A nurse is caring for a client who is at 30 weeks of gestation.
The nurse should plan to immunize the client with which of the following vaccines? (Select all that apply)

Choice A rationale

Asking about the fluid's color (clear, meconium-stained, bloody) provides information about fetal well-being and potential complications (like meconium aspiration), but it is a secondary assessment. While important, it does not supersede the need to immediately assess the most urgent physiological parameter of fetal status, which is the heart rate.

Choice B rationale

The rupture of membranes (water breaking) carries a risk of prolapsed umbilical cord, which can severely compromise fetal oxygenation by compressing the umbilical vessels. Determining the fetal heart rate (FHR) immediately is the priority action to identify signs of fetal distress, such as bradycardia (FHR <110 beats/min), indicating cord compression. The normal FHR range is 110-160 beats/min.

Choice C rationale

Monitoring cervical dilation is necessary to determine the stage and progress of labor. However, in the setting of ruptured membranes, assessing the immediate safety and stability of the fetus takes precedence over checking labor progress. A vaginal exam to check dilation is done after assessing FHR and ruling out immediate emergencies like cord prolapse.

Choice D rationale

Determining the vaginal pH with Nitrazine paper can confirm if the fluid is amniotic fluid (alkaline, pH 7.0-7.5) or urine/vaginal secretions (acidic). While this confirms the rupture of membranes, establishing the status of the fetus by assessing the FHR is the most critical and life-saving priority action to take first to prevent or quickly address fetal hypoxia.

Choice A rationale

The Diphtheria-tetanus-acellular pertussis (Tdap) vaccine is recommended during each pregnancy, ideally between 27 and 36 weeks of gestation. This timing is crucial because it allows for the maternal production and optimal transplacental transfer of pertussis antibodies to the fetus. These antibodies provide crucial passive immunity to the newborn against pertussis (whooping cough), which is a severe and potentially fatal disease in infants before they can be directly immunized.

Choice B rationale

The Human papillomavirus (HPV) vaccine is not recommended during pregnancy because there is limited safety data regarding its use in pregnant women. While it is not known to cause adverse fetal effects, it is a recombinant vaccine and, as a precautionary measure, it should be delayed until the postpartum period. Routine HPV vaccination is typically administered to adolescents and young adults up to age 26.

Choice C rationale

The Varicella vaccine is a live attenuated virus vaccine and is contraindicated in pregnancy due to the theoretical risk of transmission of the live virus to the fetus, which could potentially cause congenital varicella syndrome. Women who are non-immune to varicella should receive this vaccine postpartum, before being discharged from the hospital, to protect future pregnancies.

Choice D rationale

The Measles, mumps, and rubella (MMR) vaccine is a live attenuated virus vaccine and is contraindicated in pregnancy due to the theoretical risk of fetal infection and subsequent congenital abnormalities, particularly from the rubella component. Women who are not immune to rubella should be vaccinated postpartum and advised to avoid conception for about one month following vaccination.

Choice E rationale

The inactivated influenza (flu shot) vaccine is recommended for all women who are pregnant during the flu season, regardless of their stage of gestation, including at 30 weeks. This is a killed virus vaccine and is considered safe in pregnancy. It protects the mother from severe influenza illness and also provides the newborn with passive immunity in the initial months of life.