A newborn is jaundiced and receivesphototherapy via ultraviolet bank lights.
An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to:
Apply an oil-based lotion to the newborn’s skin to prevent drying and cracking.
Limit the newborn’s intake of milk to prevent nausea, vomiting, and diarrhea.
Place eye shields over the newborn’s closed eyes.
Change the newborn’s position every 4 hours.
The Correct Answer is C
Placing eye shields over the newborn’s closed eyes. This is because phototherapy can cause eye damage and irritation to the newborn, so eye protection is essential.
Choice A is wrong because oil-based lotion can increase the absorption of heat and cause burns to the newborn’s skin.
Choice B is wrong because limiting the newborn’s intake of milk can cause dehydration and increase the risk of hyperbilirubinemia.
Choice D is wrong because changing the newborn’s position every 4 hours is not frequent enough to prevent pressure ulcers and ensure even exposure to the light.
Normal ranges for bilirubin levels in newborns are 1 to 12 mg/dL for term infants and 3 to 14 mg/dL for preterm infants. Phototherapy is usually indicated when the bilirubin level exceeds 15 mg/dL for term infants and 10 mg/dL for preterm infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Magnesium sulfate is given to women with preeclampsia and eclampsia to prevent and treat convulsions.
Magnesium sulfate is a mineral that reduces seizure risks in women with preeclampsia. A healthcare provider will give the medication intravenously. Sometimes, it’s also used to prolong pregnancy for up to two days. This allows drugs that speed up your baby’s lung development to be administered.
Choice A is wrong because magnesium sulfate does not improve patellar reflexes or increase respiratory efficiency. In fact, it may cause decreased or absent deep tendon reflexes and respiratory depression as side effects.
Choice B is wrong because magnesium sulfate does not shorten the duration of labor. It may actually prolong labor by inhibiting uterine contractions.
Choice D is wrong because magnesium sulfate does not prevent a boggy uterus or lessen the lochial flow. It has no effect on uterine tone or bleeding after delivery.
Correct Answer is C
Explanation
The patient is showing signs of magnesium toxicity, such as respiratory depression, hyporeflexia, and flushing.
Magnesium sulfate is a high-alert medication that can cause serious adverse effects if not monitored closely.
The nurse should stop the infusion immediately and notify the provider.
Choice A is wrong because calling for a stat magnesium sulfate level will not address the immediate problem of toxicity.
The nurse should act quickly to prevent further complications.
Choice B is wrong because administering oxygen will not reverse the effects of magnesium toxicity.
Oxygen may be helpful for respiratory distress, but it will not correct the underlying cause.
Choice D is wrong because hydralazine is an antihypertensive medication that lowers blood pressure.
The patient’s blood pressure is already within the normal range for a pregnant woman with preeclampsia (140-160/90-110 mm Hg).
Hydralazine may cause hypotension and fetal distress.
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