A nurse on the labor and delivery unit is planning care for a client who has human immunodeficiency virus (HIV). Which of the following is an appropriate action for the nurse to take following the birth of the newborn?
Cleanse the newborn immediately after delivery.
Initiate contact precautions for the newborn.
Administer intravenous antibiotics to the newborn.
Encourage the mother to breastfeed her newborn.
The Correct Answer is A
A newborn who is exposed to HIV perinatally should be bathed and cleansed of maternal secretions as soon as possible after birth to reduce the risk of HIV transmission through the skin or mucous membranes¹². The newborn should also receive antiretroviral prophylaxis within six hours of delivery, preferably within two hours¹². The type and duration of prophylaxis depend on the maternal and infant factors that influence the risk of HIV transmission, such as maternal viral load, antiretroviral therapy, mode of delivery, and infant gestational age¹²³. The newborn should also undergo HIV testing at birth, at 14 to 21 days of age, at one to two months of age, and at four to six months of age¹².
The other options are incorrect because:
b) Initiating contact precautions for the newborn is not necessary or recommended. Contact precautions are used to prevent the spread of infections that are transmited by direct or indirect contact with the patient or the patient's environment. HIV is not transmited by casual contact, and standard precautions are sufficient to prevent exposure to blood or body fluids that may contain HIV¹².
c) Administering intravenous antibiotics to the newborn is not indicated for HIV prevention. Antibiotics are used to treat bacterial infections, not viral infections like HIV. Antibiotics may be given to the newborn for other reasons, such as suspected sepsis or chorioamnionitis, but they do not affect the risk of HIV transmission¹².
d) Encouraging the mother to breastfeed her newborn is contraindicated for HIV prevention. Breastfeeding can transmit HIV from the mother to the infant through breast milk, especially if the mother has a high viral load, mastitis, cracked nipples, or oral lesions in the infant. In resource-limited settings where formula feeding may not be feasible or safe, breastfeeding with maternal or infant antiretroviral therapy may be considered, but in developed countries where safe alternatives are available, breastfeeding is not recommended for mothers with HIV infection¹².
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
This is because a prescription for an amniocentesis is an indication for the administration of Rho(D) immune globulin (RhIG) to prevent RhD isoimmunization in mothers who are RhD negative¹². RhD isoimmunization is a condition where the mother's immune system produces antibodies against the RhD antigen on the baby's red blood cells, which can cause hemolytic disease of the newborn (HDN)¹². RhIG is a medication that contains antibodies against the RhD antigen, and it works by binding to and destroying any fetal red blood cells that may enter the maternal circulation, preventing the mother from making her own antibodies¹²³. RhIG is usually given to RhD negative mothers during pregnancy and after delivery if the baby is RhD positive¹².
Amniocentesis is a procedure where a needle is inserted into the uterus to obtain a sample of amniotic fluid, which contains fetal cells and other substances⁴. Amniocentesis can be done for various reasons, such as genetic testing, fetal lung maturity assessment, or infection diagnosis⁴. However, amniocentesis also carries a risk of causing bleeding or leakage of amniotic fluid, which can result in fetal-maternal hemorrhage (FMH), where fetal blood cells enter the maternal circulation⁴⁵. FMH can trigger RhD isoimmunization in RhD negative mothers, so they should receive RhIG within 72 hours of the procedure to prevent this complication⁵.
The other options are not correct because:
a) Hyperemesis gravidarum is not an indication for RhIG administration. Hyperemesis gravidarum is a condition where the mother experiences severe nausea and vomiting during pregnancy, which can cause dehydration, electrolyte imbalance, and weight loss. Hyperemesis gravidarum does not affect the blood type or compatibility of the mother and the baby, and does not increase the risk of RhD isoimmunization or HDN.
b) Rh-positive blood test results are not an indication for RhIG administration. Rh-positive blood test results mean that the mother has the RhD antigen on her red blood cells, and therefore she cannot develop antibodies against it¹². Rh-positive mothers do not need RhIG, as they are not at risk of RhD isoimmunization or HDN¹².
d) Anemia is not an indication for RhIG administration. Anemia is a condition where the mother has a low level of hemoglobin or red blood cells, which can cause fatigue, weakness, and shortness of breath. Anemia can have various causes, such as iron deficiency, bleeding, or infection. Anemia does not affect the blood type or compatibility of the mother and the baby, and does not increase the risk of RhD isoimmunization or HDN.
Correct Answer is A
Explanation
Hemolytic disease of the newborn (HDN) is a condition that occurs when there is an incompatibility between the blood types of the mother and the baby. It causes the mother's immune system to produce antibodies that attack and destroy the baby's red blood cells, leading to anemia, jaundice, organ enlargement, and other complications¹.
One of the most common causes of HDN is Rh incompatibility. This happens when the mother is Rh negative and the baby is Rh positive. The Rh factor is a protein that can be present or absent on the surface of red blood cells. People who have the protein are Rh positive and people who do not have it are Rh negative
Rh incompatibility can cause HDN when the baby's Rh positive blood cells cross the placenta and enter the mother's bloodstream. This can happen during delivery, miscarriage, abortion, or invasive prenatal testing. The mother's immune system recognizes the baby's blood cells as foreign and produces antibodies against them. These antibodies can cross back to the baby's bloodstream and attack the baby's red blood cells, causing hemolysis (breakdown) and anemia².
HDN due to Rh incompatibility usually does not affect the first pregnancy, because the mother has not been exposed to Rh positive blood before and has not developed antibodies yet. However, it can affect subsequent pregnancies with Rh positive babies, because the mother has become sensitized and has antibodies ready to attack².
The other options are not causes of HDN:
- a) The mother and the father are both Rh negative. This is not a cause of HDN because both parents have the same Rh factor and there is no incompatibility between them. The baby will also be Rh negative and will not trigger an immune response from the mother².
- b) The mother and the father are both Rh positive. This is not a cause of HDN because both parents have the same Rh factor and there is no incompatibility between them. The baby will also be Rh positive and will not trigger an immune response from the mother².
- c) The mother is Rh positive and the father is Rh negative. This is not a cause of HDN because the mother has a dominant Rh factor and will not produce antibodies against it. The baby will either be Rh positive or Rh negative, depending on whether they inherit the father's gene or not. In either case, the baby's blood type will not trigger an immune response from the mother².
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