An unsensitized Rh-negative client at 30 weeks of pregnancy is evaluated after a minor motor vehicle crash with abdominal impact. The client has no vaginal bleeding. Which prescription should the nurse anticipate?
1Schedule only the routine antibody screen at the next prenatal visit
2Delay prophylaxis until birth confirms that the newborn is Rh-positive
3Arrange fetal administration of Rh immune globulin after ultrasonography
4Administer prescribed Rh(D) immune globulin after the abdominal trauma✓ Correct answer
Explanation
Abdominal trauma can cause fetomaternal hemorrhage without vaginal bleeding. Give Rh(D) immune globulin to an unsensitized Rh-negative pregnant client after a sensitizing event to prevent anti-D antibody formation. The medication is administered to the pregnant client, not the fetus.
Quick answer Anticipate Rh(D) immune globulin for the unsensitized Rh-negative client after abdominal trauma.
Why this is correct Fetal Rh-positive red cells can enter maternal circulation after trauma without visible bleeding. Rh immune globulin clears those cells before the maternal immune system forms antibodies that could affect this or a future pregnancy.
Easy analogy or mental picture Rh immune globulin acts like a cleanup team that removes fetal Rh-positive cells before the maternal immune system records them as a target. The comparison does not mean it can reverse sensitization after anti-D antibodies already exist.
Memory hook Rh-negative and not sensitized plus a bleeding-risk event means protect before antibodies form.
NCLEX decision rule In an unsensitized Rh-negative pregnancy, anticipate Rh immune globulin after abdominal trauma or another potential fetomaternal hemorrhage unless the fetus is conclusively Rh-negative.
Why the other choices are wrong Waiting for routine screening or delivery misses protection after the current sensitizing event. Rh immune globulin is given to the pregnant client rather than directly to the fetus.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
The Rh Factor: How It Can Affect Your PregnancyAmerican College of Obstetricians and Gynecologists
[3]
RhoGAM and MICRhoGAMU.S. Food and Drug Administration
Clinical Practice GuideFor Pregnancy warning signs, compare the complete cue pattern with the client's current stability, ordered data, and expected nursing scope.
CautionDo not choose an action from one isolated cue when the full scenario changes priority or safety.
Preeclampsia — A pregnancy complication involving hypertension and possible organ involvement.
Visual Changes — A neurologic warning symptom that can occur with severe pregnancy complications.
Prenatal Care — Health care during pregnancy to monitor maternal and fetal well-being.