A nurse is reinforcing teaching with the parents of a newborn about caring for the umbilical cord stump. Which of the following instructions should the nurse include?

Choice A rationale:

Acrocyanosis, or bluish discoloration of the hands and feet, is common in the first 24 hours after birth and is typically not a cause for concern.

Choice B rationale:

A newborn not voiding within 18 hours may need evaluation, but it is not as urgent as a potential infection.

Choice C rationale:

A newborn who is 24 hours old and has not passed meconium is not the most critical concern among the options provided. While meconium (the baby's first stool) should be passed within the first 24-48 hours, a slight delay may not be an immediate cause for concern.

Choice D rationale:

The nurse should prioritize seeing the newborn with an axillary temperature of 37.8°C (100° F), as this could indicate an infection or other serious condition requiring immediate attention.

Choice A rationale:

The liver's job related to bilirubin is not changing conjugated bilirubin to unconjugated. Conjugated bilirubin is the water-soluble form of bilirubin that is excreted in bile and urine. Unconjugated bilirubin, on the other hand, is the fat-soluble form, which is transported to the liver and conjugated to become water-soluble. The conversion goes from unconjugated to conjugated, not the other way around.

Choice B rationale:

The liver's job related to bilirubin is not the synthesis of vitamin K. The liver is responsible for synthesizing clotting factors, including factors II (prothrombin), VII, IX, and X, but not vitamin K itself. Vitamin K is obtained from dietary sources or supplements and is essential for blood clotting.

Choice C rationale:

This choice is the correct answer. The liver's primary function related to bilirubin is changing unconjugated bilirubin to conjugated bilirubin. As mentioned earlier, unconjugated bilirubin is produced from the breakdown of heme in old red blood cells, and it needs to be processed in the liver to become water-soluble and eventually excreted in bile and urine.

Choice D rationale:

The liver's job related to bilirubin does not involve the removal of meconium. Meconium is the first stool passed by a newborn, and its elimination is unrelated to the liver's function in processing bilirubin.