The nurse is caring for a 37-weeks gestation infant born to a parent with hepatitis B. Which intervention will the nurse include in the plan of care?

Immune globulin given as soon as possible after delivery

Hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of birth

Hepatitis B immune globulin given within 20 hours after birth

Hepatitis B vaccine given 24 hours after birth

Answer and Explanation

The Correct Answer is B

Choice A reason: Administering immune globulin as soon as possible after delivery is a correct step but does not include the critical combination of both immune globulin and the hepatitis B vaccine, which provides optimal protection for the newborn against hepatitis B.

Choice B reason: The combination of hepatitis B immune globulin and hepatitis B vaccine given within 12 hours of birth is the most effective intervention for preventing hepatitis B transmission from the parent to the infant. This approach ensures immediate passive immunity through the immune globulin and active immunity through the vaccine, significantly reducing the risk of the newborn developing hepatitis B.

Choice C reason: Administering hepatitis B immune globulin within 20 hours after birth delays the initiation of protective measures compared to the 12-hour window. It is essential to provide both immune globulin and the vaccine as early as possible to maximize the protective effect against hepatitis B.

Choice D reason: Administering the hepatitis B vaccine 24 hours after birth is too late for immediate protection against the virus. The combination of immune globulin and vaccine should be provided within the first 12 hours to ensure the highest level of protection for the newborn. Delaying the vaccination could increase the risk of hepatitis B transmission and infection.

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Correct Answer is D

Explanation

Choice A reason: While some children with cerebral palsy may have intellectual delays, it is not accurate to generalize this condition as affecting all children with cerebral palsy. The extent of intellectual involvement can vary widely. Therefore, stating this as a definite teaching point may not be appropriate for every child.

Choice B reason: Cerebral palsy is not typically considered a genetic disorder. It is most commonly caused by damage to the developing brain either during pregnancy, childbirth, or shortly after birth. Factors that contribute to cerebral palsy can include infections, lack of oxygen, and traumatic injuries, but it is not primarily a genetic condition.

Choice C reason: While cerebral palsy can impact a child's overall health and development, stating that it will shorten the child's lifespan is not necessarily true. Many individuals with cerebral palsy live into adulthood, and lifespan can vary widely depending on the severity of the condition and the presence of associated health issues.

Choice D reason: Cerebral palsy is accurately described as a non-progressive disorder. This means that while the symptoms of cerebral palsy can change over time (due to growth, development, and other factors), the underlying brain injury does not worsen. Understanding that cerebral palsy is non-progressive can help parents focus on managing symptoms and improving their child's quality of life.

A. Ibuprofen. B. Vigorous massage. C. Cold compress. D. Formula supplements. E. Lactation consult.

Correct Answer is ["A","C","E"]

Explanation

Choice A reason: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can help relieve pain and reduce inflammation associated with cracked nipples and engorged breasts. It is commonly used to manage postpartum pain and can provide significant relief, making breastfeeding more comfortable for the patient.

Choice B reason: Vigorous massage is not recommended for engorged breasts as it can cause additional pain and may worsen the condition. Gentle massage may help in some cases, but vigorous massage can lead to tissue damage and further discomfort. The focus should be on gentle techniques to manage engorgement.

Choice C reason: Cold compresses are effective in reducing swelling and providing pain relief for engorged breasts. Applying cold packs to the breasts can help reduce inflammation and soothe discomfort, making it easier for the patient to breastfeed. Cold therapy is a simple and non-invasive method to manage engorgement and related symptoms.

Choice D reason: Formula supplements are generally not recommended as a first-line intervention for breastfeeding issues, especially when the goal is to promote exclusive breastfeeding. Introducing formula can interfere with milk supply and the breastfeeding process. Instead, addressing the underlying issues such as latch and nipple care is more appropriate.

Choice E reason: A lactation consult is an essential intervention for a patient experiencing breastfeeding difficulties. Lactation consultants are trained to provide support and guidance on breastfeeding techniques, including how to achieve a proper latch, manage engorgement, and care for cracked nipples. Their expertise can significantly improve the breastfeeding experience and help resolve common issues.

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The nurse is caring for a 37-weeks gestation infant born to a parent with hepatitis B. Which intervention will the nurse include in the plan of care?

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Naxlex Comprehensive Predictor Exams

The nurse is teaching parents about their child newly diagnosed with cerebral palsy. What will the nurse include in the teaching?

Correct Answer is D

Explanation

The nurse is caring for a patient three days postpartum who is exclusively breastfeeding. Upon assessment, the patient has cracked nipples, engorged breasts, and a painful latch. What will the nurse include in the patient's plan of care? Select all that apply.

Correct Answer is ["A","C","E"]

Explanation

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The nurse is caring for a 37-weeks gestation infant born to a parent with hepatitis B. Which intervention will the nurse include in the plan of care?