A 28-Year-Old Woman Is 30 Weeks Pregnant with Her Second

question 48

Multiple Choice

A 28-year-old woman is 30 weeks pregnant with her second child and is being seen for a scheduled obstetric visit. Her first pregnancy and delivery was uncomplicated, and she has a healthy 2-year-old girl. It is known that the mother is Rh-, and this child could be at risk for hemolytic disease of the newborn. She received RhoGAM with her first pregnancy.
-After further investigation,it is learned that the father is Rh+,and so was the first child.The patient declines the RhoGAM injection,stating "there were no complications with my first pregnancy and delivery,how can you be sure there will be with this one?" She explains how unpleasant the RhoGAM injection was with her first pregnancy,and she would like to avoid it,if at all possible.What is the most appropriate response by the nurse?  

• A)Because you received RhoGAM with your first pregnancy,it is not necessary during this pregnancy.
• B)It is important you receive your RhoGAM injection because this child will probably develop hemolytic disease of the newborn if you do not.
• C)It is important that we keep you from being sensitized to Rh factor,otherwise future pregnancies will be at risk for developing hemolytic disease of the newborn.
• D)You were probably sensitized to Rh factor with your first pregnancy,so the chances are decreased that this child will develop hemolytic disease of the newborn.I will ask the doctor if we can forego the injection.

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