Low Risk Neonatal Nurse Exam Neonatal Jaundice & Hyperbilirubinemia 1 — Questions and Answers
Question 1: Jaundice appearing within the first 24 hours of life is always considered:
- Physiologic and expected
- Pathologic and requiring immediate evaluation (Correct answer)
- A sign of normal liver maturation
- Benign if the infant is feeding well
Correct answer: Pathologic and requiring immediate evaluation
Jaundice in the first 24 hours is always pathologic, most commonly due to hemolytic disease such as ABO or Rh incompatibility, and requires urgent evaluation.
Question 2: Which tool provides hour-specific bilirubin thresholds to guide phototherapy decisions in newborns?
- APGAR scoring system
- Bhutani nomogram (hour-specific bilirubin nomogram) (Correct answer)
- Dubowitz score
- Ballard gestational age scale
Correct answer: Bhutani nomogram (hour-specific bilirubin nomogram)
The Bhutani nomogram plots total serum bilirubin against postnatal age in hours and risk category to determine when phototherapy or further evaluation is needed.
Question 3: What is the primary mechanism by which phototherapy reduces neonatal hyperbilirubinemia?
- Increases albumin binding capacity for bilirubin
- Converts unconjugated bilirubin into water-soluble isomers that can be excreted without hepatic conjugation (Correct answer)
- Stimulates hepatic glucuronyl transferase activity
- Increases renal bilirubin clearance
Correct answer: Converts unconjugated bilirubin into water-soluble isomers that can be excreted without hepatic conjugation
Phototherapy uses light energy to convert unconjugated bilirubin (lumirubin and photo-isomers) into water-soluble forms excreted in bile and urine without liver conjugation.
Question 4: Which mother-infant blood type combination most commonly causes ABO incompatibility hemolytic disease?
- Mother type A, infant type B
- Mother type O, infant type A or B (Correct answer)
- Mother type AB, infant type O
- Mother type B, infant type A
Correct answer: Mother type O, infant type A or B
Type O mothers naturally carry anti-A and anti-B IgG antibodies that can cross the placenta and hemolyze red blood cells of a type A or B infant.
Question 5: What is kernicterus?
- A specialized phototherapy device for treating severe jaundice
- Bilirubin-induced neurological dysfunction resulting from unconjugated bilirubin crossing the blood-brain barrier (Correct answer)
- A complication of exchange transfusion in neonates
- A genetic enzyme deficiency causing prolonged neonatal jaundice
Correct answer: Bilirubin-induced neurological dysfunction resulting from unconjugated bilirubin crossing the blood-brain barrier
Kernicterus refers to the chronic neurological damage caused by high levels of unconjugated bilirubin depositing in brain tissue, potentially causing cerebral palsy, hearing loss, and cognitive impairment.
Question 6: Which feeding practice is most effective in reducing physiologic jaundice in breastfed newborns?
- Supplementing every other feeding with formula
- Restricting feedings to every 4–6 hours to allow intestinal rest
- Frequent breastfeeding 8–12 times per day to promote meconium passage and reduce enterohepatic recirculation (Correct answer)
- Delaying breastfeeding until bilirubin peaks and begins declining
Correct answer: Frequent breastfeeding 8–12 times per day to promote meconium passage and reduce enterohepatic recirculation
Frequent breastfeeding stimulates meconium passage, which reduces enterohepatic recirculation of bilirubin, lowering serum bilirubin levels.
Question 7: The Kramer scale is used by neonatal nurses to assess what?
- Gestational age based on physical and neuromuscular maturity
- The cephalocaudal progression of jaundice from the head downward to estimate bilirubin level (Correct answer)
- Severity of neonatal respiratory distress syndrome
- Level of neonatal pain during procedures
Correct answer: The cephalocaudal progression of jaundice from the head downward to estimate bilirubin level
The Kramer scale divides the body into five zones (head to soles of feet), with jaundice progressing caudally; higher zones correlate with higher estimated serum bilirubin levels.
Low Risk Neonatal Nurse Exam Neonatal Jaundice & Hyperbilirubinemia 1
Jaundice appearing within the first 24 hours of life is always considered: