A nurse is evaluating morning laboratory values on a group of clients. Which of the following findings indicates a risk for impaired skin integrity?

Choice A reason: Clients do not need provider approval to sign advance directives. Advance directives are legal documents that reflect the client’s autonomy and do not require medical authorization.

Choice B reason: Clients do not need to contact the court to change a living will. They can revise or revoke their advance directives at any time as long as they are competent to make decisions.

Choice C reason: Appointing a health care surrogate is correct. This allows clients to designate someone to make medical decisions on their behalf if they become unable to do so, ensuring their wishes are respected even during periods of impaired judgment.

Choice D reason: Clients are not required to designate a guardian to initiate advance directives. Guardianship is a legal process separate from advance directives and is not necessary unless the client has been deemed legally incompetent.

Choice A reason: Maintaining therapy with the fiber optic pad while allowing parental holding during feedings is correct because it ensures continuous treatment while promoting bonding and feeding. Fiberoptic phototherapy pads are safe to use during holding, and they do not interfere with feeding. This approach balances effective bilirubin reduction with essential parent-infant interaction, which supports emotional well-being and breastfeeding success.

Choice B reason: Discontinuing overhead lights based on stool frequency is incorrect. Increased stooling is a common effect of phototherapy due to bilirubin excretion, but it is not a criterion for discontinuation. Therapy is guided by bilirubin levels and clinical assessment, not stool count. Stopping therapy prematurely could result in rebound hyperbilirubinemia.

Choice C reason: Swaddling the newborn before placing them on the fiber optic pad is inappropriate because swaddling blocks light exposure to the skin, reducing the effectiveness of phototherapy. Direct skin exposure is necessary for maximum bilirubin breakdown.

Choice D reason: Determining the positioning of overhead lights by assessing axillary temperature is incorrect. Temperature monitoring is important to prevent overheating, but light positioning is determined by distance and angle to maximize skin exposure, not by temperature readings.