A nurse is planning to administer phytonadione 0.5 mg to a newborn.

Available is 1 mg/0.5 mL. How many mL should the nurse administer? (Round the answer to the nearest hundredth.

Use a leading zero if it applies.

Do not use a trailing zero.)

Choice A rationale

Elevated maternal serum alpha-fetoprotein (MSAFP) levels can suggest a neural tube defect (NTD), such as spina bifida or anencephaly. Alpha-fetoprotein is a glycoprotein produced by the fetal liver and yolk sac. With an open NTD, this protein leaks from the exposed fetal tissue into the amniotic fluid and subsequently crosses the placenta into the maternal bloodstream, causing the observed elevation.

Choice B rationale

Trisomy 21 (Down syndrome) is typically associated with lower than normal MSAFP levels. MSAFP is part of the quad screen (or triple screen) that screens for common chromosomal abnormalities. Low levels of MSAFP, often combined with abnormal levels of other markers like β-hCG, unconjugated estriol, and inhibin A, suggest an increased risk for this aneuploidy.

Choice C rationale

Phenylketonuria (PKU) is an inherited metabolic disorder where the body cannot properly metabolize the amino acid phenylalanine due to a deficiency of the enzyme phenylalanine hydroxylase. It is not directly associated with elevated MSAFP levels. PKU is screened for in newborns via a heel stick blood test, usually 24 to 48 hours after birth.

Choice D rationale

Hemophilia is an X-linked recessive bleeding disorder caused by a deficiency in specific clotting factors, typically factor VIII (Hemophilia A) or factor IX (Hemophilia B). This condition involves defective hemostasis and is not indicated by an elevated MSAFP. Hemophilia is often diagnosed through specific clotting factor assays.

Choice A rationale

Placing tennis balls on the sacral area and leaning against them is a technique generally used to apply counter-pressure to the lower back. This method is effective for relieving the discomfort of back labor, where the fetal occiput is pressing on the mother's sacrum. It is a mechanical pain relief strategy, not acupressure, which involves applying pressure to specific anatomical points (meridians) to stimulate the body's natural pain-relieving mechanisms, such as endorphin release.

Choice B rationale

The instruction to "recognize specific signals, respond, and relax" aligns with the basic principles of acupressure use during labor. Acupressure is an intervention where the client applies sustained pressure to specific acupuncture points, which requires paying attention to the onset and intensity of contractions (signals) to effectively time the pressure application (respond) and then concentrating on relaxation techniques. This mind-body connection enhances the pain-relieving effect by stimulating endorphin release and reducing muscular tension during labor contractions.

Choice C rationale

Using light, rhythmic stroking on the abdomen while breathing is a comfort measure known as effleurage. This technique is often taught as part of prepared childbirth methods, like Lamaze, to distract the woman from the pain of contractions through cutaneous stimulation. Effleurage is a form of light touch massage, fundamentally different from acupressure, which requires deep, sustained pressure on specific points to achieve its therapeutic effect, such as modulating pain perception.

Choice D rationale

Hydrotherapy, or immersing oneself in warm water, is a widely used non-pharmacological comfort measure in labor. The warm water promotes muscle relaxation, reduces the perception of pain through buoyancy and warmth, and can increase the production of natural pain relievers (endorphins). This method provides systemic relief and is entirely distinct from acupressure, which relies on targeted, localized pressure at specific anatomical points to manage labor discomfort.