A nurse is updating the plan of care for a newborn who is undergoing phototherapy. Which of the following actions should the nurse include in the plan?
Monitor the newborn's blood glucose level hourly.
Apply lotion to the newborn's skin twice per day.
Maintain the newborn in a prone position
Encourage the newborn to breastfeed every 2 hr.
The Correct Answer is D
Choice A reason:
Monitoring the newborn's blood glucose level hourly is not necessary for a newborn undergoing phototherapy. Phototherapy does not affect blood glucose levels, and hourly monitoring would be too invasive and stressful for the newborn. •
Choice B reason:
Applying lotion to the newborn's skin twice per day is not recommended for a newborn undergoing phototherapy. Lotion can interfere with the effectiveness of the phototherapy and increase the risk of skin irritation or infection. •
Choice C reason:
Maintaining the newborn in a prone position is not advisable for a newborn undergoing phototherapy. The newborn should be positioned on alternate sides to expose as much skin surface as possible to the light source. •
Choice D reason:
Encouraging the newborn to breastfeed every 2 hr is an appropriate action for a newborn undergoing phototherapy. Frequent feeding helps to promote hydration and the elimination of bilirubin from the body.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C","D","E"]
Explanation
Choice A reason:
Discard unused formula in used bottle after 2 hours. This is correct because bacteria can grow in the formula if it is left at room temperature for too long. The formula that has been in contact with your baby's mouth can also become contaminated with saliva or germs.
Choice B reason:
Never prop a bottle. This is correct because propping a bottle can cause choking, ear infections, tooth decay, and overfeeding. It can also deprive your baby of the cuddling and bonding that they need during feeding time.
Choice C reason:
The formula is available in three forms. This is correct because the formula comes in ready-to-use, concentrated liquid, and powder forms. Each form has its own advantages and disadvantages in terms of cost, convenience, and storage.
Choice D reason:
Warm the bottle in the microwave. This is incorrect because microwaving a bottle can create hot spots that can burn your baby's mouth or throat. It can also damage the nutrients in the formula. The safest way to warm a bottle is to place it in a bowl of warm water or run it under warm tap water.
Choice E reason:
Store prepared bottles in the refrigerator. This is correct because refrigerating prepared bottles can prevent bacterial growth and keep the formula fresh. However, you should not keep prepared bottles for more than 24 hours and you should always check the expiration date on the formula container.
Correct Answer is ["A","B","C","E","F"]
Explanation
Choice A reason:
Moro is a newborn reflex that occurs when the baby is startled by a loud sound or movement. The baby will cry, throw back his or her head, and then pull his or her limbs into the body. This reflex lasts until the baby is about 2 months old.
Choice B reason:
Rooting is a newborn reflex that starts when the corner of the baby's mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking. This helps the baby find the breast or bottle to start feeding. This reflex lasts about 4 months.
Choice C reason:
Gag is a newborn reflex that prevents the baby from choking on foreign objects. The baby will cough, gag or spit out anything that touches the back of the throat or the roof of the mouth. This reflex is present throughout life.
Choice D reason:
Running is not a newborn reflex. It is a voluntary movement that develops later in childhood. Choice E reason:
Babinski is a newborn reflex that occurs when the sole of the foot is stroked from heel to toe. The baby will fan out and curl up the toes and twist the foot inward. This reflex lasts until the baby is about 12 months old.
Choice F reason:
Stepping is a newborn reflex that occurs when the baby is held upright with his or her feet touching a solid surface. The baby will appear to take steps or dance. This reflex lasts about 2 months.
Choice G reason:
The crawling reflex is a developmental milestone observed in infants around 6-8 months of age. It involves the baby moving on their hands and knees, often starting with a belly-crawling motion. Unlike newborn reflexes, this skill is learned and requires muscle coordination and strength.
Choice H reason:
Standing with support is a developmental milestone typically achieved by infants around 9-12 months. In this skill, the baby pulls themselves up to a standing position while holding onto furniture or a caregiver’s hands. It is a learned behavior reflecting increased muscle strength and balance, distinct from newborn reflexes.
Choice I reason:
The pincer grasp is a fine motor skill that usually develops between 8-12 months. It involves the baby using the thumb and index finger to pick up small objects. This ability is not a reflex but a learned skill that demonstrates improved hand-eye coordination and dexterity.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.