The nurse is teaching the parents of a newborn who is going to receive phototherapy. What other measure does the nurse teach to help reduce the bilirubin?
Increase oral intake of water between feedings.
Wrap the infant in triple blankets to prevent cold stress during phototherapy.
How to prepare the newborn for an exchange transfusion.
Increase the frequency of feedings.
The Correct Answer is D
Choice A) Increase oral intake of water between feedings is incorrect because this is not a helpful or recommended measure to help reduce the bilirubin in a newborn who is receiving phototherapy. Bilirubin is a yellow pigment that is produced when red blood cells are broken down. It is normally excreted by the liver into bile and then eliminated by the intestines. However, some newborns have high levels of bilirubin in their blood, which can cause jaundice, a condition that makes the skin and eyes look yellow. Phototherapy is a treatment that uses blue light to help break down the bilirubin and make it easier for the liver to process. Increasing oral intake of water between feedings does not have any effect on the bilirubin level, as water does not contain any nutrients or calories that can stimulate the liver or bowel function. Moreover, giving water to a newborn can cause hyponatremia, which is a low level of sodium in the blood that can lead to seizures, brain damage, or death. Therefore, this measure should be avoided or used with caution for newborns who are receiving phototherapy.
Choice B) Wrap the infant in triple blankets to prevent cold stress during phototherapy is incorrect because this is not a safe or appropriate measure to help reduce the bilirubin in a newborn who is receiving phototherapy. Cold stress is a condition that occurs when a newborn loses too much heat and has difficulty maintaining a normal body temperature. It can cause complications such as hypoglycemia, hypoxia, acidosis, or bleeding. Wrapping the infant in triple blankets may seem like a good way to prevent cold stress, but it can actually cause overheating, dehydration, or hyperthermia, which are equally dangerous for the newborn. Moreover, wrapping the infant in blankets can reduce the effectiveness of phototherapy, as it blocks the exposure of the skin to the blue light. Therefore, this measure should be avoided or used with caution for newborns who are receiving phototherapy.
Choice C) How to prepare the newborn for an exchange transfusion is incorrect because this is not a relevant or necessary measure to help reduce the bilirubin in a newborn who is receiving phototherapy. An exchange transfusion is a procedure that involves replacing some of the newborn's blood with donor blood to lower the bilirubin level and prevent brain damage. It is usually reserved for severe cases of jaundice that do not respond to phototherapy or other treatments. Preparing the newborn for an exchange transfusion involves obtaining informed consent from the parents, placing an umbilical venous catheter, monitoring vital signs and blood tests, and administering medications and fluids. However, these steps are not part of routine care for newborns who are receiving phototherapy, and they do not help to reduce the bilirubin level by themselves. Therefore, this measure should be done only when indicated by the physician and explained by the nurse.
Choice D) Increase the frequency of feedings is correct because this is an effective and recommended measure to help reduce the bilirubin in a newborn who is receiving phototherapy. Feeding provides nutrients and calories that can stimulate the liver and bowel function, which are essential for processing and eliminating bilirubin from the body. Feeding also helps to prevent dehydration, which can worsen jaundice and increase the risk of complications.
Feeding can be done by breast milk or formula, depending on the mother's preference and availability. The frequency of feedings should be increased to at least every 2 to 3 hours or on demand, as long as the newborn shows signs of hunger and satisfaction. Therefore, this measure should be encouraged and supported by the nurse for newborns who are receiving phototherapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A: This is incorrect because both physiological and nonphysiological jaundice result from breakdown of erythrocytes. Jaundice is caused by the accumulation of bilirubin, a yellow pigment that is produced when red blood cells are destroyed. However, the rate and extent of hemolysis differ between the two types of jaundice.
Choice B: This is incorrect because kernicterus is a rare and serious complication of jaundice, not a usual outcome. Kernicterus occurs when bilirubin levels are very high and the pigment deposits in the brain, causing neurological damage. It can affect both physiological and nonphysiological jaundice, but it is more likely to occur in nonphysiological jaundice due to higher bilirubin levels and underlying conditions.
Choice C: This is incorrect because both physiological and nonphysiological jaundice begin at the head and progress down the body. This is because bilirubin accumulates in areas with high fat content, such as the skin, eyes, and brain. The distribution of jaundice depends on the level of bilirubin in the blood, not on the type of jaundice.
Choice D: This is the correct answer because nonphysiological jaundice appears in the first 24 hours of life, whereas physiological jaundice appears after the first 24 hours of life. Nonphysiological jaundice is caused by factors that increase hemolysis or impair bilirubin metabolism or excretion, such as blood group incompatibility, infection, liver disease, or enzyme deficiency. Physiological jaundice is caused by normal adaptation processes that occur after birth, such as increased red blood cell turnover, immature liver function, and delayed intestinal flora colonization.
Correct Answer is ["B","C","D"]
Explanation
Choice A) Calm, easy to comfort is incorrect because this is not a sign of intrauterine drug exposure, but rather a sign of normal or healthy newborn behavior. Newborns who are calm and easy to comfort are usually well-adjusted and have a good temperament. They respond positively to soothing techniques such as holding, rocking, or singing.
They do not show signs of distress or withdrawal, which are common in newborns who are exposed to drugs in utero. Therefore, this response is irrelevant and inaccurate.
Choice B) Tremors is correct because this is a sign of intrauterine drug exposure that can indicate neurological damage or withdrawal syndrome. Tremors are involuntary shaking or quivering movements of the body or limbs that occur due to abnormal electrical activity in the brain or nervous system. Newborns who are exposed to drugs such as opioids, cocaine, or alcohol in utero may develop tremors as a result of brain injury, hypoxia, hypoglycemia, or seizures. They may also experience tremors as a symptom of neonatal abstinence syndrome (NAS), which is a condition that occurs when the newborn stops receiving the drug from the mother and goes through withdrawal. NAS can cause various physical and behavioral problems in the newborn, such as irritability, poor feeding, vomiting, diarrhea, sweating, fever, or seizures. Therefore, this response is clear and accurate.
Choice C) Persistent shrill cry is correct because this is a sign of intrauterine drug exposure that can indicate pain or discomfort in the newborn. Crying is a normal and natural way for newborns to communicate their needs and feelings. However, some newborns who are exposed to drugs such as opioids, cocaine, or alcohol in utero may cry more often, louder, or longer than usual. They may have a high-pitched or piercing cry that is difficult to soothe or stop. This may be due to various factors such as hunger, colic, infection, injury, or withdrawal. A persistent shrill cry can also affect the bonding and attachment between the newborn and the parents or caregivers. Therefore, this response is clear and accurate.
Choice D) Difficult to console is correct because this is a sign of intrauterine drug exposure that can indicate emotional or behavioral problems in the newborn. Newborns who are difficult to console are usually unhappy and restless. They do not respond well to soothing techniques such as holding, rocking, or singing. They may have trouble sleeping, feeding, or interacting with others. They may also show signs of agitation, anxiety, or depression. These problems may be caused by exposure to drugs such as opioids, cocaine, or alcohol in utero, which can affect the development and function of the brain and nervous system. They may also be influenced by the environment and relationship of the newborn with the parents or caregivers. Therefore, this response is clear and accurate.
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