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Discussion

OB question/rant

We had a question on our exam about the administration of RhoGAM to a Rh negative mother. The doctor ordered RhoGAM to be given. Before giving the shot, what would the nurse do?

This was all the information given in the scenario. I chose the answer stating for the nurse to verify that Coombs' Test was negative. The correct answer, according to the instructor, is for the nurse to verify that the newborn is Rh positive. According to her, for this case, it did not matter whether the Coombs' Test is negative or not.

My question is, would the nurse administer RhoGAM if the Coombs' Test were positive? No, right? The textbook does not go into detail about the Coombs' test, but it does state in the nursing considerations, that before adminstration of the drug, nurse must verify that mother is Rh negative, that the Coombs' Test is negative and that the baby is Rh positive. In that order! :uhoh3: I sent an email to the instructor asking for her to review the question and told her that I agree with the answer but that the Coombs' test answer is also correct. Sigh. :o

Thanks for listening.

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I agree with your instructor. An Rh negative mother who gives birth to an Rh positive baby should receive Rhogam regardless of the baby's direct Coombs test. A positive direct Coombs would indicate that some mixing of maternal and fetal blood occured during pregnancy, causing maternal antibodies to cross the placenta and attach to fetal red blood cells prior to birth. This will place the infant at greater risk for jaundice.

But mixing of maternal and fetal blood can also occur during delivery, which would not be indicated by a direct Coombs test. So, as a matter of safety and prevention, any Rh neg mother who delivers an Rh positive baby needs Rhogam.

OK, upon further research, I am going to amend my answer.

If the mother's indirect Coombs test is negative, then Rhogam should be given. If the mother's indirect Coombs test is positive during pregnancy, maternal antibodies have already developed, and Rhogam is contraindicated.

So I guess it hinges on exactly which Coombs test you are referring to.

See the following website:

http://books.google.com/books?id=yJf4e_GVr0gC&pg=RA1-PA442&lpg=RA1-PA442&dq=rhogam+and+coombs+test&source=web&ots=STHEjVyw0s&sig=2BbxD1mwnRtDP0QxK3eTeYhEknw

Maternal and Newborn Health by Janet Arenson and Patricia Drake p. 442

You gotta love those nursing school "best " right answers.....:rolleyes: That's a good one....

  • Author

Thank you so much Jolie for taking the time to research. I found the site that you posted very helpful. As far as I can remember, the scenario in the exam did not state a specific Coombs' test. Thanks, once again. I'll let you guys know if I get the 2 points LOL

  • Experts

I think you're trying to gain a few points on the test by sliding in on the technicality that the instructor didn't include the words "the first thing the nurse would do before administering the RhoGam" or "the most important thing the nurse would do before administering the RhoGam". You should have thought of the answer that way in the first place. There's no "second" guessing on the job. Would you have given RhoGam to every mother who had a postive Coombs test based on that evidence alone? I think not. A patient can have a positive Coombs test for other reasons. You'd end up being fired.

Would you have given RhoGam to every mother who had a postive Coombs test based on that evidence alone? I think not. A patient can have a positive Coombs test for other reasons. You'd end up being fired.

The OP correctly stated that she would NOT give Rhogam to a mother with a positive Coombs test.

  • Experts
The OP correctly stated that she would NOT give Rhogam to a mother with a positive Coombs test.

Yes, I understand. It's just the attitude of it. I don't particularly like the attitude of people who can't accept that they screwed up and determine how not to do it again. To flaunt the instructor's error publicly is just a little too brash for me. Go ahead a do it to get the extra points and make a better grade, but don't be smug and make a big deal about it publicly. That is a form of bragging and oneupmanship. I don't like that. There's enough back bitting in nursing that we don't need students doing it to instructors.

I don't necessarily think it is a bad thing to discuss the exam and explain your rationale to the instructor. It sounds like you started with the right thinking but didn't follow through to the point your instructor was looking for. It happens. If you don't get your 2 points, consider it a lesson learned and hope that it is on the final and then you can get your points! :)

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