A new parent asks you why their newborn has jaundice.
How would you explain?
Jaundice is caused by the newborn having too many red blood cells that are breaking down quickly.
It is a sign of liver failure due to an underlying metabolic disorder.
The baby is not drinking enough formula or breast milk, which prevents the excretion of bilirubin.
The newborn’s immune system is attacking its own red blood cells, causing elevated bilirubin.
The Correct Answer is A
Choice A rationale
Neonatal jaundice, or hyperbilirubinemia, is common and frequently results from a higher-than-normal red blood cell mass in the newborn and a shorter lifespan of these cells. This rapid breakdown releases excess unconjugated bilirubin, which the newborn's immature liver cannot process and excrete quickly enough, leading to its accumulation in the skin and sclera.
Choice B rationale
Although severe or prolonged jaundice can indicate a serious underlying disorder, such as liver failure or biliary atresia, most physiologic jaundice is a transient, normal occurrence due to liver immaturity, not a sign of immediate organ failure. Pathological jaundice requires a thorough investigation to rule out metabolic or liver pathology.
Choice C rationale
Adequate intake of breast milk or formula is crucial because it promotes gastrointestinal motility and the passage of meconium, which contains bilirubin. Delayed feeding can lead to increased enterohepatic recirculation of bilirubin, worsening jaundice, but the underlying cause is usually the rapid red blood cell breakdown, not solely a lack of feeding.
Choice D rationale
Jaundice caused by the newborn's immune system attacking red blood cells, known as hemolytic disease of the newborn (e.g., ABO or Rh incompatibility), is a type of pathological jaundice. While this does cause elevated bilirubin, it is not the explanation for the typical, common physiologic jaundice seen in most healthy newborns.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Evaporation is the loss of heat that occurs when water is converted to vapor (e.g., from wet skin after birth or bathing, or from insensible water loss through the skin and respiratory tract). Placing a blanket on the scale prevents heat transfer from the newborn's skin directly to the cold surface of the scale, which is the definition of conduction, not evaporation.
Choice B rationale
Conduction is the loss of heat from the newborn to a colder object or surface with which it is in direct contact, such as a cold mattress, scale, or stethoscope. By placing a warmed blanket on the scale, the nurse creates a layer that minimizes this direct contact and subsequent heat transfer, thus preventing significant heat loss via conduction.
Choice C rationale
Convection is the heat loss from the newborn's skin to the surrounding cooler air currents or air movement (e.g., drafts from doors, air conditioning). While controlling ambient air temperature helps minimize convection, covering a cold surface like a scale addresses heat loss through the direct contact mechanism of conduction, not convection.
Choice D rationale
Radiation is the loss of heat from the newborn's body surface to nearby cooler objects that are not in direct contact (e.g., cold walls of the incubator or examination room windows). Covering the scale does not prevent radiant heat loss; radiant heat loss is mitigated by keeping the newborn away from cold surfaces and ensuring the surrounding objects are warmed, not by surface coverage. —.
Correct Answer is D
Explanation
Choice A rationale
Washing the cord daily with soap and water is not the current recommendation for routine cord care. Excessive handling and moisture can increase the risk of infection and delay drying and separation. Current evidence-based practice supports keeping the cord clean and dry without routine soap or alcohol application, promoting an air-exposed, natural healing process.
Choice B rationale
The cord should not be covered with a diaper, as this can trap moisture, promote bacterial growth, and delay the natural drying process, which should be the primary goal of cord care. The diaper should be folded down below the stump to allow for air circulation and reduce friction and contamination from urine or feces.
Choice C rationale
Applying petroleum jelly to the cord stump is not recommended as it keeps the cord moist, which can impede the natural mummification and drying process required for the stump to fall off, typically within 10 to 14 days. The goal of cord care is to keep the area clean and dry to facilitate air exposure and separation.
Choice D rationale
Giving a sponge bath is recommended until the umbilical cord stump has completely fallen off and the site is healed. Submerging the stump in bath water before separation can increase the risk of infection, as the moist environment is conducive to bacterial growth and delays the necessary drying and separation process.
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