Nokea
A neonate born at 38 weeks' gestation is admitted to the neonatal nursery for observation. The neonate's mother, who is positive for human immunodeficiency virus (HIV) infection, has received no prenatal care. The mother asks the nurse if her neonate is positive for HIV. The nurse can tell the mother which of the following?
- A. More than $50 \%$ of neonates born to mothers who are positive for HIV will be positive at 18 months of age.'
- B. An enlarged liver at birth generally means the neonate is HIV positive.'
- C. A complete blood count analysis is the primary method for determining whether the neonate is HIV positive.'
- D. Most neonates are asymptomatic at birth and usually test positive for the HIV antibody at this time.'
Correct Answer: D
Rationale: Most neonates born to HIV-positive mothers test positive for HIV antibodies at birth due to maternal antibody transfer but are asymptomatic, with true infection status determined later.
You may also like to solve these questions
While caring for a male neonate diagnosed with gastroschisis, the nurse observes that the parents seem hesitant to touch the neonate because of his appearance. The nurse determines the presence of which of the following stages of grief?
- A. Denial.
- B. Shock.
- C. Bargaining.
- D. Anger.
Correct Answer: B
Rationale: The parents' hesitation to touch the neonate suggests shock, as they are likely overwhelmed by the neonate's condition.
Which of the following statements about a fetal biophysical profile would be incorporated into the teaching plan for a primigravid client with insulin-dependent diabetes?
- A. It determines fetal lung maturity.
- B. It is noninvasive using real-time ultrasound.
- C. It will correlate with the newborn's Apgar score.
- D. It requires the client to have an empty bladder.
Correct Answer: B
Rationale: Biophysical profiles are noninvasive and use real-time ultrasound.
Commercial formulas contain 20 calories per ounce. A 1-day-old infant's weight in the morning was 8 lb and he was fed 45 mL at 2 a.m., 5:30 a.m., 8 a.m., 11 a.m., 2 p.m., 4:30 p.m., 8 p.m., and 10:30 p.m. What is the total amount of calories the infant received today?
- A. calories.
Correct Answer: B
Rationale: The infant was fed 45 mL 8 times, totaling 360 mL. Since 1 oz ≈ 30 mL, 360 mL ÷ 30 mL/oz = 12 oz. At 20 calories per ounce, 12 oz × 20 cal/oz = 240 calories.
A neonate born by cesarean delivery at 42 weeks' gestation, weighing 4.1 kg (9 lb, 1 oz), with Apgar scores of 8 at 1 minute and 9 at 5 minutes after birth, develops an increased respiratory rate and tremors of the hands and feet 2 hours postpartum. Which of the following nursing diagnoses would be the priority?
- A. Ineffective airway clearance related to postterm gestational age.
- B. Hyperthermia related to large size and use of a radiant warmer.
- C. Decreased cardiac output related to difficult delivery.
- D. Imbalanced nutrition: Less than body requirements related to depleted glycogen stores.
Correct Answer: D
Rationale: Tremors and increased respiratory rate suggest hypoglycemia due to depleted glycogen stores, a common issue in post-term neonates.
The physician orders whole blood replacement for a multigravid client with abruptio placentae. Before administering the intravenous blood product, the nurse should first:
- A. Validate client information and the blood product with another nurse.
- B. Check the vital signs before transfusing over 5 to 6 hours.
- C. Ask the client if she has ever had any allergies.
- D. Administer 100 mL of 5% dextrose solution intravenously.
Correct Answer: A
Rationale: Validating client information and blood product is essential to prevent transfusion errors.