A nurse is reinforcing teaching about appropriate exercises during pregnancy with a client who is at 24 weeks of gestation. Which of the following statements indicates a need for additional teaching?

Choice A reason:

This is a normal WBC for a newborn. According to MedlinePlus, the normal amount of white blood cells (WBCs) found in the bloodstream of a newborn infant is between 4,500 and 10,000 per microliter of blood. The reference ranges for WBC count established by Mayo Medical Laboratories for infants from birth to 2 years are as follows:.

• Birth: 9.0 to 30.0 x 10 9 /L.

• 1 to 7 days: 9.4 to 34.0 x 10 9 /L.

• 8 to 14 days: 5.0 to 21.0 x 10 9 /L.

• 15 days to 1 month: 5.0 to 20.0 x 10 9 /L.

• 2 to 5 months: 5.0 to 15.0 x 10 9 /L. Therefore, a newborn's WBC of 15,000 is within the normal range and does not indicate any problem.

Choice B reason:

You must call the doctor. This is not a correct answer because there is no need to call the doctor for a normal WBC in a newborn. Calling the doctor unnecessarily may cause anxiety and a waste of time and resources.

Choice C reason:

This indicates a severe infection. This is not a correct answer because a WBC of 15,000 does not necessarily indicate a severe infection in a newborn. A high WBC, also called leukocytosis, may be related to infection, but it can also be caused by other factors such as stress, inflammation, trauma, medication, or blood disorders. Moreover, the type and severity of infection can be better assessed by looking at the differential count of the different types of white blood cells (neutrophils, eosinophils, basophils, monocytes, and lymphocytes) and other signs and symptoms.

Choice D reason:

This is a lab error. This is not a correct answer because a WBC of 15,000 is not likely to be a lab error in a newborn. Lab errors can occur due to improper collection, handling, or analysis of blood samples, but they are rare and usually detected by quality control measures. A WBC of 15,000 is within the normal range for a newborn and does not require repeating the test unless there is a strong suspicion of an error or an inconsistency with other results or clinical findings.

A. Discard unused formula in used bottle after 2 hours:Once a baby has started drinking from a bottle, bacteria from the baby’s mouth can contaminate the formula. Any leftover formula should be discarded after 2 hours to prevent bacterial growth and reduce the risk of infection.

B. Never prop a bottle:Propping a bottle can lead to choking, ear infections, and dental issues (such as baby bottle tooth decay). Babies should always be held upright during feedings.

C. Formula is available in three forms:Infant formula is available in three types:Ready-to-feed (no mixing needed),Liquid concentrate (mix with water),Powdered formula (mix with water).

E. Store prepared bottles in the refrigerator:If formula is prepared in advance, it must be stored in the refrigerator (≤ 4°C or 40°F) and used within 24 hours to prevent bacterial growth.

Incorrect Answer:

D. Warm the bottle in the microwave:Microwaving heats unevenly, creating hot spots that can burn the baby’s mouth. Instead, warm bottles by placing them in warm water for a few minutes and always test the temperature on the wrist before feeding.