A nurse is assessing a post-term infant who was born with intrauterine growth restriction (IUGR).

Which of the following findings should the nurse expect?

Dextrose 10% in water.This is because parenteral nutrition (PN) is a mixture of nutrients that is given through a central venous catheter (CVC) that goes directly to the heart.PN contains high concentrations of nutrition and calories, and if the PN bag is empty, it needs to be replaced with a solution that has a similar osmolarity to prevent complications such as hypoglycemia (low blood sugar) or phlebitis (inflammation of the vein).Dextrose 10% in water has an osmolarity of about 500 mOsm/L, which is close to the osmolarity of PN solutions.

Choice A is wrong because 0.9% sodium chloride has an osmolarity of about 300 mOsm/L, which is lower than PN solutions and can cause fluid overload and electrolyte imbalance.

Choice B is wrong because lactated Ringer’s has an osmolarity of about 275 mOsm/L, which is also lower than PN solutions and can cause similar problems as 0.9% sodium chloride.

Choice D is wrong because dextrose 5% in water has an osmolarity of about 250 mOsm/L, which is much lower than PN solutions and can cause rapid drop in blood sugar and vein irritation.

This is because phototherapy can cause dehydration and increase insensible water loss, so covering the genitalia can prevent excessive fluid loss and maintain thermoregulation.

Some possible explanations for the other choices are:

• Choice A is wrong because monitoring skin temperature every hour is not enough to prevent hyperthermia or hypothermia during phototherapy.The skin temperature should be monitored continuously or at least every 15 minutes.

• Choice C is wrong because repositioning newborn every 4 hours is not frequent enough to prevent pressure ulcers, skin breakdown, or eye damage from the light source.The newborn should be repositioned at least every 2 hours.

• Choice D is wrong because encouraging parent-infant interaction as tolerated is not a specific intervention for phototherapy.

While parent-infant interaction is important for bonding and development, it should not interfere with the effectiveness of phototherapy.The newborn should be exposed to the light as much as possible, except for feeding and diaper changes.

Normal ranges for serum bilirubin levels vary depending on the age, gestational age, and risk factors of the newborn.Generally, the levels should be below 5 mg/dL for term infants and below 7 mg/dL for preterm infants by the fifth day of life.