A nurse is planning care for a newborn who has a new diagnosis of phenylketonuria (PKU).
Which of the following actions should be included in the plan of care?
Administer thyroid hormone replacement.
Educate parents on blood glucose monitoring.
Obtain a blood sample for blood type.
Initiate a controlled low-protein diet.
The Correct Answer is D
A. Administering thyroid hormone replacement is not indicated for phenylketonuria (PKU). PKU is a metabolic disorder involving the inability to metabolize phenylalanine, an amino acid, and it does not involve thyroid dysfunction.
B. Blood glucose monitoring is not directly related to the management of PKU. In PKU, the focus is on monitoring and restricting phenylalanine intake, not blood glucose levels.
C. Obtaining a blood sample for blood type may be necessary for general newborn screening but is not specific to the management of PKU.
D. Initiating a controlled low-protein diet is the cornerstone of management for PKU. This diet restricts phenylalanine intake, which is essential for preventing neurological damage and
developmental delays in affected infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The findings described are within the expected range for 1 hour postpartum, as lochia rubra and small clots are normal during the early postpartum period. The firm, midline fundus suggests adequate uterine contraction. Documenting the findings and continuing to monitor the client's progress are appropriate.
B. Increasing the frequency of fundal massage is not necessary as the fundus is already firm and midline.
C. Encouraging the client to empty her bladder is important for uterine involution, but it is not the priority in this scenario, as the fundus is already firm and midline.
D. Notifying the client's provider is not necessary at this time, as the findings are within the expected range for the early postpartum period and do not indicate any immediate complications.
Correct Answer is C
Explanation
A. Applying cold compresses is not indicated for pain and redness of the calf, which may
indicate deep vein thrombosis (DVT). Cold therapy is not recommended as it can worsen the condition.
B. Massaging the area is contraindicated in suspected DVT as it can dislodge a clot and lead to complications such as pulmonary embolism.
C. Elevating her leg helps to reduce swelling and improve venous return, which can alleviate symptoms of DVT and prevent further complications.
D. Flexing her knee while resting is not specifically indicated for the management of suspected DVT and may not address the underlying cause of pain and redness in the calf.
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