A patient who stopped taking teriflunomide (Aubagio) 1 year prior tells the nurse that she has just found out she is pregnant. Which action by the nurse is correct?

A. Automatically reassuring the patient that her fetus will be safe is inappropriate because teriflunomide is a known teratogen. Even though she stopped taking it a year ago, the drug has a very long half-life (approximately 18–19 days) and undergoes enterohepatic recirculation, meaning it can remain in the body for months to over a year. Residual drug could still pose a risk of birth defects, so the nurse cannot assume fetal safety without verification. B. Suggesting abortion is beyond the scope of nursing practice and is a personal and medical decision that must be made in consultation with the patient’s healthcare provider. The nurse’s role is to provide information, support, and appropriate referral, not to direct personal medical choices. C. The appropriate action is to contact the provider to obtain an order for serum teriflunomide levels. Testing the levels determines whether the drug is still present at potentially harmful concentrations. If significant drug remains, the provider may initiate an accelerated elimination procedure using cholestyramine or activated charcoal to rapidly reduce the drug concentration, minimizing teratogenic risk to the fetus. This step is critical because teriflunomide exposure during early pregnancy can significantly increase the risk of congenital malformations. D. While teriflunomide can theoretically affect the neonate, nursing restrictions are not the immediate priority. The first priority is to assess potential fetal exposure and collaborate with the provider on necessary interventions. Breastfeeding considerations are secondary and can be addressed after ensuring fetal safety.