A nurse is reviewing laboratory results for a newborn who was born to a mother who has type O positive blood and tested negative for hepatitis B surface antigen (HBsAg).

The newborn has type A positive blood and tested positive for Coombs antibody (anti-A).

Which of the following actions should the nurse take?

Monitor the newborn for signs of jaundice and anemia.

This is because the newborn has a positive Coombs test, which means that there are antibodies against the newborn’s red blood cells (RBCs) in the blood.

These antibodies can cause hemolysis (destruction) of the RBCs, leading to jaundice (yellowing of the skin and eyes due to high bilirubin levels) and anemia (low RBC count and hemoglobin levels).The most likely cause of the positive Coombs test in this case is ABO incompatibility, which occurs when the mother has type O blood and the newborn has type A or B blood.

Choice A is wrong because administering hepatitis B immune globulin (HBIG) to the newborn within 12 hours of birth is indicated for newborns whose mothers are positive for hepatitis B surface antigen (HBsAg), which is not the case here.

Choice C is wrong because obtaining a blood sample from the newborn for blood typing and crossmatching is not necessary, as the newborn’s blood type is already known to be A positive.

Choice D is wrong because preparing the newborn for exchange transfusion with type O negative blood is a treatment option for severe cases of hemolytic disease of the newborn (HDN), which is not evident in this scenario.Exchange transfusion involves replacing the newborn’s blood with donor blood to remove antibodies and bilirubin.

The nurse should follow the sequence of 1, 2, 3, 4, 5 when assessing the client’s conjunctiva.This is because the nurse should first apply examination gloves to prevent contamination and infection.Then, the nurse should instruct the client to look up to expose the lower eyelid and conjunctiva.Next, the nurse should place the thumbs below each of the client’s lower eyelids and gently pull the skin down to the top edge of the bony orbital rim.This allows the nurse to inspect the color and condition of the conjunctiva and sclera, noting any color change, swelling, drainage, or lesions.The sclera should be white and the conjunctiva should be pink.

Choice B is wrong because the nurse should not pull down the skin before instructing the client to look up.

This could cause discomfort and injury to the eye.

Choice C is wrong because the nurse should not instruct the client to look up after pulling down the skin.

This could also cause discomfort and injury to the eye.

Choice D is wrong because the nurse should not place the thumbs below each of the client’s lower eyelids before applying examination gloves.

This could introduce infection and irritants to the eye.