A nurse in a provider's office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?

Choice A rationale
This is incorrect because a decrease in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 140/85 mm Hg indicates pre-existing hypertension, which may or may not worsen during pregnancy. A current BP of 129/80 mm Hg indicates an improvement in the BP control, but not a risk for pregnancy-induced hypertension.

Choice B rationale
This is correct because an increase in BP from the baseline by 30 mm Hg systolic or 15 mm Hg diastolic is a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 110/70 mm Hg indicates a normal BP before pregnancy. A current BP of 145/85 mm Hg indicates a significant elevation in the BP, which could lead to complications such as preeclampsia, eclampsia, or placental abruption.

Choice C rationale
This is incorrect because a slight increase in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 120/80 mm Hg indicates a normal BP before pregnancy. A current BP of 126/85 mm Hg indicates a minor elevation in the BP, which is within the normal range and does not pose a risk for pregnancy-induced hypertension.

Choice D rationale
This is incorrect because a slight increase in BP from the baseline is not a sign of pregnancy-induced hypertension. A normal BP during pregnancy is less than 140/90 mm Hg. A baseline BP of 110/60 mm Hg indicates a normal BP before pregnancy. A current BP of 120/63 mm Hg indicates a minor elevation in the systolic BP, but a decrease in the diastolic BP, which is within the normal range and does not pose a risk for pregnancy-induced hypertension.

Choice A rationale
This is correct because the newborn might be actively shedding the virus if the mother has rubella at the time of delivery. Rubella is a highly contagious viral infection that can be transmitted through respiratory droplets or contact with body fluids. The newborn should be placed in isolation to prevent the spread of the infection to other susceptible individuals, such as pregnant women or immunocompromised persons.

Choice B rationale
This is incorrect because the child might develop encephalitis, a complication of rubella, is not an appropriate response by the nurse. Encephalitis is a rare but serious condition that involves inflammation of the brain. It can occur as a complication of rubella, but it is more common in adults than in children. The nurse should not scare the mother with this possibility, but rather focus on the prevention of transmission.

Choice C rationale
This is incorrect because the newborn is at risk for developing a TORCH infection is not an appropriate response by the nurse. TORCH is an acronym for a group of infections that can cause congenital anomalies in the fetus or newborn. It stands for toxoplasmosis, other infections (such as syphilis, varicella, or parvovirus), rubella, cytomegalovirus, and herpes simplex virus. The nurse should not use this term, as it is vague and confusing for the mother. The nurse should specify the type of infection and the potential consequences for the newborn.

Choice D rationale
This is incorrect because exposure to rubella will suppress the newborn's immune response is not an appropriate response by the nurse. Exposure to rubella will not suppress the newborn's immune response, but rather stimulate it to produce antibodies against the virus. However, these antibodies may not be sufficient to protect the newborn from the infection, and they may interfere with the effectiveness of the rubella vaccine later in life. The nurse should explain the importance of immunization for the newborn and the mother.