Chapter 47: Nursing Care of the Child With an Alteration in Immunity/Immunologic Disorder

A pregnant client who is HIV positive asks the nurse if she will be able to breastfeed the newborn. Which response by the nurse is most appropriate? "Since your newborn will have HIV it is okay for you to breastfeed." "Breastfeeding passes protective immunity along to your newborn." "Breastfeeding will increase your newborn's risk of contracting HIV." "You should speak to your primary health care provider about breastfeeding."

"Breastfeeding will increase your newborn's risk of contracting HIV." HIV can be transmitted by breastfeeding. A newborn who received the recommended plan of drug treatment has a reduced risk for contracting the infection. Contracting HIV is not an absolute for this newborn. The client should be discouraged from breastfeeding to limit exposure to the newborn. Breastfeeding does provide immunity when the mother is free of infection but not in this scenario. Telling the mother to speak to the health care provider is not the best response as the nurse is able to provide this education to the client.

The nurse is caring for a 6-month-old infant with Wiskott-Aldrich syndrome. Which teaching does the nurse provide the parent? "Do not encourage a pacifier due to possible oral malformation." "Do not use a sponge bath for light cleaning." "Do not insert anything in the rectum." "Do not use a tub bath for daily cleansing."

"Do not insert anything in the rectum." Children with Wiskott-Aldrich syndrome should not be given rectal suppositories or temperatures since these children are at a high risk for bleeding. Tub baths are not contraindicated. Pacifiers are not contraindicated in Wiskott-Aldrich but should be kept as sanitary as possible to avoid oral infections.

The parent of a school-age child comments to the nurse, "Every time my child eats enchiladas at our local Mexican restaurant the child gets a rash. It just does not make sense to me." How should the nurse respond? "That is odd. Does anyone else in your family react that way?" "Has your child ever been tested for a peanut allergy?" "Maybe it is an allergy to something else and you just notice after eating there by coincidence." "Is your child allergic to milk?"

"Has your child ever been tested for a peanut allergy?" Enchilada sauce is an unexpected food that may contain a form of peanuts (such as peanut oil) that may be causing an allergic reaction in the child.

A nurse is conducting a physical examination of a 12-year-old girl with suspected systemic lupus erythematosus (SLE). How would the nurse best interview the girl? "Do you have any shoulder pain or abdominal tenderness?" "Have you noticed any hair loss or redness on your face?" "Have you noticed any new bruising or different color patterns on your skin?" "Do you notice any wheezing when you breathe or a runny nose?"

"Have you noticed any hair loss or redness on your face?" Alopecia and the characteristic malar rash (butterfly rash) on the face are common clinical manifestations of SLE. Rhinorrhea, wheezing, and an enlarged spleen are not hallmark manifestations of SLE. Petechiae and purpura are more commonly associated with hematological disorders, not SLE.

A pediatric client is newly diagnosed with a stinging-insect allergy. Which advice is most appropriate for the nurse to provide this client's parent? "Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily." "Arrange for your child to receive allergy testing for foods with ingredients similar to those in insect venom." "Your child should join a peer support group to help relieve anxiety about this problem." "I recommend you consult a genetic counselor to reveal other susceptible family members."

"Obtain your child a medical alert ID bracelet so the presence of the allergy can be identified easily." Stinging-insect allergy can lead to anaphylactic shock. Alerting others to the possibility of an insect sting and allergy is important. To alert others of the allergy, the client should wear a medical alert ID bracelet at all times. A support group may be joined if needed, but is not priority over the client's safety. Genetic testing is not appropriate for allergies. These are tested through allergy testing. It is also not appropriate to recommend testing for foods similar to insect venom.

The mother of a child with myasthenia gravis inquires about thymus gland removal. She has read that this is a possible cure for her child. What response by the nurse is indicated? "Removal of the thymus gland is not performed in children." "This is a promising treatment and can result in a total cure for your child." "Once your child is 15 this action can be considered." "Removal of this gland may not improve your child's symptoms."

"Removal of this gland may not improve your child's symptoms." Myasthenia gravis is an autoimmune condition. It is characterized by progressive weakness and fatigue. There is no cure. Removal of the thymus gland is recommended by some professionals but the thymus gland and its relationship to this disease are not clear. Removal of the gland may not improve the child's condition.

The nurse is providing instructions to the parents of a child with a severe peanut allergy. Which statement by the parents indicates a need for further teaching about the use of an epinephrine auto-injector? "The epinephrine auto-injector should be jabbed into the upper arm." "We must massage the area for 10 seconds after administration." "The epinephrine auto-injector must be held firmly for 10 seconds." "We must make sure that the black tip is pointed downward."

"The epinephrine auto-injector should be jabbed into the upper arm." An epinephrine auto-injector should be jabbed into the outer thigh, as this is a larger muscle, at a 90 degree angle, not into the upper arm. The other statements are correct.

The nurse is teaching the parents of a 4-year-old client with a peanut allergy about dietary restrictions. Which response by the parents indicates a need for further teaching? "We cannot go wrong with barbeque and french fries." "Some hot chocolate mixes have peanuts." "Baked goods often contain hidden peanut ingredients." "We must be careful with Asian food."

"We cannot go wrong with barbeque and french fries." The nurse needs to remind the parents that peanut oil might be a hidden ingredient in barbecue sauce. Baked goods can be hidden sources for peanut oil and peanuts. Hot chocolate may contain peanuts or peanut oil. Asian foods may contain hidden peanuts.

The nurse is monitoring the CD4 count of an infant who has contracted HIV from the mother in utero. The nurse is concerned that treatment with antiretroviral therapy is not effective when noting which CD4 level? 1900/mm3 1300/mm3 1700/mm3 1500/mm3

1300/mm3 The number of CD4 T lymphocytes in the blood helps to determine the effectiveness of antiretroviral therapy. Normal is 1500/mm3 in the infant, so anything below that number may indicate that the therapy is not effective.

A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus? Immunoglobulin electrophoresis Erythrocyte sedimentation rate Enzyme-linked immunosorbent assay (ELISA) Polymerase chain reaction test

Enzyme-linked immunosorbent assay (ELISA) The ELISA test will be positive in infants of HIV-infected mothers because of trans-placentally received antibodies. These antibodies may persist and remain detectable up to 24 months of age, making the ELISA test less accurate in detecting true HIV infection in infants and toddlers than the polymerase chain reaction (PCR). The PCR test is positive in infected infants over the age of 1 month. The erythrocyte sedimentation rate would be ordered for an immune disorder initial workup or ongoing monitoring of autoimmune disease. Immunoglobulin electrophoresis would be ordered to test for immune deficiency and autoimmune disorders.

A nurse is giving a talk to high school students about preventing the spread of human immunodeficiency virus (HIV). What does the nurse identify as ways in which HIV is spread? Select all that apply. Perinatally from mother to fetus Exposure to blood and body fluids through sexual contact Through breastfeeding Transfusion of contaminated blood Sharing the same bathroom Sharing contaminated needles

Exposure to blood and body fluids through sexual contact Sharing contaminated needles Transfusion of contaminated blood Perinatally from mother to fetus Through breastfeeding HIV is spread by exposure to blood and other body fluids through sexual contact, sharing of contaminated needles for injection, transfusion of contaminated blood, perinatally from mother to fetus, and through breastfeeding. It cannot be contracted by using the same bathroom. It must be direct contact.

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which immunoglobulin? IgE IgA IgG IgM

IgE Anaphylaxis is an acute IgE-mediated response to an allergen that involves many organ systems and may be life-threatening.

The nurse is preparing educational materials for a group of new parents about allergic reactions. Which specific immunoglobulin should the nurse emphasize as being responsible for these types of reactions? IgG IgM IgE IgA

IgE IgE is involved in immediate hypersensitivity reactions and is associated with allergy and parasitic infections. IgA is found in saliva, sweat, and tears and provides defense against pathogens on exposed surfaces. IgG is the most frequently occurring antibody in plasma and neutralizes bacterial toxins. IgM lyses cell walls and is early to arrive in the presence of an infection in the bloodstream.

The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child's heart is beating very fast. What action by the nurse is indicated? Instruct the child be brought to the emergency department promptly. Inquire about any changes in the child's normal routine. Make an appointment for the child to be seen by the physician within 24 hours. Inquire about when the child's last dose of medication was taken.

Instruct the child be brought to the emergency department promptly. Myasthenia gravis is an autoimmune disorder that is characterized by weakness and fatigue. There is no cure. The disease may be aggravated by stress, exposure to extreme temperatures, and infections, resulting in a myasthenic crisis. Myasthenic crisis is a medical emergency with symptoms including sudden respiratory distress, dysphagia, dysarthria, ptosis, diplopia, tachycardia, anxiety, and rapidly increasing weakness. The symptoms reported are consistent with a crisis and prompt care is indicated. Waiting 24 hours to have the child seen by the physician is not appropriate. Questions about changes in routine and medication compliance may be asked but the first priority is to have the child seen.

The nursing instructor is describing the events of anaphylaxis. Place the assessment findings in the order that they would occur from first to last. Hypoxia Seizures Nausea, vomiting, diarrhea Bronchospasm uticaria, angioedema

Nausea, vomiting, diarrhea uticaria, angioedema bronchospasm hypoxia seizures Initially, a child may be nauseous, with vomiting and diarrhea, because of the sudden increase in gastrointestinal secretions produced by the stimulation of histamine. This is followed by urticaria and angioedema. Bronchospasm can become so severe the child becomes dyspneic and hypoxemic. Continued bronchospasm leads to hypoxia. As blood vessels dilate, the blood pressure and pulse rate fall. Seizures and death may follow as soon as 10 minutes after the allergen is introduced into the child's body.

The nurse is providing education regarding 2030 Health Goals to reduce the incidence of acquired immunodeficiency syndrome (AIDS) within the community. Which goal will the nurse choose as a primary prevention strategy? Reduce the baseline level of allergens in dust within homes and buildings. Provide education to sexually active females about proper condom usage. Refer at-risk community members to the clinic for HIV/AIDS screening. Increase the number of schools with an indoor air management system.

Provide education to sexually active females about proper condom usage. Primary prevention strategies focus on preventing a disease before it occurs, which includes condom usage to prevent being exposed to AIDS. Screening for the presence of AIDS is a secondary prevention strategy because it does not prevent an individual from contracting AIDS, but would allow for early identification. Improving air quality and reducing allergens are goals to prevent allergies.

The nurse is instructing a group of women of childbearing age about human immunodeficiency virus (HIV) during pregnancy. What would be a priority recommendation in this setting? Prophylactic treatment for HIV Proper nutrition Screening for sexually transmitted infections (STIs) Screening for HIV

Screening for HIV No screening mandate has been put forth for HIV, but all pregnant women should be encouraged to undergo this test. Prophylactic treatment would be initiated only once the woman has been screened. Screening for STIs and ensuring proper nutrition are also part of health promotion for women in this age group, but they are of lower priority than identifying HIV-positive individuals.

What nursing instruction would best identify foods to which a child is allergic? Hyposensitivity testing in the arm Complete dietary protein restriction Thoughtful elimination of diet choices Corticosteroid challenge testing

Thoughtful elimination of diet choices Elimination diets involve adding foods slowly to a child's diet so foods to which the child is allergic can be identified. Hypersensitivity, no hyposensitivity, testing is used to assess reactions to certain potential allergens. No need to restrict protein. Corticosteroid challenge testing is used to assess adrenal functioning.

The nurse is caring for a child who is having bronchospasm. The nurse would expect to administer what medication? diphenhydramine epinephrine corticosteroid albuterol

albuterol The nurse would expect to administer bronchodilation inhalation treatment (albuterol) if bronchospasm is present. Epinephrine, diphenhydramine, and/or corticosteroids are administered to reverse the allergic process.

The nurse is educating a child with a peanut allergy about the signs and symptoms of an anaphylactic reaction. The nurse realizes additional teaching is needed when the child identifies which sign/symptom? constipation nausea itchy mouth anxiety

constipation Signs and symptoms of an anaphylactic allergic reaction include nausea, anxiety, and itchy mouth. Diarrhea, rather than constipation, is a sign of an allergic reaction.

The nurse is assessing a child who is experiencing renal complications as a result of lupus. Which finding is of greatest concern? elevated temperature hypotension reduced body temperature elevated blood pressure

elevated blood pressure Renal complications may result from lupus. This may be accompanied by hypertension, making monitoring of blood pressure of the highest importance.

The most accurate screening test for the presence of HIV antigen in young children is : polymerase chain reaction (PCR). enzyme-linked immunosorbent assay (ELISA). Western blot. CD4 count.

polymerase chain reaction (PCR). PCR tests directly for the HIV antigen. ELISA and the Western blot test detect the presence of HIV antibodies. The CD4 count is used as a measure of disease status and progression.

A child is diagnosed with a food allergy to milk. When teaching the parents about this allergy, what would the nurse suggest as a possible substitution(s) for milk? Select all that apply. soy milk ice cream rice milk fruit juice yogurt

soy milk rice milk fruit juice Milk can be replaced with water, fruit juice, rice milk, or soy milk. Yogurt and ice cream are made with milk.

The nurse is teaching the parents of a child with a suspected diagnosis of juvenile idiopathic arthritis about the disease. Which statement by the parents demonstrates the need for further teaching? "A warm bath at bedtime and warm compresses can increase our child's comfort." "If our child does not have a positive rheumatoid factor, our child does not have the disease." "Swimming is a good activity that will help our child maintain joint mobility." "It is important to control our child's inflammation and pain."

"If our child does not have a positive rheumatoid factor, our child does not have the disease." Unlike adult rheumatoid arthritis, few types of juvenile arthritis actually demonstrate a positive rheumatoid factor. Therapeutic management focuses on inflammation control, pain relief, promotion of remission, and maintenance of mobility. The parents can promote sleep and comfort with a warm bath at bedtime and warm compresses to affected joints or massage. Swimming is a particularly useful exercise to maintain joint mobility without placing pressure on the joints.

Which nursing intervention is priority when caring for a child with HIV? Review laboratory CD4 counts daily. Assist the child with daily activities. Administer prescribed medications. Assess pain after invasive procedures.

Administer prescribed medications. Although assisting with activities, assessing pain, and reviewing CD4 counts are all important, the priority when caring for a child with HIV is to administer prescribed medications. Prescribed medications prevent progressive deterioration of the immune system and provide prophylaxis against opportunistic infections.

The nurse is completing a care plan for a child who has recently had a bone marrow transplant. Which nursing interventions should the nurse include in the care plan? Select all that apply. Perform meticulous hand hygiene and ensure all visitors follow these precautions. Monitor the client for signs and symptoms of graft versus host disease. Maintain contact transmission-based precautions for the first 2 weeks of care. Administer immunosuppressive medications as ordered. Provide oral care at least every shift, but more often as needed.

Administer immunosuppressive medications as ordered. Monitor the client for signs and symptoms of graft versus host disease. Provide oral care at least every shift, but more often as needed. Perform meticulous hand hygiene and ensure all visitors follow these precautions. The client who has had a bone marrow transplant is at high risk for bone marrow rejection and must receive immunosuppressive medications as scheduled to prevent rejection. Protective isolation, not contact precautions, are followed to prevent infection in this immunocompromised client, as does hand hygiene. Oral hygiene prevents infections from beginning in the mouth. Graft versus host disease is an allergic reaction that can occur; early recognition is vital.

The nurse is assisting with skin testing for allergies in a pediatric client. What will the nurse do to ensure the results are accurate? Read the test results within 40 minutes of administration. Inject the allergens into the muscle of the child's forearm. Be certain the child has not received an antihistamine in the past 8 hours Apply a topical diphenhydramine cream to the site following each injection.

Be certain the child has not received an antihistamine in the past 8 hours Skin testing is done to detect the presence of IgE in the skin, or to isolate an antigen (allergen) to which the IgE is responding or to which a child is sensitive. When an allergen is introduced into the child's skin and the child is sensitive to that allergen, a wheal or flare response will appear at the site of the test from the release of histamine, which leads to local vasodilation. Because this reaction appears quickly, the test should be read in 20 minutes, not 40 minutes. Systemic or aerosol administration of an antihistamine will inhibit the flare response, so the nurse must be certain the child has not received these drugs for 8 hours before skin testing. Applying a diphenhydramine cream would interfere with the results. Diphenhydramine is an antihistamine medication and should be avoided up to 10 days prior to the procedure.

The nurse is helping the parents of a toddler identify foods that are causing allergic symptoms in the child. Which strategy should the nurse encourage the parents to use? Corticosteroid challenge testing Complete dietary protein restriction Elimination diet Hyposensitivity testing

Elimination diet An elimination diet is a traditional method to detect food allergens. Parents feed the child only foods that rarely cause allergy, such as rice, lamb, carrots, peas, and sweet potatoes, for about 7 days. Then they add, one by one, at 2- to 3-day intervals, foods that are suspected of causing allergy. When a food is introduced this way, the child must be encouraged to eat a lot of it that day. If symptoms occur, the food is then eliminated from the child's meals on a permanent basis. If no symptoms occur, the child can continue to eat the food. Hyposensitivity testing is unreliable with food allergies. Corticosteroids delay hypersensitivity reactions. It is difficult to totally eliminate protein from the diet, and this is not a method to determine the cause of food allergies in the toddler.

The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin? IgE IgA IgM IgG

IgE Skin testing is done to detect the presence of IgE in the skin that responds to a particular allergen. IgM is part of the body's primary response, and IgG is part of the body's secondary response to infection. IgA is present in the mucous membranes of the body to fight against infection.

The parents of a 10-year-old with HIV have never told their child that he has the virus. The child asks the nurse why he is "on so many medications." What action should the nurse take? The nurse should explain the infection to the child. The nurse should encourage the child to talk with his parents about his medications. The nurse should suggest to the child to speak with his doctor. The nurse should tell the parents when they enter the child's room that their child has a question for them.

The nurse should encourage the child to talk with his parents about his medications. Generally, children older than 6 years of age will eventually need to have their diagnosis disclosed to them in an age-appropriate manner. They begin to ask questions and often seem to sense that something is going on other than what they've been told so far. Encouraging discussion with the parents is the best first step.

A nurse is providing education to pregnant women diagnosed with HIV. Which statement indicates the need for further teaching? Pregnancy will accelerate the progression of the disease. It is not safe to breastfeed my baby, so I will use formula. Antiretroviral treatment is effective in reducing maternal-fetal transmission. My health care provider may want me to have a cesarean birth.

Pregnancy will accelerate the progression of the disease. Of the nearly 1,000,000 people in the United States infected with HIV, 25% are female. There isn't any research showing pregnancy accelerates the progression of the disease. Women with HIV should not breastfeed, because they could transmit the virus to the baby via the breastmilk. Early use of antiretroviral medications are effective in reducing transmission, and a cesarean birth may be scheduled to reduce potential transmission to the newborn.

The nurse is administering intravenous immune globulin (IVIG). The nurse assesses vital signs and adverse reactions every 15 minutes for the first hour of administration. After the first hour, the nurse will continue to assess the child at which frequency? every 45 minutes every 60 minutes at the end of the transfusion every 30 minutes

every 30 minutes The nurse needs to continue assessments according to institutional protocol. Every 15 minutes for the first hour and every 30 minutes through the remainder of the infusion is the standard assessment protocol.

A child is brought to the emergency department with bronchospasm, wheezing, and urticaria. The primary health care provider prescribes the medications listed below. Which medication will the nurse administer first? methylprednisolone IV diphenhydramine IM epinephrine IM albuterol via nebulizer

epinephrine IM The child is exhibiting signs and symptoms of anaphylaxis. Epinephrine, injected intramuscularly, is the standard of care for the treatment of anaphylaxis regardless of the cause. Diphenhydramine intramuscularly or IV would be used to address urticaria (itching and swelling). A nebulized bronchodilator such as albuterol would be used to halt wheezing. A corticosteroid may be administered as a second-line drug. This does not act immediately but does reduce inflammation. IV methylprednisolone is a drug typically given as second-line treatment.

The nurse is caring for a child with juvenile idiopathic arthritis (JIA). There is involvement of five or more small joints and it is affecting the body symmetrically. This tells the nurse that the child: is at risk for anaphylaxis. has systemic JIA. has polyarticular JIA. has pauciarticular JIA.

has polyarticular JIA. Polyarticular JIA is defined by the involvement of five or more joints, frequently the small joints, and affects the body symmetrically. Pauciarticular JIA is defined by the involvement of four or fewer joints. Systemic JIA presents with fever and rash in addition to join involvement at the time of diagnosis. The child with JIA is not at greater risk for anaphylaxis.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are caring for a pediatric client with an immune disorder receiving a stem cell transplant. Which action by the UAP will cause the RN to intervene? The UAP places a lunch tray in the client's room. The UAP wears a mask when entering the client's room. The UAP assists the client to ambulate in the room. The UAP takes a rectal temperature on the client.

The UAP takes a rectal temperature on the client. Precautions must be taken to protect the client from infection. The RN would intervene if the UAP takes a rectal temperature because this increases the client's risk for infection. The client should not receive rectal suppositories as well. The RN would ensure meticulous oral care is provided and encourage appropriate and adequate nutrition. Delivering a meal tray, wearing a mask when entering the room, and assisting the client to ambulate in the room are all appropriate actions by the UAP.

The nurse is caring for a school-age child recently diagnosed with an allergy to peanuts. Which nursing action is a priority? Offer the parents information about a community support group. Advise parents the child may benefit from skin testing. Include the child when discussing foods that contain peanuts. Remind parents to report the allergy to the child's school teacher.

Include the child when discussing foods that contain peanuts. Involving school-age children in education related to their allergy helps them play an active role in their own care. Involving the child in teaching also helps to plan nursing care that meets QSEN competencies and also best meets the family's needs. Although advising parents the child may benefit from skin testing of other allergies, informing the child's school of the peanut allergy, and offering information about community support groups are important, involving the child in education is the best method to prevent exposure to the allergen.

The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education? "I have found a website that makes medical alert bracelets in my daughter's favorite color." "If we need to use the EpiPen® we will need to notify her physician's office the next business day." "The grey part of the EpiPen® should never be removed until right before we use it." "I will make sure my daughter always has her EpiPen® with her all the time."

"If we need to use the EpiPen® we will need to notify her physician's office the next business day." If an EpiPen® is used, the child still needs immediate medical attention. An EpiPen should be carried with the client at all times. When administering an EpiPen, the grey safety cap should not be removed until immediately prior to use. Medical alert bracelets or necklaces should be worn by all children with severe allergies.

The nurse is providing education to a 16-year-old who has recently been diagnosed with myasthenia gravis. Which statement(s) by the adolescent indicates an understanding of the information provided? Select all that apply. "It is important I avoid triggers." "Attending public school will likely no longer be possible." "It can take several months to cure this disease." "I am going to incorporate a short nap into my daily routine." "Getting a flu shot will be important."

"It is important I avoid triggers." "Getting a flu shot will be important." "I am going to incorporate a short nap into my daily routine." Myasthenia gravis is an autoimmune condition characterized by weakness and fatigue. Management involves avoiding triggers such as stress and illness. Taking a flu shot will help avoid influenza, which can be dangerous for someone with this disease. Fatigue is a concern and rest periods should be incorporated into the client's schedule. There is no cure for the condition. There will need to be modifications in the adolescent's normal routine but attending public schools is possible.

The registered nurse (RN) and an unlicensed assistive personnel (UAP) are providing care to a client receiving intravenous (IV) immune globulin (IVIG) for the treatment of Kawasaki disease. Which task will the RN delegate to the UAP? Disconnecting the client from the IV to assist the client to the bathroom Taking the client's meal tray into the room Obtaining supplies needed for the client's care Discussing the rationale for needing an intravenous line (IV)

Taking the client's meal tray into the room The nurse can only delegate tasks that are within the UAP's scope of practice and that they have been trained in. It is appropriate for the UAP to take the client's meal tray into the room. There are no contraindications to the UAP entering the client's room. The UAP should not disconnect a client's IV as it is a skilled procedure. Discussing the rationale of medical care should be completed by a medical professional. Obtaining supplies needed for care should be completed only when specific instructions are provided.

A mother who is HIV positive is distraught when she learns that her 6-month-old baby is also HIV-positive. The child had undergone open heart surgery as a newborn and had received numerous blood transfusions. The nurse recognizes that the most likely means of transmission of the disease to this child was: breastfeeding. the mother kissing the baby on the forehead. placental spread during pregnancy. blood transfusion products contaminated with the virus.

placental spread during pregnancy. Although it is decreasing in incidence, transmission of HIV from mother to child by placental spread is still the most common reason for childhood HIV infection in the United States. Children with hemophilia no longer have a high incidence of the disease because blood products are now screened for the virus. HIV is not transmitted by animals or through usual casual contact, such as shaking hands or kissing, or in households, day care centers, or schools. Infection via breast milk is possible but less likely than via placental spread.