Which of the following vaccines should a nurse plan to immunize a client who is at 30 weeks of gestation with? (Select all that apply)

Choice A reason: Rho(D) immune globulin is administered after a miscarriage in Rh-negative women to prevent isoimmunization, as fetal blood mixing can occur. This immunoglobulin neutralizes Rh-positive fetal antigens, preventing maternal antibody formation that could affect future pregnancies. The immune response could otherwise lead to hemolytic disease in subsequent Rh-positive fetuses.

Choice B reason: Administering Rho(D) immune globulin at 12 weeks is not standard practice. It is typically given at 28 weeks and post-delivery or after events like miscarriage. Early administration is unnecessary unless a sensitizing event occurs, as maternal-fetal blood mixing is rare before the third trimester, per immunological principles.

Choice C reason: Rho(D) immune globulin does not prevent preterm labor, which is driven by uterine or hormonal factors. The injection targets Rh isoimmunization by neutralizing Rh-positive fetal antigens. Preterm labor involves prostaglandin and oxytocin pathways, unrelated to Rh sensitization, making this statement irrelevant to the immunoglobulin’s immunological mechanism.

Choice D reason: Rho(D) immune globulin is unnecessary post-delivery if the baby is Rh-negative, as no sensitization occurs without Rh-positive fetal blood. The injection is given only if the baby is Rh-positive to prevent maternal antibody formation. This statement reflects a misunderstanding of Rh immunology and isoimmunization risk in pregnancy.

Choice A reason: Administering 20 mL per feeding is not universally appropriate, as gavage feeding volumes depend on the newborn’s weight, gestational age, and medical condition. Standardized volumes risk over- or underfeeding, potentially causing gastric distress or inadequate nutrition. Neonatal physiology requires individualized feeding plans to support digestion and growth, guided by medical prescriptions and clinical assessment.

Choice B reason: Nonnutritive sucking, such as on a pacifier, supports neurological development and soothes newborns during gavage feeding. It stimulates the suck-swallow reflex, enhancing gastrointestinal motility and reducing feeding intolerance. Scientifically, this practice promotes oral motor skills, aiding transition to oral feeding, and provides comfort, which is critical for neonatal stress reduction and developmental progress.

Choice C reason: Placing a newborn in a supine position after gavage feeding increases the risk of aspiration, as milk may reflux into the airway. Neonatal physiology favors a side-lying or prone position to facilitate gastric emptying and reduce regurgitation. This position supports safer digestion and minimizes respiratory complications, aligning with evidence-based neonatal care practices for gavage-fed infants.

Choice D reason: Cluster feedings mimic natural breastfeeding patterns, supporting neonatal nutritional needs and growth. Newborns often feed in clusters to meet caloric demands, stabilize blood glucose, and promote weight gain. This practice aligns with neonatal physiology, as the stomach’s small capacity benefits from frequent, smaller feedings, enhancing digestion and nutrient absorption in gavage-fed infants.