The RN in the newborn nursery is reviewing the newborn’s chart and notices that the bilirubin levels are elevated. What intervention should the nurse perform next?

Correct Answer: D

Rationale: The correct answer is D because elevated bilirubin levels in newborns indicate jaundice, which can lead to complications if not treated promptly. Phototherapy helps break down bilirubin and is the first-line treatment for neonatal jaundice. Applying phototherapy as per hospital protocol is essential to decrease bilirubin levels. Notifying the physician is also crucial for ongoing monitoring and management. Choice A (Place the patient NPO and notify a physician) is incorrect because NPO status is not necessary for managing neonatal jaundice, and phototherapy is the primary intervention. Choice B (Weigh the patient to see if weight loss has occurred) is incorrect because weight loss is not directly related to elevated bilirubin levels in newborns. Choice C (Take the newborn’s vital signs and report to the physician) is incorrect because while vital signs are important, the immediate intervention for elevated bilirubin levels is phototherapy to prevent complications.

Correct Answer: B

Rationale: The correct answer is B because a 5-day-old term newborn with bilirubin levels of 13 mg/dL and exclusively breastfeeding is at higher risk for developing physiological jaundice. Breastfeeding jaundice occurs due to inadequate milk intake leading to limited bowel movements, causing reabsorption of bilirubin. The other choices are incorrect because: A has normal bilirubin levels and is bottle feeding, which is less likely to cause jaundice. C is a premature baby with low bilirubin levels and meconium passage. D is a term newborn with high bilirubin levels but is breastfed frequently, reducing the risk of jaundice.

Correct Answer: D

Rationale: The correct answer is D: Cord blood gas. When the mother has Rh type O blood and the newborn's Apgar score is low, it indicates potential oxygenation issues during birth. Cord blood gas analysis is crucial to assess the newborn's oxygenation status and acid-base balance. A low Apgar score suggests the need to evaluate the newborn's respiratory and metabolic functions, which can be done through cord blood gas analysis. A: Cardiac enzymes - Not relevant in this scenario as the focus is on oxygenation and respiratory function, not cardiac issues. B: Blood glucose - Not directly related to the situation described, as low Apgar score and Rh blood type are more indicative of oxygenation and potential Rh incompatibility. C: Electrolyte panel - While electrolyte imbalance is important, cord blood gas analysis provides more immediate information on oxygenation and acid-base balance, which are crucial in low Apgar score situations.

Correct Answer: C

Rationale: The correct answer is C. Placing the infant directly on the scale for weight measurement is incorrect as it can lead to inaccurate results due to factors like clothing or diaper weight. The correct method is to weigh the infant without clothing and then subtract the weight of the diaper. A: Heel stick method for blood glucose is appropriate. B: Placing an infant on phototherapy after swaddling is acceptable practice. D: Performing Ortolani and Barlow maneuvers in the supine position is also correct.

Correct Answer: D

Rationale: The correct answer is D: Decline in fetal erythrocytes around 2 months of age. Physiological anemia of infancy occurs around 2-3 months of age due to a natural decline in fetal erythrocytes. This decline is a normal process as the infant's body adjusts to extrauterine life. A: Gestational diabetes leading to LGA in the infant is unrelated to physiological anemia. B: Hypervolemia from maternal bleeding is not a known cause of physiological anemia in infants. C: Red blood cell death every 15 days is not a recognized physiological process leading to anemia in infants. In summary, the correct answer is D because it directly addresses the natural decline in fetal erythrocytes that occurs around 2 months of age, leading to physiological anemia of infancy. The other choices are incorrect as they do not provide a relevant explanation for the occurrence of physiological anemia in infants.