The nurse is preparing to care for a newborn receiving phototherapy.
Which interventions should be included in the plan of care? Select all that apply.
Avoid stimulation.
Decrease fluid intake.
Monitor skin temperature closely.
Cover the newborn’s eyes with eye shields or patches.
Reposition the newborn every 2 hours.
Correct Answer : C,D,E
Choice A rationale
Avoiding stimulation is not a necessary intervention for a newborn receiving phototherapy. Phototherapy is a treatment for jaundice where the exposure of skin to a light source converts unconjugated bilirubin molecules into water-soluble isomers that can be excreted by the usual pathways. There is no specific need to avoid stimulation during this treatment.
Choice B rationale
Decreasing fluid intake is not a recommended intervention for a newborn receiving phototherapy. In fact, adequate hydration is important during phototherapy to promote the excretion of bilirubin. Therefore, fluid intake should not be decreased.
Choice C rationale
Monitoring skin temperature closely is a necessary intervention for a newborn receiving phototherapy. The lights used in phototherapy can generate heat, so it’s important to monitor the baby’s temperature to prevent overheating.
Choice D rationale
Covering the newborn’s eyes with eye shields or patches is a necessary intervention during phototherapy. This is done to protect the baby’s eyes from the bright lights used in the treatment.
Choice E rationale
Repositioning the newborn every 2 hours is a necessary intervention during phototherapy. This helps to expose different areas of the baby’s skin to the light, which can improve the effectiveness of the treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Understanding the cause of illness is a complex cognitive task that typically develops later in childhood. Preschool-aged children are still developing their understanding of cause and effect, and their thinking is often more concrete than abstract.
Choice B rationale
Describing manifestations of illness is also a complex task that requires a certain level of cognitive and language development. While preschool-aged children are developing their language skills rapidly, their ability to describe complex phenomena such as the manifestations of illness is still developing.
Choice C rationale
Awareness of body functioning is a concept that typically develops later in childhood. Preschool-aged children are still learning about their bodies and how they work. Their understanding of body functioning is often concrete and based on what they can see and feel.
Choice D rationale
Relating fears to magical thinking is a characteristic of preschool-aged children’s cognitive development. At this age, children’s thinking is often dominated by fantasy and magic. They may attribute events or experiences to magical causes, and their fears may be related to these magical beliefs.
Correct Answer is A
Explanation
Choice A rationale:
Developmental dysplasia of the hip (DDH) is a condition in which the hip joint is not properly formed or is unstable. Asymmetric thigh folds are a common finding in infants with DDH, as the affected hip may be dislocated or subluxated, leading to a difference in thigh fold appearance.
Choice B rationale:
An inwardly turned foot is not a specific indication of DDH. Instead, it may suggest other conditions, such as clubfoot or metatarsus adductus (no reference).
Choice C rationale:
Absent plantar reflexes are not associated with DDH. This finding might indicate a neurological issue or spinal cord injury (no reference).
Choice D rationale:
A lengthened thigh is not a typical finding in DDH. Instead, a shortened thigh on the affected side might be present due to the displacement of the femoral head (no reference).
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.