A nurse is caring for a newborn who is formula-fed. The newborn takes 0.5 oz of formula at 0800, 1 oz at 1100, 0.5 oz at 1300, 0.5 oz at 1600, and 0.5 oz at 1830. How many mL of formula should the nurse record as the client's intake for the shift?

Choice A rationale:

Activating respiratory arrest procedures is not necessary in this situation. The newborn's respiratory rate, although slightly elevated, does not indicate respiratory arrest. Instead, such procedures are reserved for situations where the newborn has stopped breathing or is in acute respiratory distress.

Choice B rationale:

Requesting an order for supplemental oxygen may be premature. The newborn's respiration rate of 44/min, although shallow with periods of apnea, is still within the normal range for a newborn. Providing supplemental oxygen should be considered when the newborn is showing signs of significant respiratory distress or if oxygen saturation levels are low.

Choice C rationale:

The most appropriate action in this scenario is to continue routine monitoring of the newborn's respiratory rate and overall condition. Newborns often exhibit irregular breathing patterns, including periods of apnea, especially in the first few hours after birth. As long as the newborn's color, heart rate, and overall appearance are stable, routine monitoring is appropriate.

Choice D rationale:

There is no need to report the observation to the charge nurse immediately, as the newborn's respiratory rate and pattern fall within the expected range for a 12-hour-old newborn.

Reporting should be considered when there are significant deviations from the norm or if the newborn's condition deteriorates.

Choice A: Warm the bottle in the microwave.

• Rationale: Warming bottles in the microwave is not recommended. Microwaving can cause uneven heating, creating hot spots in the milk or formula that can burn the baby's mouth. Instead, bottles should be warmed by placing them in a container of warm water or using a bottle warmer.

Choice B: Store prepared bottles in the refrigerator.

• Correct
• Rationale: Prepared bottles of formula should be stored in the refrigerator to prevent bacterial growth. Formula should be used within 24 hours of preparation when properly stored in the refrigerator.

Choice C: Discard unused formula in used bottle after 2 hours.

• Correct
• Rationale: Any unused formula that has been in contact with the baby’s mouth should be discarded after 2 hours due to the risk of bacterial contamination. Bacteria from the baby's saliva can grow in the leftover formula.

Choice D: Never prop a bottle.

• Correct
• Rationale: Bottles should never be propped up and left in the baby’s mouth. This practice increases the risk of choking, ear infections, and tooth decay. Caregivers should always hold the bottle and the baby during feedings.

Choice E: Formula is available in three forms.

• Correct
• Rationale: Formula is available in three forms: powdered, concentrated liquid, and ready-to-feed. Parents should be informed of these options so they can choose the most convenient or appropriate form based on their needs.