# A 31-year-old client at 29 weeks' gestation comes for a prenatal visit in October. Prenatal laboratory results show rubella IgG nonimmune. The client received Tdap during a previous pregnancy 3 years ago and has not received an influenza vaccine this season. The client reports developing hives after eating scrambled eggs as a child and has had no reactions to any vaccine. Which immunization actions should the nurse anticipate? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=617272&lang=en > language: en > subject: Ante/Intra/Postpartum and Newborn Care > category: HPM ## Question A 31-year-old client at 29 weeks' gestation comes for a prenatal visit in October. Prenatal laboratory results show rubella IgG nonimmune. The client received Tdap during a previous pregnancy 3 years ago and has not received an influenza vaccine this season. The client reports developing hives after eating scrambled eggs as a child and has had no reactions to any vaccine. Which immunization actions should the nurse anticipate? Select all that apply. 1 Give MMR vaccine at this prenatal visit 2 Give Tdap vaccine at this prenatal visit 3 Refer to an allergist before any influenza vaccine 4 Give inactivated influenza vaccine at this visit 5 Give MMR vaccine after delivery, before discharge ## Explanation Tdap is given in every pregnancy at 27 to 36 weeks regardless of a prior dose, and inactivated influenza vaccine is given in any trimester during the season; a history of hives after eggs needs no special precaution. The rubella gap is real, but MMR is a live vaccine and is given after delivery, before discharge, not during pregnancy. The traps are the prior Tdap dose, the egg history, and the urge to fix the nonimmune result right away. ## In-depth explanation Quick answer Give Tdap and inactivated influenza vaccine now, and plan MMR after delivery before discharge (options 2, 4, 5). Why this is correct Apply each detail. At 29 weeks the client is inside the window for Tdap, and Tdap is repeated in every pregnancy so the newborn receives antibodies, even though a dose was given 3 years ago. It is October and the client has not had this season's influenza vaccine; inactivated vaccine is safe in any trimester. Childhood hives after eggs is not a reason to delay or refer, because influenza vaccines can be given to people with egg allergy without extra precautions. Rubella nonimmunity is addressed with MMR, but because MMR is live, it waits until after delivery. Easy analogy or mental picture Think of vaccines in pregnancy as deliveries to a house under construction: killed (inactivated) packages can be dropped off any time, but live packages wait until the building work (the pregnancy) is finished. Memory hook Every pregnancy gets Tdap; flu shot any trimester; live MMR waits for the postpartum unit. NCLEX decision rule Decide each vaccine by the client's current status (pregnancy, gestational age, season) and the vaccine type (live or inactivated), not by the history alone. Why the other choices are wrong MMR now (option 1) is tempting because the laboratory result shows a clear rubella gap, but MMR is a live vaccine and is not given during pregnancy; the gap is closed after delivery. Referral to an allergist before influenza vaccine (option 3) reflects older teaching about egg allergy, but current guidance allows any age-appropriate influenza vaccine without extra precautions, and delaying vaccination in flu season leaves both client and newborn unprotected. References 1CDC: Vaccine Safety and Recommendations for PregnancyTdap in every pregnancy, inactivated influenza vaccine in any trimester, and live vaccines such as MMR deferred until after delivery 2CDC: Influenza (Flu)People with egg allergy can receive any age-appropriate influenza vaccine without extra precautions ## Clinical scenario Scenario A pregnant client at 29 weeks in October is rubella nonimmune, had Tdap in a previous pregnancy, has not had this season's influenza vaccine, and reports childhood hives after eating eggs. ## Key concepts - **Tdap in pregnancy** — A tetanus, diphtheria, and acellular pertussis dose given in each pregnancy, preferably at 27 to 36 weeks, to pass antibodies to the newborn. - **Live attenuated vaccine** — A vaccine containing weakened live virus, such as MMR, that is not given during pregnancy. - **Rubella nonimmune** — A rubella IgG result showing no protective antibody, managed with MMR vaccination after delivery. ## Related questions - [A nurse is providing preconception counseling to a 28-year-old woman planning a pregnancy …](https://mymerci.kr/pages/nclex_q.php?qn_id=364076&lang=en) - [A 28-year-old client at 6 weeks gestation, gravida 1 para 0, presents to the prenatal clin…](https://mymerci.kr/pages/nclex_q.php?qn_id=368130&lang=en) - [Stage 2 — Analyze cues. 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