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?

Initiate contact precautions for the newborn.

Administer IV antibiotics to the newborn.

Cleanse the newborn immediately after delivery.

Encourage the mother to breastfeed her newborn.

Answer and Explanation

The Correct Answer is C

A. While contact precautions may be necessary for certain infections, they are not specifically required for an HIV-positive mother’s newborn if the infant is not infected. The newborn’s HIV status should be confirmed through testing.

B. IV antibiotics are not routinely administered to newborns of HIV-positive mothers unless there is a specific indication for infection prevention or treatment.

C. It is crucial to clean the newborn promptly after delivery to reduce the risk of HIV transmission, as HIV can be present in blood and other bodily fluids. Proper cleansing helps minimize the risk of exposure.

D. Breastfeeding is contraindicated for mothers with HIV because HIV can be transmitted through breast milk. Instead, formula feeding is recommended to prevent transmission.

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Correct Answer is C

Explanation

Administer oxygen to the client via face mask at 10 L/min. Eclampsia is a serious complication of pregnancy characterized by seizures or convulsions. The primary intervention for eclampsia is to control the convulsions and prevent injury to the mother and fetus. Administering oxygen to the client via face mask at 10 L/min is indicated to prevent hypoxia and reduce the risk of maternal and fetal complications.

A. Conduct a vaginal exam. B. Perform vibroacoustic stimulation. C. Collect a specimen for an indirect Coombs' test. D. Place the client in the Trendelenburg position.

Correct Answer is B

Explanation

Perform vibroacoustic stimulation. A nonstress test is a prenatal test that is used to evaluate fetal well-being. It involves monitoring the fetal heart rate in response to fetal movement. The absence of accelerations for 20 minutes may indicate fetal distress. Vibroacoustic stimulation is a technique used to elicit fetal movement and accelerate the fetal heart rate. It involves applying a vibrating device to the mother's abdomen.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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