis is a hemolytic disease of the newborn that occurs due to Rh incompatibility between the mother and the fetus. It involves the maternal immune system producing antibodies that attack fetal red blood cells. There is no known scientific or physiological link between the use of cocaine and the development of Rh isoimmunization or hemolytic anemia. This condition is strictly related to blood group antigens rather than substance abuse or maternal vasoconstriction.

Choice C rationale

The systemic effects of cocaine involve the inhibition of norepinephrine reuptake at nerve endings, leading to a state of chronic sympathetic overactivity. This results in persistent vasoconstriction and increased peripheral vascular resistance, which manifests as gestational hypertension. The cardiovascular strain placed on the mother by regular cocaine use increases the likelihood of developing preeclampsia or other hypertensive disorders of pregnancy, which can have devastating effects on maternal organ systems and placental perfusion.

Choice D rationale

Cocaine use during pregnancy causes chronic intrauterine hypoxia due to decreased blood flow through the placental bed. When the fetus is deprived of adequate oxygen and essential nutrients over a long period, growth is significantly restricted. This often results in the infant being small for gestational age at birth. The vasoconstrictive properties of the drug limit the transfer of glucose and amino acids, which are necessary for normal fetal weight gain and development.

Choice E rationale

Substance abuse is frequently associated with various lifestyle factors, including poor nutritional intake. Cocaine acts as a powerful appetite suppressant, which often leads to the mother neglecting her caloric and vitamin requirements. Inadequate maternal nutrition further compounds the risks to the fetus, as the lack of essential building blocks like folic acid, iron, and protein can lead to anemia, low birth weight, and other developmental complications during the gestation period.