A nurse is caring for an infant who is receiving phototherapy. Which of the following findings requires intervention by the nurse?

Choice A reason: Painless red vaginal bleeding is the most characteristic finding of placenta previa, which is a condition where the placenta covers the cervical opening and can cause bleeding in the third trimester. Painless red vaginal bleeding occurs because the placenta is detached from the lower uterine segment as the cervix dilates or effaces, and the blood vessels are torn. The bleeding can be mild or severe, and it can recur or persist until delivery.

Choice B reason: Intermittent abdominal pain following passage of bloody mucus is not a finding that supports placenta previa, but rather a finding that suggests normal labor or preterm labor. Intermittent abdominal pain is caused by uterine contractions, which can be regular or irregular, and can increase in frequency, duration, and intensity. Bloody mucus is the mucus plug that is expelled from the cervix as it dilates or effaces, and it can be tinged with blood or streaked with blood.

Choice C reason: Increasing abdominal pain with a nonrelaxed uterus is not a finding that supports placenta previa, but rather a finding that indicates abruptio placentae, which is a premature separation of the placenta from the uterine wall. Increasing abdominal pain is caused by the bleeding and the hematoma formation behind the placenta, which can compress the uterine muscle and the nerve endings. Nonrelaxed uterus is a sign of uterine hypertonicity, which can reduce the blood flow and the oxygen delivery to the fetus.

Choice D reason: Abdominal pain with scant red vaginal bleeding is not a finding that supports placenta previa, but rather a finding that suggests ectopic pregnancy, which is a condition where the fertilized ovum implants outside the uterine cavity, usually in the fallopian tube. Abdominal pain is caused by the rupture of the tube and the bleeding into the peritoneal cavity, which can irritate the diaphragm and the abdominal wall. Scant red vaginal bleeding is a sign of implantation bleeding, which can occur when the fertilized ovum attaches to the tube wall.

Choice A reason: Hypocalcemia is not the priority focus of care, as it is a low level of calcium in the blood that can cause muscle twitching, seizures, or cardiac arrhythmias. Hypocalcemia can affect newborns who have mothers with diabetes mellitus, but it is less common and less severe than hypoglycemia.

Choice B reason: Hyperbilirubinemia is not the priority focus of care, as it is a high level of bilirubin in the blood that can cause jaundice, a yellowish discoloration of the skin and eyes. Hyperbilirubinemia can affect newborns who have macrosomia, but it is usually a benign and self-limiting condition that resolves within a few days.

Choice C reason: Hypomagnesemia is not the priority focus of care, as it is a low level of magnesium in the blood that can cause tremors, tetany, or seizures. Hypomagnesemia can affect newborns who have mothers with diabetes mellitus, but it is rare and usually asymptomatic.

Choice D reason: Hypoglycemia is the priority focus of care, as it is a low level of glucose in the blood that can cause diaphoresis, jitteriness, lethargy, or apnea. Hypoglycemia can affect newborns who have macrosomia and mothers with diabetes mellitus, as they have increased insulin production and decreased glucose supply after birth. Hypoglycemia can lead to brain damage or death if not treated promptly.