A nurse is caring for a client who has hyperemesis gravidarum.
Which of the following laboratory tests should the nurse anticipate?

Choice A rationale

Limiting the newborn's intake of milk is contraindicated in the treatment of hyperbilirubinemia. Adequate hydration and frequent feedings are essential to promote bilirubin excretion through stool and urine. Decreased intake can exacerbate dehydration and worsen jaundice. Normal feeding frequency for newborns is typically every 2-3 hours.

Choice B rationale

Feeding the newborn every six hours is not an appropriate intervention for a jaundiced infant receiving phototherapy. Frequent feedings, typically every 2-3 hours, are necessary to promote bilirubin excretion. Prolonged intervals between feedings can lead to dehydration and hinder the effectiveness of phototherapy.

Choice C rationale

Turning the infant every two hours is a crucial nursing intervention during phototherapy. This ensures that all body surfaces are exposed to the ultraviolet light, maximizing the breakdown of bilirubin in the skin. Consistent exposure of all areas helps to lower bilirubin levels more effectively.

Choice D rationale

Applying an oil-based lotion to the newborn's skin during phototherapy is contraindicated. Oil-based lotions can create a barrier on the skin, reducing the penetration and effectiveness of the ultraviolet light. Only water-based lotions, if necessary, should be used sparingly and with caution, as some may absorb UV light.

Rationales for Each Condition

Molar Pregnancy

1. Abdominal Pain: In a molar pregnancy, the uterus enlarges disproportionately due to abnormal trophoblastic growth. This excessive expansion can cause discomfort or mild cramping.
2. Blood Pressure: Molar pregnancies can be associated with gestational trophoblastic disease, which may lead to preeclampsia-like symptoms. However, this client’s blood pressure is currently within normal limits (120/78 mm Hg), so severe hypertension has not yet developed.
3. Ultrasound Findings: The presence of grape-like vesicles within the uterus and the absence of a fetal heartbeat are hallmark findings of a molar pregnancy, indicating abnormal placental tissue proliferation.
4. Perineal Pad Findings: The passage of small clear vesicles is a characteristic feature of a molar pregnancy, distinguishing it from other causes of vaginal bleeding in pregnancy.

Ectopic Pregnancy

1. Abdominal Pain: Ectopic pregnancies often cause sharp lower abdominal pain due to tubal rupture or irritation. However, in this case, the client’s pain is mild and less suggestive of tubal rupture.
2. Blood Pressure: If an ectopic pregnancy ruptures, hypotension due to internal bleeding would be expected. Since the client’s blood pressure is normal, this finding does not support an ectopic pregnancy.
3. Ultrasound Findings: The absence of a fetal heartbeat and vesicular structures inside the uterus make ectopic pregnancy unlikely, as ectopic pregnancies typically occur in the fallopian tube.
4. Perineal Pad Findings: Ectopic pregnancies rarely cause the passage of vesicular tissue, further suggesting that this is not an ectopic pregnancy.