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A nurse is reviewing lab results for a client who is at 37 wks gestation. The nurse notes that the client is rubella non-immune, positive for group A beta-hemolytic strep, and has a blood type O neg. What action should the nurse take?

a. instruct the client to obtain a rubella immunization after delivery
b. request a script for an antibiotic until delivery
c. inform the client that she will have to deliver via c-section
d. administer a dose of Pho(D) immune globulin

1 Answer

3 votes

Final answer:

The appropriate actions include administering a dose of Rho(D) immune globulin after delivery to prevent HDN in future pregnancies, and instructing the client to get a rubella vaccine postpartum due to non-immunity. the correct option is d. administer a dose of Pho(D) immune globulin.

Step-by-step explanation:

The most appropriate action for the nurse to take is to administer a dose of Rho(D) immune globulin after delivery. Given the client's blood type O neg (Rh-negative), and the potential risk of hemolytic disease of the newborn (HDN) if she is carrying an Rh-positive baby, a Rho(D) immune globulin injection can prevent the development of Rh antibodies that might harm future pregnancies.

Additionally, the nurse should instruct the client to obtain a rubella immunization after delivery to ensure her immunity for any subsequent pregnancies because the client is rubella non-immune. Although the client is positive for group A beta-hemolytic strep, the administration of antibiotics is typically done during labor to reduce the risk of transmission to the baby, and not continuously until delivery. A caesarean section is not indicated based on the information provided, as the blood types and infections mentioned do not necessitate this intervention.

User Greg Tatum
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