A client arrives for her second prenatal visit and the provider is reviewing the results of her tests.The client’s blood type and Rh factor are B- (negative). What additional intervention is needed for this client?
Blood transfusion just after delivery.
Maternal serum alpha-fetoprotein (MSAFP) at 24 weeks gestation.
RhO(D) immune globulin at 28 weeks gestation.
Three-hour glucose tolerance test at 26 weeks gestation.
The Correct Answer is C
Choice A rationale
A blood transfusion just after delivery is not a standard intervention for a client with Rh-negative blood type. The primary concern for Rh-negative clients is the potential for Rh incompatibility with the fetus, which can lead to hemolytic disease of the newborn. This condition is prevented by administering RhO(D) immune globulin during pregnancy.
Choice B rationale
Maternal serum alpha-fetoprotein (MSAFP) testing is used to screen for certain fetal abnormalities, such as neural tube defects, but it is not specifically related to Rh incompatibility. The primary intervention for Rh-negative clients is the administration of RhO(D) immune globulin to prevent sensitization.
Choice C rationale
RhO(D) immune globulin is administered at around 28 weeks of gestation to prevent Rh sensitization in Rh-negative clients. This intervention is crucial for preventing the development of antibodies that could harm the fetus in current or future pregnancies.
Choice D rationale
A three-hour glucose tolerance test is used to screen for gestational diabetes, which is a separate concern from Rh incompatibility. The primary intervention for Rh-negative clients is the administration of RhO(D) immune globulin.
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Correct Answer is B
Explanation
Choice A rationale
Lisinopril is not a beta blocker; it is an ACE inhibitor. Beta blockers, such as metoprolol, are generally considered safer during pregnancy compared to ACE inhibitors. Beta blockers work by blocking the effects of adrenaline on your heart and blood vessels, which helps to lower blood pressure. However, they are not without risks and should be used under medical supervision during pregnancy.
Choice B rationale
Lisinopril is an ACE inhibitor, which is contraindicated during pregnancy, especially in the second and third trimesters. ACE inhibitors can cause fetal renal dysfunction, oligohydramnios, and even fetal death. Therefore, it is essential to discuss alternative medications that are safer during pregnancy.
Choice C rationale
This statement is incorrect because ACE inhibitors, including lisinopril, are not safe to continue during pregnancy. They pose significant risks to the fetus, particularly in the later stages of pregnancy.
Choice D rationale
Lisinopril is not an angiotensin II receptor blocker (ARB); it is an ACE inhibitor. ARBs, like ACE inhibitors, are also contraindicated during pregnancy due to similar risks of fetal toxicity and adverse outcomes.
Correct Answer is D
Explanation
Choice A rationale
Striae gravidarum, or stretch marks, are a common occurrence during pregnancy due to the rapid stretching of the skin. They are not a medical emergency and do not require immediate attention from a healthcare provider.
Choice B rationale
During pregnancy, the nipples and areola typically become darker, not paler, as the breasts enlarge. This change is due to hormonal influences and increased blood flow to the area.
Choice C rationale
Fetal movement, also known as quickening, is usually felt by the mother between 18 to 25 weeks of gestation, not as early as 10 weeks. At 10 weeks, the fetus is still too small for its movements to be felt by the mother.
Choice D rationale
Some nausea and vomiting, known as morning sickness, is normal during pregnancy. However, if a pregnant woman is unable to keep food or water down, it is important to contact a healthcare provider to ensure she and the baby are receiving adequate nutrition and hydration.