A nurse is collecting a blood phenylketonuria (PKU) test for a newborn prior to discharge. The newborn's guardian asks the nurse what a positive PKU test would mean.
Which of the following statements should the nurse make?

Choice A rationale

Droplet precautions are implemented for pathogens transmitted via large respiratory droplets, such as influenza or meningococcal disease. Herpes simplex virus is typically transmitted through direct contact with lesions or secretions, not primarily through airborne droplets. Therefore, instituting droplet precautions would not be the most scientifically appropriate measure for preventing HSV transmission in this context.

Choice B rationale

Ceftriaxone sodium is a broad-spectrum cephalosporin antibiotic used to treat bacterial infections, such as gonorrhea or bacterial meningitis. Herpes simplex virus is a viral infection, and antibiotics are ineffective against viruses. Administering ceftriaxone would not address the underlying viral etiology of the newborn's exposure to HSV.

Choice C rationale

Bottle-feeding the newborn is not a primary intervention to prevent transmission of HSV from a mother with active genital herpes to a newborn. HSV is transmitted through direct contact during passage through the birth canal. Breastfeeding is generally considered safe for mothers with HSV unless there are active lesions on the breast.

Choice D rationale

Obtaining surface cultures from the newborn is a crucial diagnostic step to confirm the presence of HSV infection in a neonate exposed during birth. This allows for timely initiation of antiviral therapy, such as acyclovir, which is essential to prevent systemic dissemination and severe complications like encephalitis, which can be life-threatening in newborns.

Choice A rationale

Placing the newborn under a radiant warmer is crucial for thermoregulation, preventing cold stress, which can lead to increased metabolic rate and oxygen consumption. While important, assessing for potential airway compromise due to meconium aspiration takes immediate precedence over maintaining temperature, as respiratory status is critical for survival.

Choice B rationale

Providing tactile stimulation can encourage respiratory effort in a depressed newborn. However, in the presence of meconium-stained amniotic fluid, initial assessment of the airway and the need for suctioning must occur before stimulating the newborn to breathe deeper, which could potentially draw meconium further into the lungs.

Choice C rationale

When meconium-stained amniotic fluid is present, the primary concern is meconium aspiration syndrome. Determining if the mouth and nose require bulb suctioning is the first action to clear any meconium from the upper airway, preventing its aspiration into the lungs upon the newborn's first breaths, thereby mitigating respiratory distress.

Choice D rationale

Initiating skin-to-skin contact promotes maternal-newborn bonding and can stabilize the newborn's temperature and blood glucose. While beneficial, it is not the immediate priority when meconium is present. Airway management and respiratory stabilization must be ensured before initiating skin-to-skin contact to prevent complications from meconium aspiration.