Which client should the nurse report to the healthcare provider as needing a prescription for Rh Immune Globulin (RhoGAM)?

• A. Woman whose blood group is AB Rh-positive.
• B. Newborn with rising serum bilirubin level.
• C. Newborn whose Coombs test is negative.
• D. Primigravida mother who is Rh-negative.

Answer: (D)

RhoGAM is given to an Rh-negative pregnant woman to prevent her immune system from developing antibodies against Rh-positive fetal red blood cells. This protection is important even in a first pregnancy because fetal cells can cross the placenta during pregnancy or at delivery, and sensitization can affect future pregnancies.

Therefore, the primigravida mother who is Rh-negative should receive RhoGAM to prevent alloimmunization. The other scenarios don’t indicate a need for RhoGAM at this time: an Rh-positive mother wouldn’t need it; a newborn with rising bilirubin suggests hemolysis in the baby but RhoGAM is given to the mother, not the infant; a newborn with a negative Coombs test shows no evidence of sensitization, so there’s no immediate indication for RhoGAM for the newborn.