A newborn is jaundiced and receiving phototherapy 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
Choice A rationale:
Applying oil-based lotion is not recommended during phototherapy as it can block the pores and reduce the effectiveness of the therapy. The baby's skin should be exposed to the light as much as possible to treat hyperbilirubinemia effectively.
Choice B rationale:
Limiting the newborn's intake of milk is not appropriate. Adequate hydration and nutrition are essential for infants, especially those undergoing phototherapy. Dehydration can worsen jaundice, so the baby should be encouraged to feed frequently.
Choice C rationale:
Placing eye shields over the newborn's closed eyes is essential during phototherapy. Exposure to high-intensity light can damage the baby's eyes, so protecting the eyes with shields is necessary.
Choice D rationale:
Changing the newborn's position every 2-3 hours is recommended during phototherapy. This helps ensure that all parts of the baby's skin receive equal exposure to the light, maximizing the effectiveness of the treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
Applying oil-based lotion is not recommended during phototherapy as it can block the pores and reduce the effectiveness of the therapy. The baby's skin should be exposed to the light as much as possible to treat hyperbilirubinemia effectively.
Choice B rationale:
Limiting the newborn's intake of milk is not appropriate. Adequate hydration and nutrition are essential for infants, especially those undergoing phototherapy. Dehydration can worsen jaundice, so the baby should be encouraged to feed frequently.
Choice C rationale:
Placing eye shields over the newborn's closed eyes is essential during phototherapy. Exposure to high-intensity light can damage the baby's eyes, so protecting the eyes with shields is necessary.
Choice D rationale:
Changing the newborn's position every 2-3 hours is recommended during phototherapy. This helps ensure that all parts of the baby's skin receive equal exposure to the light, maximizing the effectiveness of the treatment.
Correct Answer is D
Explanation
Choice A rationale: Pouring warm water over the perineum provides sensory stimulation that can trigger the micturition reflex. This is a non-invasive nursing intervention typically attempted before proceeding to more invasive measures.
Choice B rationale: Placing oil of peppermint in a bedpan is a traditional nursing measure. The aromatic vapors are thought to relax the pelvic floor muscles and urinary sphincter, facilitating spontaneous voiding.
Choice C rationale: Analgesics may reduce perineal pain that inhibits voiding, but they do not directly address a full bladder. Medications are generally not the "last resort" for immediate mechanical emptying of the bladder.
Choice D rationale: Urinary catheterization is an invasive procedure that carries a risk of infection. It is reserved as the final intervention when all non-invasive methods have failed to resolve bladder distention.
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