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

True labor contractions persist and often intensify with activity, such as walking, because physical exertion promotes the release of oxytocin. In contrast, Braxton Hicks or false labor contractions typically diminish or cease with ambulation. Therefore, contractions persisting with walking indicate the cervical changes characteristic of progression into the active phase of labor.

Choice B rationale

Urinary frequency is a common discomfort throughout the third trimester of pregnancy due to the pressure of the enlarged uterus on the bladder. While present, it is not a specific indicator of the progression of labor from the latent to the active phase, which is characterized by measurable changes in cervical dilation and effacement.

Choice C rationale

Increased blood-tinged vaginal mucus, known as "bloody show," results from the cervical capillaries breaking as the cervix effaces and dilates. While this indicates cervical change, the most definitive sign of labor progression is a change in the frequency, duration, and intensity of contractions coupled with measurable descent or cervical dilation increase.

Choice D rationale

The station is the relationship of the presenting part to the ischial spines (zero station). The client's initial station was -1 cm. A change to -3 cm station indicates the fetus has moved up and away from the ischial spines, which signifies regression, or higher negative numbers, in the engagement, not the desired progression into the maternal pelvis.

Choice A rationale

Skin mottling, characterized by a patchy, net-like, reddish-blue discoloration of the skin, is typically caused by vasoconstriction in response to cold exposure or by circulatory changes in individuals with poor peripheral perfusion. This is not a typical, expected body change during a normal pregnancy; expected skin changes relate more to hyperpigmentation (e.g., chloasma, linea nigra).

Choice B rationale

During pregnancy, hormonal changes, particularly the increase in estrogen, shift a greater proportion of hair follicles into the anagen (growth) phase, leading to thicker, fuller hair. Hair thinning (telogen effluvium) is commonly experienced postpartum when hormone levels drop and the hair follicles shift rapidly back into the telogen (resting) phase, thus it is not expected at 14 weeks gestation.

Choice C rationale

Nipple inversion is a structural variation where the nipple is retracted into the areola; it is not a change that typically develops during pregnancy. Expected breast changes include areolar darkening (hyperpigmentation), prominent Montgomery's tubercles, and nipple erection. Nipple inversion is a pre-existing condition that may present challenges for breastfeeding.

Choice D rationale

Breast enlargement (hypertrophy) is an expected and early body change during pregnancy, beginning in the first trimester (around 6 weeks). This growth is driven by elevated estrogen and progesterone levels, stimulating the development of the mammary glands in preparation for lactation, and is often accompanied by tenderness and increased vascularity.