Exhibits
The nurse has reviewed the I&O and Diagnostic Results from Day 2. Select the 2 orders the nurse should anticipate the provider to prescribe.
Wake the newborn to breastfeed every 2 hr.
Supplement feedings with sterile water.
Obtain blood cultures.
Prepare for an exchange transfusion.
Obtain a total bilirubin level.
Correct Answer : A,E
Choice A rationale: Frequent breastfeeding every 2 hours enhances bilirubin excretion by promoting hydration and stooling. Bilirubin is eliminated via feces, and increased feeding stimulates gastrointestinal motility. Breast milk also supports hepatic conjugation of bilirubin. In late preterm infants, feeding cues may be subtle, so scheduled waking ensures intake adequacy. This intervention is critical in managing hyperbilirubinemia conservatively and preventing escalation to invasive treatments such as exchange transfusion.
Choice B rationale: Sterile water lacks calories and nutrients, and does not promote bilirubin excretion. It may dilute serum sodium and increase the risk of water intoxication. Newborns require energy-dense feeds to support hepatic function and bowel activity. Supplementation with sterile water is contraindicated in hyperbilirubinemia management. Instead, formula or breast milk should be used to ensure adequate caloric intake and hydration, both of which are essential for bilirubin clearance.
Choice C rationale: Blood cultures are indicated when sepsis is suspected. In this case, the newborn is afebrile, vigorous, and has stable vital signs. Hyperbilirubinemia alone does not warrant blood cultures unless accompanied by signs of infection such as temperature instability, lethargy, or poor perfusion. The absence of systemic symptoms and a known cause (birth trauma, prematurity) makes sepsis unlikely. Therefore, blood cultures are not anticipated at this stage.
Choice D rationale: Exchange transfusion is reserved for severe hyperbilirubinemia unresponsive to phototherapy or when bilirubin levels approach neurotoxic thresholds. The American Academy of Pediatrics recommends exchange transfusion when bilirubin exceeds 25 mg/dL or if signs of acute bilirubin encephalopathy are present. This newborn’s bilirubin peaked at 18.5 mg/dL and decreased to 14.2 mg/dL with phototherapy, indicating effective response. Thus, exchange transfusion is not currently indicated.
Choice E rationale: Serial bilirubin monitoring is essential to assess treatment efficacy and guide phototherapy duration. The newborn’s bilirubin decreased from 18.5 mg/dL to 14.2 mg/dL, but continued monitoring is needed to ensure sustained improvement and prevent rebound hyperbilirubinemia. Total serum bilirubin levels provide accurate quantification and help determine whether phototherapy can be discontinued or adjusted. This order supports safe, evidence-based management of neonatal jaundice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
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.
Correct Answer is B
Explanation
Choice A rationale
Carrots are an excellent source of β-carotene, a precursor to Vitamin A, and fiber, but they contain minimal amounts of iron. Iron is critical during pregnancy for supporting the expanded maternal red blood cell mass and fetal development, with a recommended intake of 27 mg per day for pregnant women.
Choice B rationale
Chicken breast is a source of heme iron (approximately 0.7 mg per 100g serving), which is highly bioavailable (absorbed at 15% to 35%) compared to non-heme iron. Although organ meats and red meat have more iron, lean poultry is a significantly better source than the other listed options for increasing intake.
Choice C rationale
Apples are a good source of fiber, Vitamin C, and antioxidants, but they contain only trace amounts of iron. While Vitamin C aids in the absorption of non-heme iron (from plant sources), the apple itself does not contribute significantly to the daily required intake.
Choice D rationale
Feta cheese is primarily a source of calcium, protein, and fat, with a high sodium content, but it contains negligible amounts of iron. Dairy products, in general, are poor sources of iron, and high calcium intake can sometimes inhibit the absorption of iron.
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