The nurse in the neonate nursery notices a neonate, born 45 minutes ago, is unresponsive to external stimuli, and has a respiratory and heart rate below normal range. Which action does the nurse take?

Correct Answer: B

Rationale: The correct answer is B because newborns typically go through a period of deep sleep immediately after birth. This state is characterized by decreased responsiveness to external stimuli and lower respiratory and heart rates. It is important for the nurse to allow the neonate to naturally continue deep sleep as this is a normal physiological process. Picking up the neonate (choice A) may disrupt this important sleep state. Asking another nurse for assistance (choice C) may not be necessary at this point as the neonate's condition is likely normal. Notifying the caregiver (choice D) may cause unnecessary alarm as the neonate is most likely exhibiting normal behavior for this stage.

Correct Answer: D

Rationale: The correct answer is D because the nurse does not mention the term "hyperbilirubinemia" to the mother. Instead, the nurse focuses on explaining the high level of unconjugated bilirubin causing jaundice. A: The nurse likely mentioned that the blood test does not indicate a pathological disease to reassure the mother that jaundice is a common condition in newborns. B: The nurse would have explained that the newborn's liver converts bilirubin to a water-soluble substance as part of the discussion on how bilirubin is processed in the body. C: An abundance of RBCs and their short lifespan contributing to jaundice would be relevant information that the nurse would provide to explain the underlying causes of the condition.

Correct Answer: A

Rationale: The correct answer is A because avoiding bottles helps maintain the baby's preference for breastfeeding, leading to a higher likelihood of continuing beyond 6 months. Using formula for every other feeding (choice B) introduces a different feeding method, potentially reducing breastfeeding duration. Offering water or formula after breastfeeding (choice C) can reduce the baby's interest in breastfeeding exclusively. A satisfied baby for 4 hours after feeding (choice D) does not necessarily indicate a longer breastfeeding duration as other factors like feeding frequency play a role.

Correct Answer: B

Rationale: The correct answer is B (100 to 110 kcal/kg). Full-term formula-fed infants need around 100 to 110 kcal/kg per day for optimal growth and development. This amount is tailored to meet their energy requirements and support proper weight gain. Choices A, C, and D are incorrect because they either fall below or exceed the recommended range for infants. Option A (50 to 75 kcal/kg) is too low, which may lead to inadequate energy intake. Option C (120 to 140 kcal/kg) and Option D (150 to 200 kcal/kg) are too high, potentially causing excessive weight gain or metabolic issues. Therefore, option B is the most suitable and balanced choice for meeting the energy needs of formula-fed infants.

Correct Answer: A

Rationale: The correct answer is A because assessing the woman's knowledge of breastfeeding is crucial to understand her current understanding and skill level. By doing so, the tutor can identify any misconceptions or gaps in knowledge that need to be addressed. This step lays the foundation for providing tailored education and support to the mother. Choice B is incorrect because providing instruction on the composition of breast milk is informative but not the first step in assisting the breastfeeding mother. Choice C is incorrect as discussing hormonal changes is important but not the initial step. Choice D is incorrect because helping the mother obtain a comfortable position and placing the infant to the breast should come after assessing her knowledge to ensure effective nursing.