A nurse is caring for a newborn who is undergoing phototherapy to treat hyperbilirubinemia. Which of the following actions should the nurse take?
Cover the newborn's eyes while under the phototherapy light: It is important to protect the newborn's eyes from the bright light during phototherapy. Covering the eyes with an eye mask or using a specific eye shield helps prevent potential eye damage.
Keep the newborn in a shirt while under the phototherapy light: The newborn should ideally be undressed and have as much skin exposed to the phototherapy light as possible. This enhances the effectiveness of the treatment by allowing more skin surface to be exposed to the light.
Apply a light moisturizing lotion to the newborn's skin: It is generally recommended to avoid applying lotions or oils to the newborn's skin during phototherapy, as these substances can interfere with the effectiveness of the treatment. The skin should be clean and dry.
Turn and reposition the newborn every 4 hr while undergoing phototherapy: Turning and repositioning the newborn is important for general care, but the frequency may be more frequent than every 4 hours, especially when undergoing phototherapy. The goal is to ensure even exposure of the skin to the light.
The Correct Answer is A
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is C. Hypotension.
A. Respiratory depression is not a common complication of epidural anesthesia. It is more associated with opioid analgesics or excessive administration of other anesthetics.
B. Tachycardia is generally not associated with epidural anesthesia. It is more commonly observed in response to pain or anxiety.
C. Hypotension is a common complication of epidural anesthesia.
Epidural anesthesia can cause vasodilation, leading to a decrease in blood pressure. This is particularly common when the block is administered rapidly or with a higher dose.
D. Vomiting is not a direct complication of epidural anesthesia. Nausea and vomiting are more commonly associated with opioid analgesics or general anesthesia.
Correct Answer is D
Explanation
A. Contractions lasting longer than 90 seconds: Prolonged contractions lasting longer than 90 seconds may indicate uterine hyperstimulation, which can compromise fetal oxygenation and lead to fetal distress. This finding should be reported to the provider promptly for further evaluation and management.
B. Client reports feeling contractions in the lower back: This is a common sensation during labor and may not necessarily indicate a complication. However, if associated with other signs of fetal distress, it should be reported.
C. Contractions occurring every 3 to 5 minutes: This frequency is within the normal range for the active phase of labor and does not necessarily indicate a problem. However, it is essential to consider the duration and intensity of contractions along with this frequency.
D. Contractions are strong in intensity: While strong contractions are typical during the active phase of labor, the intensity alone may not be a cause for concern unless they are associated with uterine hyperstimulation.
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