A nurse is caring for a child who has impetigo contagiosa that developed in the hospital. Which of the following actions should the nurse take?

The correct answer is Choice B.

Choice A rationale

Applying a cool pack to the heel prior to the procedure is not recommended as it can constrict blood vessels and make it more difficult to obtain a blood sample.

Choice B rationale

Puncturing the outer aspect of the heel is the correct technique for collecting a capillary blood specimen from an infant. This area has fewer nerve endings and is less likely to cause pain or injury.

Choice C rationale

Using a surgical blade to obtain the specimen is not appropriate for a capillary blood draw. A lancet should be used instead to make a small puncture in the skin.

Choice D rationale

Wiping the site with alcohol after the puncture is not recommended as it can cause irritation and discomfort. The site should be cleaned with alcohol before the puncture and then covered with a sterile gauze pad after the procedure. .

The correct answer is Choice C.

Choice A rationale

Checking the newborn’s eyes every 8 hours is not necessary for the management of hyperbilirubinemia or phototherapy. The primary concern during phototherapy is monitoring the newborn’s temperature and hydration status.

Choice B rationale

Placing mittens on the newborn’s hands is unrelated to the management of hyperbilirubinemia or phototherapy. Mittens are typically used to prevent the newborn from scratching themselves.

Choice C rationale

Monitoring the newborn’s temperature every 2 hours is essential during phototherapy because infants are at risk of hypothermia due to increased heat loss from the lights. This helps ensure the newborn maintains a stable body temperature.

Choice D rationale

Applying lotion to the newborn’s skin is not recommended during phototherapy as it can interfere with the effectiveness of the lights. The lotion can act as a barrier, reducing the amount of light that reaches the skin.