On her first visit, a patient had a baseline hemoglobin of 13.0 gm and a hematocrit of 42.9%.She has been taking ferrous sulfate tablets and eating an iron-rich diet.She returned to the clinic at 30 weeks gestation and has a hemoglobin of 11.0 gm and a hematocrit of 36.3%.She is concerned and confused about why these lab values have gone down.
In responding, which physiological change during pregnancy should the nurse describe to the patient?

The correct answer is choice C. Assess the client’s blood pressure.Methylergonovine is a uterotonic medication that can cause hypertension and is contraindicated for clients with preeclampsia or cardiac disease.

Therefore, the nurse should check the client’s blood pressure before administering this medication to ensure it is within normal range (120/80 mm Hg or lower).

Choice A is wrong because assessing the client’s pain scale is not a priority assessment before giving methylergonovine.

Pain is not a contraindication for this medication and does not affect its effectiveness.

Choice B is wrong because assessing the client’s respiratory rate is not a priority assessment before giving methylergonovine.

Respiratory rate is not affected by this medication and does not indicate any adverse effects.

Choice D is wrong because assessing the client’s last bowel movement is not a priority assessment before giving methylergonovine.

Bowel movement is not related to postpartum hemorrhage or uterine atony, which are the indications for this medication.

A rubella titer of 1:33 indicates a low level of immunity to rubella, which can be dangerous for a pregnant woman and her fetus.

Rubella is a viral infection that can cause birth defects or miscarriage if contracted during pregnancy.A rubella titer of 1:10 or higher is considered protective.

Choice B is wrong because a non-reactive serologic test for syphilis (STS) means that the patient does not have syphilis, which is a bacterial infection that can also harm the fetus if untreated.

Choice C is wrong because blood type A-negative does not require further assessment unless the patient has antibodies to the Rh factor, which can cause hemolytic disease of the newborn if the fetus is Rh-positive.

This can be prevented by giving the patient Rh immunoglobulin injections during pregnancy and after delivery.

Choice D is wrong because hemoglobin 12.2 gm/dL is within the normal range for a pregnant woman, which is 11 to 14 gm/dL.

Hemoglobin is the protein in red blood cells that carries oxygen.

A low hemoglobin level can indicate anemia, which can affect the oxygen delivery to the fetus and increase the risk of preterm labor or low birth weight.