A nurse is collecting data from an adolescent during a routine prenatal visit at 26 weeks of gestation.
Which of the following statements by the adolescent indicates they have accepted the pregnancy?

Choice A rationale

A BP of 132/84 mm Hg is within the normal range for a pregnant woman and does not require immediate reporting.

Choice B rationale

A weight gain of 1 kg (2.2 lb) in one month is within the expected range for a pregnant woman at 26 weeks gestation.

Choice C rationale

Pedal edema is a common symptom in pregnancy and is usually not a cause for concern unless accompanied by other symptoms.

Choice D rationale

Double vision is a concerning symptom that could indicate a serious condition such as preeclampsia. It should be reported to the provider immediately.

Choice A rationale

Applying lotion to the newborn’s extremities every 8 hours is not recommended during phototherapy. Lotions and ointments can cause burns when exposed to phototherapy lights and may interfere with the treatment’s effectiveness.

Choice B rationale

Repositioning the newborn every 4 hours is not frequent enough. The newborn should be repositioned every 2 hours to ensure even exposure to the phototherapy light and to prevent pressure sores.

Choice C rationale

Removing the eye mask during feedings is correct. The eye mask should be removed during feedings to allow for bonding and to check for any signs of irritation or infection. This also ensures that the newborn’s eyes are protected from the phototherapy light when not under the lamp.

Choice D rationale

Supplementing feedings with glucose water is not recommended. Breast milk or formula should be used to ensure the newborn receives adequate nutrition and hydration. Glucose water does not provide the necessary nutrients and can interfere with breastfeeding.