HESI - OB, RHO(D) Immune Globulin
A primipara presents to the labor unit for delivery after the demise of the fetus at 22 weeks' gestation. After delivery, the nurse notices that the practitioner has ordered a 50 mcg dose of Rho(D) IG. What is the most appropriate nursing intervention? A. Question the practitioner regarding the dose because it may not be appropriate for the patient. B. Question the practitioner about the need for Rho(D) IG because the delivery involved fetal demise. C. Administer the Rho(D) IG because this indication and dose are appropriate. D. Administer the Rho(D) IG and ask the practitioner whether a second dose should be administered in the future.
A. Question the practitioner regarding the dose because it may not be appropriate for the patient. Rationale: The nurse should question the dose because a 50 mcg dose of Rho(D) IG is administered only when the possibility exists that less than 2.5 ml of fetal blood has crossed the placenta into the maternal blood; this amount is appropriate for gestations of less than 13 weeks. In gestations of 13 weeks and longer, more than 2.5 ml may cross the placenta; therefore, the appropriate dose for this patient is 300 mcg of Rho(D) IG. Unless there is an indication that more than 15 ml of fetal blood crossed the placenta, only one dose is needed. Fetal demise is an appropriate indication for Rho(D) IG administration.
When a patient's blood is Rh negative and the fetal blood is Rh positive, what is the risk to the fetus during pregnancy? A. The maternal immune system becomes sensitized to the Rh positive factor and destroys fetal red blood cells. B. The maternal immune system becomes sensitized to the Rh positive factor and destroys maternal red blood cells. C. The fetal immune system becomes sensitized to the Rh positive factor and destroys its own red blood cells. D. The fetal immune system becomes sensitized to the Rh positive factor and destroys the maternal red blood cells.
A. The maternal immune system becomes sensitized to the Rh positive factor and destroys fetal red blood cells. Rationale: When a patient's blood is Rh negative and the fetal blood is Rh positive, there is a risk that the maternal immune system will become sensitized to the fetal Rh positive factor during pregnancy and destroy fetal red blood cells. The patient's first child is typically not affected because the maternal blood has not yet been sensitized. However, with subsequent pregnancies, the maternal immune system becomes sensitized to the Rh positive factor and destroys fetal red blood cells. Although Rh incompatibility does not affect the mother, it poses a risk of erythroblastosis fetalis to the fetus or hyperbilirubinemia to the newborn. The fetal immune system does not become sensitized to the Rh factor and does not destroy its own blood cells or the maternal red blood cells.
The nurse is preparing to administer Rho(D) IG to an Rh-negative mother who delivered a full-term infant 48 hours ago. What is the usual dose of Rho(D) IG? A. 200 mcg Rho(D) IG B. 300 mcg Rho(D) IG C. 400 mcg Rho(D) IG D. 100 mcg Rho(D) IG
B. 300 mcg Rho(D) IG Rationale: A single dose of 300 mcg Rho(D) IG suppresses the maternal immune response to as much as 15 ml of Rh-positive blood and is usually sufficient. A dose of 100 mcg or 200 mcg is too small, and 400 mcg would be too large in normal circumstances
A multigravida is brought to the emergency department at 25 weeks' gestation after a motor vehicle crash. The patient states that a seat belt was worn, and the nurse notices bruising across the abdomen. Blood work indicates that the patient has A-negative blood. Which statement most accurately describes this patient? A. The patient is a candidate for Rho(D) IG if the result of Coombs testing is positive. B. The patient is a candidate for Rho(D) IG if the result of Coombs testing is negative. C. The patient is not a candidate for Rho(D) IG because 28 weeks' gestation has not been reached. D. The patient is not a candidate for Rho(D) IG because labor has not begun.
B. The patient is a candidate for Rho(D) IG if the result of Coombs testing is negative. Rationale: Because the patient has sustained abdominal trauma, Rho(D) IG can be administered if the result of the Coombs test is negative. A positive Coombs test result would indicate that the patient is already sensitized to Rh antigens; therefore, Rho(D) IG would not be of value. Rho(D) IG administration is not indicated for labor. Rho(D) IG may be administered before 28 weeks' gestation if an indication for its administration exists.
A 16-year-old primipara presents to the labor unit at term. The mother has not had any prenatal care. The nurse obtains orders for a complete prenatal panel, which includes a blood type and screen and a Coombs test. The tests indicate that the patient has AB-negative blood and a negative Coombs test result. What should the nurse do? A. Request an order for Rho(D) IG administration before delivery because the patient did not get a dose at 28 weeks' gestation. B. Wait until after delivery to determine whether the newborn's blood type warrants Rho(D) IG administration to the patient. C. Understand that Rho(D) IG is not necessary after the birth of a patient's first child. D. Understand that Rho(D) IG is not necessary because the patient is already sensitized.
B. Wait until after delivery to determine whether the newborn's blood type warrants Rho(D) IG administration to the patient. Rationale: The nurse should wait for the birth to confirm the newborn's blood type and the need for Rho(D) IG administration. Although Rho(D) IG administration after delivery does not affect the outcome for a first child, it improves outcomes for the patient's subsequent pregnancies and births. Rho(D) IG administration before delivery is appropriate for subsequent pregnancies when the first newborn's blood type is known to conflict with the maternal Rh value. The negative result of Coombs testing indicates that the patient is not sensitized to fetal Rh antigens.
A student nurse is helping to care for a multipara at 39 weeks' gestation who delivered 24 hours ago. The mother is A negative. The physician has just ordered Rho(D) IG. The student nurse asks the nurse how Rho(D) IG prevents antibody formation when sensitization is possible in an Rh-negative mother. Which explanation should the nurse provide? A. "Rho(D) IG suppresses the immune response of the Rh-negative mother to the Rh antibodies in the fetal blood before the maternal immune system forms antigens against them." B. "The Rho(D) IG suppresses the immune response of the Rh-positive infant to the Rh antibodies in the maternal blood before the fetal immune system forms antigens against them." C. "The Rho(D) IG suppresses the immune response of the Rh-negative mother to the Rh antigens in the fetal blood before the maternal immune system forms antibodies against them." D. "The Rho(D) IG suppresses the immune response of the Rh-positive infant to the Rh antigens in the maternal blood before the fetal immune system forms antibodies against them."
C. "The Rho(D) IG suppresses the immune response of the Rh-negative mother to the Rh antigens in the fetal blood before the maternal immune system forms antibodies against them." Rationale: Rho(D) IG suppresses the immune response of the Rh-negative mother to the Rh antigens (not the Rh antibodies) in the fetal blood before the maternal immune system forms antibodies (not antigens) against them. The mother's immune response, not the fetal immune response, is suppressed by the Rho(D) IG to prevent antibodies in the mother's blood from being formed against the infant's Rh antigens.
A multigravida delivered 1 day ago at 40 weeks' gestation. On admission, the admitting nurse is informed that the patient is of the Jehovah's Witnesses faith. The patient is A negative, and the practitioner has ordered Rho(D) IG to be administered. What should the nurse's next action be? A. Administer the Rho(D) IG as ordered. B. Hold the Rho(D) IG because the patient is of the Jehovah's Witnesses faith. C. Teach the patient that Rho(D) IG is made from human plasma before administering it. D. Have the patient sign the organization's "refusal of blood products" form.
C. Teach the patient that Rho(D) IG is made from human plasma before administering it Rationale: Because the patient is of the Jehovah's Witnesses faith, administering the Rho(D) IG as ordered without first teaching the patient that it is made from human plasma would be inappropriate. Holding the Rho(D) IG without first educating the patient on the benefits and risks would be inappropriate as well. Only after the patient declines the Rho(D) IG should the nurse have the patient sign the "refusal of blood products" form per the organization's practice.
A primipara who delivered vaginally 2 hours ago is transferred with the newborn to the postpartum unit. During the change-of-shift report, the nurse assuming the patient's care is told that the patient has B-negative blood and that cord blood has been sent to the laboratory. What is the first step the nurse should take in following up with the care of this patient and newborn? A. Administer Rho(D) IG within 72 hours of the delivery. B. Draw blood for a blood type and screen on the newborn. C. Verify that a Coombs test was ordered for the patient. D. Verify the father's blood type
C. Verify that a Coombs test was ordered for the patient. Rationale: Before administering Rho(D) IG, the nurse must confirm that the patient is not already sensitized by checking the results of the Coombs test, which is routinely performed after an Rh-negative patient gives birth. Theoretically, Rho(D) IG is unnecessary if the newborn's father is also Rh negative; however, the standard of care does not factor this into the decision when determining whether to administer the IG. Although Rho(D) IG should be administered within 72 hours of delivery, a blood product should not be administered without an order and a Coombs test result. Because cord blood was obtained and sent to the laboratory, drawing a specimen from the newborn is unnecessary. The Rho(D) IG should not be administered until the Coombs test results have been returned and the practitioner has written the appropriate order.
A 40-year-old multipara presents to the antepartum unit for amniocentesis at 18 weeks' gestation. The patient has A-negative blood and a negative response to the Coombs test. Which treatment should the nurse anticipate? A. Defer Rho(D) IG administration because the patient does not currently have an indication for it. B. Defer Rho(D) IG administration because the patient is Rh negative but already is sensitized to the Rh factor. C. Defer Rho(D) IG administration because the patient is Rh negative but not yet at 28 weeks' gestation. D. Administer Rho(D) IG because the patient is Rh negative, is not sensitized to the Rh factor, and will undergo an invasive procedure that may cause fetal blood to cross into maternal blood.
D. Administer Rho(D) IG because the patient is Rh negative, is not sensitized to the Rh factor, and will undergo an invasive procedure that may cause fetal blood to cross into maternal blood. Rationale: Amniocentesis is an indication for an Rh-negative, multipara patient to receive Rho(D) IG because the invasive procedure may cause fetal blood to cross into maternal blood. The negative result on the Coombs test indicates that the patient is not already sensitized to the Rh factor. Rho(D) IG may be administered before 28 weeks' gestation if an indication for its administration exists.
During delivery, a multigravida at 38 weeks' gestation has a fetomaternal hemorrhage. What would be the effect of the patient's Rh negative status? A. The mother will not need Rho(D) IG. B. The mother may require a smaller dose of Rho(D) IG. C. The mother's Rh negative status has no effect on the administration of Rho(D) IG. D. The mother may require additional doses of Rho(D) IG.
D. The mother may require additional doses of Rho(D) IG. Rationale: Due to the mother's Rh negative status, Rho(D) IG is needed. If clinical or laboratory indications of fetomaternal hemorrhage are present, the patient may require additional doses of Rho(D) IG. A pharmacist should be consulted for directions on pooling when multiple doses are required. Giving no dose or a smaller dose would be inappropriate