Which of the following statements by the nurse is appropriate when reviewing a client's rubella titer of 1:8 at her second prenatal visit?

Choice A reason: Early decelerations of the FHR result from head compression during contractions, a benign response reflecting vagal stimulation. They mirror contraction patterns and do not indicate fetal distress. Epidural analgesia may reduce maternal blood pressure, but early decelerations are unrelated to hypoxia, requiring no immediate reporting in this context.

Choice B reason: FHR accelerations of 15 beats/min for 15 seconds indicate fetal well-being, reflecting a responsive autonomic nervous system. They occur with fetal movement or stimulation and are not concerning. Epidural analgesia does not typically cause accelerations, and these findings do not warrant reporting, as they signify normal fetal oxygenation and neurological function.

Choice C reason: An FHR of 150/min is within the normal range (110-160/min) and does not indicate distress. Epidural analgesia may cause maternal hypotension, affecting placental perfusion, but a stable FHR within normal limits reflects adequate fetal oxygenation. This finding does not require immediate reporting, as it aligns with normal fetal physiology.

Choice D reason: Prolonged absent FHR variability suggests fetal compromise, as variability reflects autonomic nervous system function and oxygenation. Epidural analgesia can cause maternal hypotension, reducing placental perfusion and leading to hypoxia, which diminishes variability. This critical finding requires immediate reporting to address potential fetal distress and prevent adverse outcomes like acidosis.

Choice A reason: Immediately bathing a newborn with herpes simplex virus (HSV) is not recommended, as it may spread lesions or increase infection risk. HSV, a viral infection, requires antiviral therapy, not bathing, to manage cutaneous lesions. Bathing could disrupt skin integrity, potentially exacerbating viral spread or secondary bacterial infections in a compromised neonate.

Choice B reason: Administering ampicillin, a bacterial antibiotic, is ineffective against HSV, a viral infection. Neonatal HSV requires antiviral drugs like acyclovir to target viral replication. Ampicillin addresses bacterial infections, such as group B streptococcus, but lacks efficacy against herpesviruses, making it an inappropriate treatment choice for this condition based on microbiological principles.

Choice C reason: Withholding breastfeeding is unnecessary unless active HSV lesions are present on the breast. HSV transmission via breast milk is rare, and breastfeeding supports neonatal immunity. If the mother has no active lesions, breastfeeding is safe with proper hygiene, as the virus primarily spreads through direct contact with lesions, not milk.

Choice D reason: Initiating contact precautions is critical for neonatal HSV, as the virus spreads through direct contact with lesions or secretions. Precautions, including gloves and gowns, prevent transmission to healthcare workers and other patients. HSV’s high infectivity in neonates, due to immature immunity, necessitates strict isolation to control viral spread in clinical settings.