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A nurse is admitting a client in labor who is HIV positive.
Which intervention is contraindicated for this client?

A.

Application of external fetal monitors.

B.

Prepare to administer antiviral medication.

C.

Preparation for caesarean section delivery.

D.

Application of internal fetal scalp electrode.

Answer and Explanation

The Correct Answer is D

Choice A rationale

External fetal monitors are non-invasive and do not pose a risk of transmitting HIV from mother to baby. They are considered safe for monitoring fetal well-being in an HIV-positive mother.

 

Choice B rationale

Administering antiviral medication is essential in reducing the risk of mother-to-child transmission of HIV. It's a standard care practice for managing HIV-positive pregnant women.

 

Choice C rationale

Preparing for a caesarean section may be recommended to reduce the risk of vertical transmission of HIV during delivery, especially if the viral load is high.

 

Choice D rationale

Internal fetal scalp electrodes are contraindicated because they can create a portal for HIV transmission from mother to baby through small abrasions or punctures on the fetal scalp.


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View Related questions

Correct Answer is B

Explanation

Choice A rationale

Copious vernix is typically found on preterm newborns, not those born post-term.

Choice B rationale

Dry, cracked skin is a common finding in post-term newborns due to prolonged exposure to amniotic fluid.

Choice C rationale

Decreased subcutaneous fat is more likely in preterm newborns, while post-term newborns might lose some fat due to nutrient depletion.

Choice D rationale

Scant scalp hair is more common in preterm infants, whereas post-term infants usually have more developed hair. .

Correct Answer is B

Explanation

Choice A rationale

Monitoring the newborn's blood pressure does not directly address symptoms like diaphoresis, jitteriness, and lethargy. These symptoms indicate an immediate need to check blood glucose levels for hypoglycemia.

Choice B rationale

Obtaining blood glucose by heel stick is the correct step because diaphoresis, jitteriness, and lethargy in a newborn are classic signs of hypoglycemia. Timely detection and correction of blood glucose levels are critical.

Choice C rationale

Placing the newborn in a radiant warmer might help maintain body temperature but does not address the root cause of the symptoms, which is likely hypoglycemia.

Choice D rationale

Initiating phototherapy is used to treat jaundice (high bilirubin levels) and is not indicated for managing symptoms of hypoglycemia like diaphoresis, jitteriness, and lethargy.

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