A nurse is assessing a newborn who is breastfed and has a weight loss of 11% at 48 hr after birth.
Which of the following findings should the nurse report to the provider?

Choice A rationale

A positive finding for galactosemia, not PKU, indicates the inability to metabolize galactose. Galactosemia is a different metabolic disorder that requires a separate dietary intervention.

Choice B rationale

A positive PKU test does not indicate slow metabolism. Instead, it signifies the inability to metabolize phenylalanine, an amino acid.

Choice C rationale

Phenylketonuria (PKU) is a genetic disorder that leads to the inability to break down the amino acid phenylalanine. Without proper management, it can accumulate in the body and cause brain damage and other health issues.

Choice D rationale

A positive PKU test is not directly linked to an increased risk for neurological anomalies in general. The specific issue in PKU is the inability to metabolize certain amino acids, primarily phenylalanine, which can cause neurological damage if untreated. .

The correct answer is Choice C

Choice A rationale: Clinical manifestations of hypovolemic shock typically begin when approximately 15% to 30% of total blood volume is lost. In pregnancy, total blood volume increases by about 30% to 50%, so signs may be masked initially. However, waiting until 20% loss to expect symptoms is misleading. Tachycardia, pallor, and hypotension may appear earlier. Therefore, this statement underestimates the sensitivity of maternal physiology to blood loss and is not scientifically accurate.

Choice B rationale: Hemorrhagic shock leads to tissue hypoperfusion and anaerobic metabolism, resulting in lactic acid accumulation and metabolic acidosis. This causes a decrease in serum pH, not an increase. Normal serum pH ranges from 7.35 to 7.45. In shock states, pH often drops below 7.35, indicating acidosis. An increase in pH would suggest alkalosis, which is not consistent with the pathophysiology of hemorrhagic shock. Thus, this statement contradicts basic acid-base science.

Choice C rationale: Urine output is a direct and sensitive indicator of renal perfusion and overall organ perfusion. The kidneys require adequate blood flow to maintain glomerular filtration. In shock, decreased cardiac output reduces renal perfusion, leading to oliguria. Normal urine output is ≥30 mL/hr. Persistent reduction below this threshold reflects compromised perfusion. Unlike blood pressure or heart rate, urine output is less influenced by compensatory mechanisms, making it a reliable marker of end-organ function.

Choice D rationale: Fluid resuscitation in hemorrhagic shock typically involves a 3:1 ratio of isotonic crystalloid (e.g., lactated Ringer’s) to blood loss volume. This accounts for the distribution of fluid into the interstitial and intracellular compartments. Administering only 1 mL of fluid per 1 mL of blood loss is insufficient to restore intravascular volume. The 3:1 replacement rule is based on fluid dynamics and vascular compartmentalization. Therefore, this statement misrepresents standard resuscitation protocols.