A nurse is teaching a pregnant client who is Rh-negative about Rh(D) immune globulin. Which of the following statements by the client indicates an understanding of the teaching?

Choice A rationale:

The client is experiencing continuous abdominal pain and vaginal bleeding, which are key signs of abruptio placentae. This condition occurs when the placenta prematurely separates from the uterine wall before the baby is born, leading to bleeding and potential fetal distress. The history of cocaine use can be a risk factor for abruptio placentae, as cocaine use may lead to vasoconstriction and reduced blood flow to the placenta.

Choice B rationale:

Hydatidiform mole is not likely in this case because it presents with symptoms such as vaginal bleeding and a "grape-like” mass on ultrasound. The continuous abdominal pain is not typical for a hydatidiform mole.

Choice C rationale:

Preterm labor is not the likely complication in this scenario because the client is at 38 weeks of gestation, which is considered full term. Preterm labor refers to labor that occurs before 37 weeks of gestation.

Choice D rationale:

Placenta previa is not the likely complication as it presents with painless vaginal bleeding in the third trimester, and the abdominal pain described in the question suggests a different condition.

Choice A rationale:

In Rh incompatibility, if the mother's blood does not contain the Rh factor (Rh-negative) and she is exposed to Rh-positive blood (usually from the fetus during delivery), her immune system may produce anti-Rh antibodies. However, these antibodies do not typically cross the placental barrier during the first pregnancy. Rh incompatibility occurs when the mother's blood is Rh- negative, and she is carrying an Rh-positive fetus during her second or subsequent pregnancies, leading to sensitization and potential hemolysis in future pregnancies.

Choice B rationale:

This choice is correct. Rh incompatibility occurs when the mother is Rh-negative, and the newborn is Rh-positive. During the first pregnancy, the mother is not sensitized to the Rh factor and does not produce significant amounts of anti-Rh antibodies. However, if the fetus is Rh- positive, there is a risk of sensitization during childbirth or any other event where maternal and fetal blood may mix. In subsequent pregnancies, if the mother becomes pregnant with another Rh-positive fetus, her immune system will recognize the Rh antigen as foreign and produce antibodies that can cross the placenta and attack the fetal red blood cells, leading to hemolysis and hyperbilirubinemia in the newborn.

Choice C rationale:

This choice is not related to the mechanism of Rh incompatibility. Receiving a transfusion with Rh-negative blood would not cause the mother's immune system to produce anti-Rh antibodies or lead to Rh incompatibility with her newborn.

Choice D rationale:

This choice describes the ABO blood group system, not the Rh factor. ABO incompatibility can occur when a mother with blood type O (producing anti-A and anti-B antibodies) has a newborn with blood type A, B, or AB, leading to hemolysis of the fetal red blood cells. However, the question specifically mentions Rh incompatibility, which involves the Rh factor, not the ABO system.