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?

Choice A reason:

All milk- and lactose-containing formulas, including breast milk, must be stopped during infancy. Soy protein is the formula of choice for newborns and infants with galactosemia. Breast milk should not be used in newborns and infants with galactosemia because it contains galactose, which they cannot metabolize properly.

Choice B reason:

Adding amino acids to the breast milk will not help the newborn with galactosemia, because the problem is not a lack of amino acids, but a deficiency of the enzyme that breaks down galactose. Amino acids are the building blocks of proteins, not sugars.

Choice C reason:

Substituting a lactose-containing formula for breast milk will worsen the condition of the newborn with galactosemia because lactose is composed of glucose and galactose. The newborns will still be exposed to galactose, which will accumulate in the blood and tissues and cause damage.

Choice D reason:

Giving the appropriate enzyme along with breast milk is not a feasible option for the newborn with galactosemia, because there is no oral enzyme replacement therapy available for this condition. The only treatment is dietary restriction of galactose.

Choice A reason:

Fetal heart rate irregularities are not a sign of hydatidiform mole, as this condition involves an abnormal fertilization of the egg that results in an abnormal or absent fetus.

Choice B reason:

A hydatidiform mole is more commonly associated with dark brown to bright red vaginal bleeding, not whitish discharge. The bleeding may resemble prune juice and is often a sign of the abnormality.

Choice C reason:

Rapidly dropping human chorionic gonadotropin (hCG) levels are not a sign of hydatidiform mole, as this condition causes very high levels of hCG due to the proliferation of trophoblastic tissue.

Choice D reason:

In a hydatidiform mole, the uterus often enlarges more rapidly than expected for the gestational age due to the overgrowth of trophoblastic tissue and the accumulation of fluid-filled vesicles. This excessive uterine enlargement is a key sign that could indicate the presence of a molar pregnancy.