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: Transmission of HSV-2 to the newborn is higher with active lesions at birth, as direct contact during vaginal delivery increases neonatal herpes risk. The virus can cause severe neonatal infections, affecting the central nervous system. Cesarean delivery is often recommended to reduce transmission, per obstetric virology guidelines.

Choice B reason: Antiviral medications like acyclovir suppress HSV-2 symptoms and reduce transmission but do not cure the condition, as the virus remains latent in nerve ganglia. Chronic management is required, and this statement misrepresents the virological nature of herpes, which persists lifelong despite treatment, per infectious disease principles.

Choice C reason: Wearing tight-fitting undergarments during HSV-2 lesions is not recommended, as it may cause irritation, delaying healing. Loose clothing minimizes friction, supporting lesion recovery. This advice does not address viral transmission or fetal risk, focusing on comfort rather than the virological or obstetric management of HSV-2.

Choice D reason: HSV-2 can harm the fetus, especially with primary infection, causing congenital herpes, preterm birth, or neurological damage. While rare, transplacental transmission or exposure during delivery poses risks. This statement is incorrect, as HSV-2’s potential for fetal harm necessitates careful management, per perinatal infection guidelines.

Choice A reason: Assessing for abdominal tenderness does not address uterine atony or vaginal bleeding. Tenderness may indicate other issues, like infection, but atony requires immediate uterine contraction to control hemorrhage. Fundal massage directly stimulates myometrial contraction, addressing the primary cause of bleeding, per postpartum hemorrhage management protocols.

Choice B reason: Performing a fundal massage is the priority for uterine atony, as it stimulates myometrial contractions, promoting hemostasis at the placental site. Atony causes excessive bleeding due to poor uterine tone, and massage enhances oxytocin release, constricting blood vessels to reduce hemorrhage, aligning with obstetric emergency interventions.

Choice C reason: Avoiding sterile vaginal examinations does not address uterine atony or bleeding. Examinations assess cervical or vaginal trauma but do not correct myometrial failure. Atony requires active interventions like fundal massage to restore uterine tone and control hemorrhage, making this action irrelevant to the immediate physiological need.

Choice D reason: Obtaining a Kleihauer-Betke test assesses fetal-maternal hemorrhage, relevant for Rh-negative mothers, not uterine atony. Atony causes bleeding from poor uterine contraction, not fetal blood loss. This test does not address the immediate need to control hemorrhage through myometrial stimulation, per postpartum hemorrhage management principles.