The nurse is educating a parent after the birth of a newborn who is diagnosed with phenylketonuria (PKU). Which parent statement indicates teaching has been effective?

Choice A rationale

Placing the neonate, who is anticipated to be vigorous based on the current reassuring fetal status (baseline 145, moderate variability, accelerations), directly onto the mother's chest, skin-to-skin, facilitates thermoregulation through maternal heat transfer. This action also promotes bonding and encourages early breastfeeding, releasing oxytocin for uterine involution. Immediate drying prevents evaporative heat loss, and the mother's chest provides a warm, stable thermal environment, crucial for stabilizing the newborn's core temperature and vital signs.

Choice B rationale

Routine drying and warming are essential immediate steps for all newborns to prevent hypothermia, which increases metabolic demands and oxygen consumption. Evaporative heat loss from amniotic fluid is significant; drying removes this fluid. Warming measures, such as pre-warmed blankets or radiant warmer, are critical to maintain the newborn's thermoregulation and achieve a target temperature of 36.5°C to 37.5°C (97.7°F to 99.5°F), preventing cold stress which can lead to hypoglycemia and metabolic acidosis.

Choice C rationale

Hyperbilirubinemia, or neonatal jaundice, typically manifests as a serum total bilirubin level above 5 mg/dL and is generally a later post-delivery finding, often peaking between 3 to 5 days of life, not an immediate one. While factors like prematurity (38 weeks is term, ≥ 37 weeks), prolonged rupture of membranes (19 hours), and potential infection (chorioamnionitis risk) can slightly increase risk, it is not an anticipated immediate concern at delivery, and thus requires close postnatal monitoring, not immediate delivery preparation.

Choice D rationale

Immediate transfer to the Neonatal Intensive Care Unit (NICU) is reserved for newborns with severe distress, significant congenital anomalies, or requiring complex support, such as immediate endotracheal intubation. Given the current reassuring fetal heart rate (FHR) tracing (moderate variability, accelerations, early decelerations), a severely compromised infant requiring immediate intensive care is not anticipated. The FHR's recovery from the prior deceleration suggests the fetus has currently compensated well, supporting a plan for routine or slightly enhanced delivery care.

Choice E rationale

Although the current FHR is reassuring, the history of prolonged rupture of membranes (19 hours), Pitocin augmentation, and a prior episode of uterine tachysystole with a 4-minute prolonged deceleration elevates the risk for perinatal asphyxia or meconium aspiration (though fluid was clear). Therefore, having suction (bulb syringe, deep suction equipment) and oxygen delivery systems (free-flow oxygen, Positive Pressure Ventilation (PPV) device) immediately ready is a standard and prudent precautionary measure for any potential unexpected neonatal resuscitation need.

Choice F rationale

Respiratory depression is commonly associated with maternal opioid administration close to delivery or severe perinatal asphyxia. Despite the earlier FHR changes, the current tracing is reassuring, and the mother did not receive recent depressant medications, thus significant respiratory depression is improbable. While all newborns have a risk of transient tachypnea, severe, immediate respiratory depression necessitating immediate ventilation is not the primary expected outcome given the current fetal status.

Choice G rationale

Positive Pressure Ventilation (PPV) is indicated if the newborn is apneic, gasping, or has a heart rate below 100 beats per minute despite drying and stimulation. The current reassuring FHR tracing makes an immediate need for PPV unlikely. Preparation for PPV is required as per Choice E, but the immediate need is not anticipated, as the fetus currently appears stable and non-acidotic, suggesting a transition requiring only minimal support.

Choice H rationale

A Stat Cesarean Section is indicated for non-remediable, persistent Category III FHR tracings, such as absent variability with recurrent late/variable decelerations or a sinusoidal pattern, which indicate severe fetal compromise. The current FHR tracing is Category I (reassuring), with a normal baseline and moderate variability. Therefore, a Stat Cesarean Section is contraindicated and unnecessary; the delivery should proceed vaginally as planned. —. ##

Choice A reason: Fluid restriction is contraindicated in cystic fibrosis. These children are prone to dehydration due to excessive salt loss in sweat. Adequate hydration is essential, especially during infections.

Choice B reason: Physical activity is encouraged in children with cystic fibrosis as it helps improve lung function, mobilize secretions, and enhance overall well-being. Restriction is not recommended unless medically indicated.

Choice C reason: Pancreatic enzyme replacement is critical in cystic fibrosis due to pancreatic insufficiency. Enzymes must be taken with all meals and snacks to aid digestion and nutrient absorption. This is a cornerstone of nutritional management.

Choice D reason: Children with cystic fibrosis require high-calorie, high-protein diets to meet increased metabolic demands and support growth. A low-calorie, low-protein diet would be inappropriate and harmful.