A nurse is planning care for a newborn who is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan?
Give the newborn 1 oz of glucose water every 4 hr.
Apply a thin layer of lotion to the newborn's skin every 8 hr.
Ensure the newborn's eyes are closed beneath the shield.
Dress the newborn in a thin layer of clothing during therapy.
The Correct Answer is C
The correct answer is choice C, Ensure the newborn's eyes are closed beneath the shield. Phototherapy is a treatment used to reduce high bilirubin levels in newborns. It involves exposing the newborn's skin to special lights, which helps to break down the excess bilirubin in the blood. It is important to ensure that the newborn's eyes are closed beneath the shield to prevent damage to the eyes from the bright lights. Giving the newborn 1 oz of glucose water every 4 hr, applying lotion to the newborn's skin every 8 hr, and dressing the newborn in a thin layer of clothing during therapy are not indicated interventions during phototherapy.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Answer and explanation
A. Decreased maternal hormones during pregnancy might affect fetal development, but it is not directly linked to the assessment finding of flat areola with no bud in a newborn.
B. Preterm gestational age is the most likely condition indicated by the finding of flat areola with no bud. Breast tissue development in newborns correlates with gestational age. In preterm infants, the breast tissue is often less developed, resulting in a flat areola without a bud.
C. Ambiguous secondary sex characteristics refer to physical traits that do not distinctly fit typical definitions of male or female. The described finding of flat areola with no bud is a specific developmental feature rather than a characteristic of ambiguous secondary sex traits.
D. Congenital anomalies are structural or functional abnormalities present at birth, but the described finding of flat areola with no bud is more indicative of prematurity rather than a congenital anomaly.
Correct Answer is D
Explanation
The correct answer is choice D, Sharp pelvic pain. An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tube. Sharp pelvic pain is a classic sign of an ectopic pregnancy, as the developing embryo can cause the tube to rupture or stretch, leading to pain. A scaphoid abdomen, elevated blood pressure, and bright red vaginal discharge are not typical manifestations of an ectopic pregnancy. 
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