The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement indicates that teaching was effective?

A) Rubra, serosa, alba:
The normal progression of lochia, the vaginal discharge after childbirth, follows a predictable sequence of stages. Lochia rubra is the initial stage, occurring within the first few days postpartum. It is bright red and consists primarily of blood, tissue, and debris from the placenta. After 3-4 days, the discharge changes to lochia serosa, which is pinkish-brown and contains a mixture of blood, serous fluid, and mucous. After 10-14 days, it progresses to lochia alba, which is white or pale yellow and consists mostly of leukocytes (white blood cells), mucus, and epithelial cells. This is the expected progression, which marks the natural healing process after childbirth.

B) Rubra, alba, serosa:
This order is incorrect because lochia serosa comes before lochia alba in the normal sequence. Lochia alba occurs after lochia serosa, not before. This progression would not accurately reflect the typical stages of lochia.

C) Serosa, alba, rubra:
This sequence is incorrect as lochia rubra is the first stage, not lochia serosa. The initial discharge following childbirth is always red and blood-tinged, which is lochia rubra. Serosa and alba come later in the progression, so this order does not follow the correct timeline.

D) Alba, rubra, serosa:
This order is completely incorrect. Lochia rubra (red blood discharge) is the first stage, not lochia alba (white discharge). After childbirth, rubra occurs first, followed by serosa, and then finally alba. This sequence does not reflect the normal postpartum discharge process.

A) A rubella injection is advised:
Since the rubella titer is non-immune, the woman is not protected against rubella, which is important to address during the postpartum period. The rubella vaccine is typically given to women who are non-immune to rubella after childbirth, but it is contraindicated during pregnancy because it is a live vaccine. The best action in this case would be to administer the rubella vaccine to the postpartum woman before discharge, with instructions to avoid becoming pregnant for at least 28 days after vaccination to prevent harm to a future fetus.

B) A blood transfusion is advised:
The hematocrit of 30% indicates that the woman has mild anemia, but it does not require immediate intervention like a blood transfusion. Normal hematocrit levels for postpartum women typically range between 32% and 42%. A transfusion would be indicated if the hematocrit were much lower (usually below 20-25%) or if there were symptoms of significant blood loss, which are not indicated in this case.

C) The nurse should contact the provider for an antibiotic order:
There is no indication from the provided laboratory results or the scenario that the woman requires antibiotics. Group B Streptococcus (GBS) was negative, which eliminates the need for prophylactic antibiotics. There is no mention of any infection risk requiring an antibiotic prescription, and since her GBS result is negative, antibiotics are not warranted.

D) RhoGAM injection should be administered within 72 hours:
RhoGAM (Rh immunoglobulin) is typically administered to a woman with Rh-negative blood who has given birth to an Rh-positive baby to prevent Rh sensitization in future pregnancies. In this case, the woman has an Rh-positive blood type (A+), so she does not need RhoGAM. RhoGAM would only be necessary if the woman had an Rh-negative blood type, which she does not.