# Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU) of a government hospital. She is responsible for newborn screening and for the unit's newborn screening records. The mother of a healthy term newborn who is 30 hours old declines newborn screening. She says, "We cannot afford another bill, and he looks healthy anyway." The family is a PhilHealth member. What should the nurse do? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=629458 > language: ko > subject: Nursing Practice II — Maternal and Child Health Nursing ## 문제 Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU) of a government hospital. She is responsible for newborn screening and for the unit's newborn screening records. The mother of a healthy term newborn who is 30 hours old declines newborn screening. She says, "We cannot afford another bill, and he looks healthy anyway." The family is a PhilHealth member. What should the nurse do? ## 보기 1. Schedule the test for the first clinic visit, when the family can pay 2. Have the mother sign a refusal form stating her reason for declining 3. Explain what screening detects and that PhilHealth benefits cover it **✔ 정답** 4. Collect the sample as scheduled, since the law makes screening mandatory **정답: 3** ## 해설 RA 9288 requires health practitioners to inform parents about newborn screening, and parents may refuse only on religious grounds with a written refusal. This mother's reasons are cost and the belief that a healthy-looking baby needs no test. The nurse explains that screening finds disorders before symptoms appear and that PhilHealth benefits cover it, then collects the sample within the 3-day window with her agreement. ## 심화 해설 Address the reason for refusal first The Newborn Screening Act of 2004 (RA 9288) requires health practitioners to inform parents about newborn screening. Parents may refuse screening only on religious grounds, and the refusal must be in writing. This mother's reasons are cost and the belief that a baby who looks healthy needs no test. Neither is a religious objection, and both come from a gap in information. The nurse explains what screening detects and that PhilHealth benefits cover it, then collects the sample with the mother's agreement. Why information changes the decision Newborn screening looks for disorders, such as congenital hypothyroidism and certain metabolic conditions, that cause no visible signs in the first days but can lead to intellectual disability or death if untreated. Key point! The whole purpose of screening is to find disease before symptoms appear, so a healthy appearance is not a reason to skip it. The family is a PhilHealth member, and newborn screening is part of the PhilHealth newborn care benefit, which removes the cost barrier. The timing window The sample is collected after 24 hours of life and not later than 3 days after birth. The baby is now 30 hours old, which is within the ideal window. Scheduling the test for a later clinic visit risks missing this window and delaying diagnosis of a treatable condition. Why the other options are wrong Having the mother sign a refusal form skips the education the law requires and accepts a reason that is not a legal ground for refusal. Collecting the sample over her objection because screening is mandatory ignores informed agreement; a procedure performed over a parent's objection can be considered battery. Postponing until the family can pay is unnecessary because the cost is covered, and it risks missing the collection window. Exam takeaway Under RA 9288, refusal is allowed only on religious grounds and in writing; any other reason calls for education first. Watch out! Do not jump to a refusal form or to forced testing. The nurse's first action is to correct the misunderstanding, then collect the sample within the window with the parent's agreement. ## 임상 시나리오 Parent Declines Newborn ScreeningCost concern in a PhilHealth member family Under RA 9288, parents may refuse newborn screening only on religious grounds, in writing. Cost and a healthy appearance are not such grounds. Explain that screening detects serious disorders before symptoms appear and that PhilHealth benefits cover the test. Collect the heel sample after 24 hours and not later than 3 days of life, with the mother's agreement. CautionDo not collect over the parent's objection and do not accept a nonreligious refusal before giving full information. ## 핵심 개념 - **RA 9288** — The Newborn Screening Act of 2004, requiring practitioners to inform parents about and offer newborn screening. - **Newborn screening** — A blood test from a heel prick that detects treatable congenital disorders before symptoms appear. - **PhilHealth** — The Philippine Health Insurance Corporation, the national health insurer whose newborn care benefit covers screening. - **Battery** — Unconsented physical contact or procedure performed on a person. ## 같은 주제 문제 - [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629456) - [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629457) - [Situation: A nurse works in the newborn nursery and the neonatal intensive care unit (NICU…](https://mymerci.kr/pages/nclex_q.php?qn_id=629459) - [Situation: A nurse works on the pediatric ward of a tertiary hospital, where children weig…](https://mymerci.kr/pages/nclex_q.php?qn_id=629460) - [Situation: A nurse works on the pediatric ward of a tertiary hospital, where children weig…](https://mymerci.kr/pages/nclex_q.php?qn_id=629461) - [Situation: A nurse works on the pediatric ward of a tertiary hospital, where children weig…](https://mymerci.kr/pages/nclex_q.php?qn_id=629462) - [Situation: A nurse works in the clinic of a public integrated school that has both element…](https://mymerci.kr/pages/nclex_q.php?qn_id=629463) - [Situation: A nurse works in the clinic of a public integrated school that has both element…](https://mymerci.kr/pages/nclex_q.php?qn_id=629464) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._