A nurse in a clinic is collecting data from a client. The client reports that they do not believe in receiving immunizations. Which of the following questions should the nurse ask the client?

A) Rubella titer nonimmune: A nonimmune rubella titer indicates that the client is not immune to rubella, which is a common finding in many pregnant women. However, rubella vaccination is not given during pregnancy because the vaccine is a live virus. The client will typically be vaccinated postpartum. Follow-up would be required, but it is not an urgent concern during the pregnancy itself.

B) Negative varicella titer: A negative varicella titer means the client is not immune to chickenpox, which is a concern because varicella can cause serious complications during pregnancy. However, similar to rubella, the varicella vaccine is contraindicated during pregnancy, and vaccination would be given postpartum. This requires follow-up after delivery but does not require urgent intervention during the pregnancy.

C) Positive Rh factor: The Rh factor is a blood type characteristic, but what is typically more concerning is the Rh incompatibility, which occurs when a Rh-negative mother carries a Rh-positive baby. A positive Rh factor is not a problem for the client themselves but could be important if the father is Rh-positive. If there is concern for Rh incompatibility, the nurse would monitor for the development of Rh sensitization and administer Rh immunoglobulin (RhoGAM) if needed. This does not require urgent intervention unless Rh incompatibility is confirmed.

D) Positive serologic test for syphilis: A positive test for syphilis requires immediate follow-up intervention. Syphilis is a sexually transmitted infection that can cause serious complications during pregnancy, including miscarriage, stillbirth, preterm birth, and congenital syphilis. Treatment with penicillin is recommended to prevent transmission to the baby and to treat the infection in the mother. A positive serologic test for syphilis warrants prompt intervention.

A) Encourage the client to use overbed trapeze:
Encouraging the client to use an overbed trapeze is an appropriate intervention to promote independence and mobility after an above-the-knee amputation. The trapeze allows the client to move, reposition themselves, and perform activities of daily living more independently, which is important for regaining strength and confidence during the rehabilitation process. It aids in improving upper body strength and assists in early mobility efforts.
B) Maintain abduction of the client's residual limb with a pillow:
Placing a pillow under the residual limb in a position that maintains abduction (separation of the residual limb away from the body) is not recommended after an above-the-knee amputation. This position can lead to contractures of the hip joint, limiting mobility and the ability to use a prosthetic limb in the future. Proper positioning usually involves keeping the residual limb flat or neutral to avoid deformities.

C) Caution the client to avoid a prone position while in bed:
This recommendation is incorrect. In fact, encouraging the client to spend time in the prone position (lying on their stomach) can help prevent hip contractures, especially after an above-the-knee amputation. It is important for the client to position their body in ways that encourage proper limb alignment and prevent long-term complications such as contractures that could impede mobility.

D) Keep a loose, absorbent dressing over the client's surgical site:
A loose, absorbent dressing is not ideal for post-surgical care following an amputation. A dressing should be secure, sterile, and changed regularly to prevent infection and promote optimal wound healing. Keeping a dressing loose could lead to the risk of infection or delayed healing. The nurse should follow the provider’s orders for dressing changes and monitor for signs of infection.