A nurse is assessing a newborn who was born at 35 weeks of gestation and has physiologic jaundice.

Which of the following factors increases the risk of hyperbilirubinemia in this newborn?

Prematurity

Breastfeeding

Asian ethnicity

All of the above.

Answer and Explanation

The Correct Answer is D

All of the above factors increase the risk of hyperbilirubinemia in this newborn. Hyperbilirubinemia is a condition of high levels of bilirubin in the blood that can cause jaundice and brain damage.

Choice A is wrong because prematurity is a risk factor for hyperbilirubinemia, especially in babies born before 38 weeks of gestation. Premature babies have immature livers that are less able to process bilirubin and eliminate it from the body.

Choice B is wrong because breastfeeding is a risk factor for hyperbilirubinemia, particularly in some breast-fed babies who do not get enough milk or calories. Breastfeeding can also cause increased enterohepatic circulation of bilirubin, which means that bilirubin is reabsorbed from the intestines into the bloodstream instead of being excreted in the stool.

Choice C is wrong because Asian ethnicity is a risk factor for hyperbilirubinemia, as some Asian populations have higher rates of glucose-6-phosphate dehydrogenase deficiency, a genetic condition that causes red blood cells to break down more easily and release more bilirubin. Asian infants may also have lower levels of uridine diphosphate glucuronosyltransferase, an enzyme that helps convert bilirubin into a form that can be excreted by the liver.

Normal ranges for bilirubin levels vary depending on the age, weight, and health status of the newborn. Generally, bilirubin levels peak between the third and seventh day after birth and then decline gradually. The AAP recommends using a nomogram based on the infant’s age in hours and serum bilirubin level to determine the risk of severe hyperbilirubinemia and the need for treatment. Treatment options include phototherapy and exchange transfusion.

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Correct Answer is A

Explanation

This is because phototherapy can damage the baby’s eyes and cause retinal injury.Eye pads should be used to protect the baby’s eyes from the light and should be removed every 4 hours to check for infection or injury.

Choice B is wrong because turning the lights off for ten minutes every hour would reduce the effectiveness of phototherapy and prolong the treatment time.Phototherapy aims to expose the baby’s skin to as much light as possible.

Choice C is wrong because clothing the baby in a shirt and diaper only would limit the amount of skin exposed to the light.The baby should be naked or wear only a diaper during phototherapy.

Choice D is wrong because tightly swaddling the baby in a baby blanket would also limit the amount of skin exposed to the light and increase the risk of overheating.The baby should be loosely wrapped or uncovered during phototherapy.

Correct Answer is B

Explanation

This is because phototherapy can cause dehydration and increase insensible water loss, so covering the genitalia can prevent excessive fluid loss and maintain thermoregulation.

Some possible explanations for the other choices are:

• Choice A is wrong because monitoring skin temperature every hour is not enough to prevent hyperthermia or hypothermia during phototherapy.The skin temperature should be monitored continuously or at least every 15 minutes.

• Choice C is wrong because repositioning newborn every 4 hours is not frequent enough to prevent pressure ulcers, skin breakdown, or eye damage from the light source.The newborn should be repositioned at least every 2 hours.

• Choice D is wrong because encouraging parent-infant interaction as tolerated is not a specific intervention for phototherapy.

While parent-infant interaction is important for bonding and development, it should not interfere with the effectiveness of phototherapy.The newborn should be exposed to the light as much as possible, except for feeding and diaper changes.

Normal ranges for serum bilirubin levels vary depending on the age, gestational age, and risk factors of the newborn.Generally, the levels should be below 5 mg/dL for term infants and below 7 mg/dL for preterm infants by the fifth day of life.

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A nurse is assessing a newborn who was born at 35 weeks of gestation and has physiologic jaundice. Which of the following factors increases the risk of hyperbilirubinemia in this newborn?

Nursing Test Bank

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A nurse is assessing a newborn who was born at 35 weeks of gestation and has physiologic jaundice.

Which of the following factors increases the risk of hyperbilirubinemia in this newborn?