A nurse is caring for a client who has preeclampsia and is receiving magnesium sulfate. Which of the following clinical findings should the nurse instruct the client to report?

Phototherapy is a treatment that uses light to lower the level of bilirubin in the blood of newborns who have jaundice. Jaundice is a condition that causes yellowing of the skin and eyes due to high levels of bilirubin, a waste product that is normally removed by the liver. Phototherapy helps the body break down and eliminate bilirubin through urine and stool¹.
Phototherapy can be done at home or in the hospital, depending on the severity of jaundice and the type of light used. The most common types of light are fluorescent lamps, halogen lamps, or light-emitting diodes (LEDs). The light can be delivered through overhead units, fiber-optic blankets, or fiber-optic pads. The light should cover as much of the newborn's skin as possible, except for the eyes and genitals¹².

The nurse should follow certain guidelines when caring for a newborn who is receiving phototherapy, such
as:
- Monitor the newborn's temperature, hydration, weight, and urine and stool output regularly
- Protect the newborn's eyes with eye patches or goggles to prevent eye damage
- Turn the newborn every 2 to 4 hours to expose different parts of the body to the light
- Feed the newborn frequently to prevent dehydration and promote bilirubin excretion

- Check the newborn's skin color and bilirubin level periodically to evaluate the effectiveness of
phototherapy
- Provide emotional support and education to the parents about jaundice and phototherapy
One of the important guidelines is to avoid using lotion or ointment on the newborn's skin during phototherapy. This is because lotion or ointment can block the light from reaching the skin and reduce the effectiveness of phototherapy. Lotion or ointment can also cause skin irritation, rash, or burns if they react with the light. The newborn's skin should be clean and dry before phototherapy¹²³.

The other options are not actions that the nurse should include in the plan of care:
- a) Keep the newborn supine throughout treatment. This is not correct because keeping the newborn in one position can limit the exposure of different parts of the body to the light and reduce the effectiveness of phototherapy. The nurse should turn the newborn every 2 to 4 hours to expose different parts of the body to the light¹².
- b) Dress the newborn in lightweight clothing. This is not correct because dressing the newborn in clothing can block the light from reaching the skin and reduce the effectiveness of phototherapy. The newborn should be undressed except for a diaper during phototherapy¹².
- c) Measure the newborn's temperature every 8 hours. This is not correct because measuring the newborn's temperature every 8 hours may not be frequent enough to detect any changes in temperature that may occur during phototherapy. Phototherapy can cause overheating or hypothermia in newborns, depending on the type and intensity of light used. The nurse should monitor the newborn's temperature more often, such as every 2 to 4 hours, and adjust the room temperature or use blankets as needed¹².

A nonstress test (NST) is a test in pregnancy that measures fetal heart rate in response to movement and contractions²³. A normal nonstress test will show a baseline fetal heart rate between 110 and 160 beats per minute with moderate variability (5- to 25-interbeat variability) and 2 qualifying accelerations in 20 minutes with no decelerations³⁴. An acceleration is defined as an increase in the fetal heart rate of at least 15 beats per minute above the baseline for at least 15 seconds²³⁴.
A nonstress test can be affected by uterine contractions, which can cause fetal heart rate decelerations or reduced variability²³. Uterine contractions can also indicate preterm labor or placental abruption, which are serious complications that require intervention². Therefore, if the nurse observes three or more uterine contractions within a 20-minute period during a nonstress test, they should intervene by notifying the provider, assessing the patient for signs of labor or bleeding, and preparing for further evaluation or treatment²⁵.

The other options are not correct because they do not require intervention by the nurse:
a) One acceleration of the FHR within a 20-min period is not enough to meet the criteria for a reactive nonstress test, but it does not indicate fetal distress or compromise. The nurse should continue monitoring the fetal heart rate for another 20 minutes or until two accelerations are observed²³⁴.
b) Uterine contractions lasting 20 to 30 seconds each are normal and expected during pregnancy, especially in the third trimester. They are called Braxton Hicks contractions and they help prepare the uterus for labor. They are usually painless and irregular, and do not cause cervical changes. They do not require intervention by the nurse unless they become frequent, intense, or painful².
d) An FHR that peaks 20 beats above the baseline is considered an acceleration and is a sign of fetal well- being. It does not require intervention by the nurse unless it is associated with decelerations or reduced variability²³⁴.