A nurse is reinforcing teaching about immunizations to a client who is pregnant. Which of the following immunizations should the nurse identity as contraindicated during pregnancy?

A. Pain rating of 4 on a scale of 0 to 10: Mild to moderate pain is expected in the early postoperative period due to surgical trauma. While pain should be monitored, a rating of 4 is not specific for infection and can be considered within normal postoperative discomfort.

B. Temperature of 37.2° C (99.0°F): A slightly elevated temperature within the normal range is common after surgery due to inflammatory response. It does not necessarily indicate infection unless it continues to rise or is accompanied by other systemic signs.

C. Increased urinary output: Increased urine output is generally a positive sign of adequate renal perfusion and fluid balance. It is not indicative of infection and may instead reflect normal postoperative recovery or fluid administration.

D. Elevated WBC count: Leukocytosis is a key laboratory indicator of infection. An elevated white blood cell count suggests an inflammatory or infectious process, which is particularly concerning in the postoperative period and warrants further assessment and intervention.

A. "You should give your child captopril 200 mg PO daily.": Captopril is an antihypertensive and is not routinely prescribed for Wilms’ tumor unless the child has hypertension. It is not part of standard preoperative management and should not be included in general parent teaching for tumor care.

B. "Your child should have surgery in 7 to 10 days to remove the tumor.": The timing of surgery is individualized based on the child’s condition, staging, and preoperative assessments. Providing a specific timeframe may be inaccurate and cause unnecessary confusion or anxiety.

C. "Your child will not require further treatment after removal of the tumor.": Wilms’ tumor often requires multimodal therapy, including chemotherapy and sometimes radiation, depending on tumor stage and histology. Parents should be aware that surgery alone may not be sufficient for complete treatment.

D. "You should not palpate your child's abdomen prior to surgery.": Palpating the abdomen can risk rupturing the tumor and spreading cancer cells, which could worsen prognosis. Parents should be instructed to avoid abdominal palpation and handle the child gently until surgical removal of the tumor.