When should the nurse expect jaundice to be present in a full-term infant with hemolytic disease?
a. At birth
b. Within 24 hours after birth
c. 25 to 48 hours after birth
d. 49 to 72 hours after birth
ANS: B
In hemolytic disease of the infant, jaundice is usually evident within the first 24 hours of life. Infants with hemolytic disease are usually not jaundiced at birth, although some degree of hepatosplenomegaly, pallor, and hypovolemic shock may occur when the most severe form, hydrops fetalis, is present. Twenty-five to 72 hours after birth is too late for hemolytic disease of the infant. Jaundice at these ages is most likely caused by physiologic or early-onset breastfeeding jaundice.
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