A hepatitis B screen is performed on a pregnant client and results indicate the presence of antigens in the maternal blood. Which of the following should the nurse anticipate to be prescribed to protect the neonate?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

When a pregnant client tests positive for Hepatitis B surface antigen (HBsAg), it signifies an active infection with a high risk of transmitting the virus to the neonate during delivery.
The standard of care to protect the neonate is post-exposure prophylaxis, which involves administering both Hepatitis B Immune Globulin (HBIG) and the first dose of the Hepatitis B vaccine.
HBIG provides immediate, passive immunity by supplying ready-made antibodies against the virus.
The Hepatitis B vaccine stimulates the infant's own immune system to create long-lasting, active immunity.
For maximum effectiveness, both injections must be given within 12 hours of birth at separate anatomical sites to prevent the immune globulin from neutralizing the vaccine.

Option A: Obtaining serum liver enzymes is an appropriate intervention to assess the mother's liver function and disease status, but it is a diagnostic test for the mother and offers no protection to the neonate.
Option B: The mother's positive antigen test already confirms her infectious status. Repeating the screen is unnecessary and dangerously delays the time-sensitive administration of prophylaxis to the newborn.
Option C: Hepatitis B is a viral infection. Antibiotics are ineffective against viruses and are used to treat bacterial infections.

Clinical Relevance

Nursing practice connection: Use the key finding related to Post-exposure prophylaxis for neonates born to Hepatitis B positive mothers to guide bedside assessment, documentation, and the next nursing action.
Nurses are responsible for verifying the mother's HBsAg status and ensuring the neonate receives both the vaccine and HBIG within the critical 12-hour post-birth window.
Proper administration technique is vital: the vaccine and HBIG must be injected into different limbs (e.g., right and left vastus lateralis muscles).
Educating the parents about the importance of completing the entire hepatitis B vaccine series for their infant is a key nursing role to ensure long-term immunity.

How to Approach the Question

First, identify the core clinical problem: a pregnant client is positive for Hepatitis B antigens (HBsAg-positive).
Recognize the immediate risk this poses to the neonate: vertical transmission (mother to child) during birth.
The question asks for the intervention to protect the neonate. This directs you to look for a prophylactic (preventive) measure for the baby, not a diagnostic or treatment measure for the mother.
Evaluate the options based on this goal. Option A (liver enzymes) is diagnostic for the mother. Option B (repeat screen) is a delay. Option C (antibiotics) is the wrong drug class for a virus.
Conclude that Option D provides a specific, two-part prophylactic treatment for the neonate (vaccine for active immunity, immune globulin for passive immunity), which directly addresses the risk of transmission and is the established standard of care.

Concept Tested & Keywords

Concept Tested: Post-exposure prophylaxis for neonates born to Hepatitis B positive mothers.
Stem keywords: hepatitis B screen, pregnant client, antigens in maternal blood, neonate
Lead-in keywords: anticipate to be prescribed
Clinical cues: Positive hepatitis B antigen screen in a pregnant client indicates a high risk of vertical transmission to the neonate.
Negative lead-in flag: false

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E6 Medicine Harrison 22e Part 2 p. 568-570

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 250-252

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