Low Risk Neonatal Nurse Exam Neonatal Jaundice & Hyperbilirubinemia 2

Question 1

What defines 'physiologic jaundice' in a full-term newborn?

Accepted Answer

Jaundice appearing after 24 hours, peaking around days 3–5, and resolving by 2 weeks of age

Answer

Jaundice appearing within the first 24 hours of life

Answer

Any jaundice requiring phototherapy

Answer

Jaundice caused by ABO or Rh blood group incompatibility

Question 2

What does a positive direct antiglobulin test (DAT/Coombs) indicate in a jaundiced newborn?

Accepted Answer

Maternal antibodies are attached to the infant's red blood cells, indicating immune-mediated hemolysis

Answer

The infant has elevated unconjugated bilirubin from hepatic immaturity

Answer

The infant has G6PD deficiency

Answer

Sepsis is the cause of the jaundice

Question 3

How does breast milk jaundice differ from breastfeeding (insufficient intake) jaundice?

Accepted Answer

Breastfeeding jaundice occurs in the first week from inadequate intake; breast milk jaundice appears after day 5–7 and may persist several weeks from substances in mature breast milk

Answer

Breast milk jaundice occurs in the first week due to inadequate milk intake; breastfeeding jaundice occurs after week 2

Answer

Both conditions occur at the same time and have identical causes

Answer

Breast milk jaundice requires immediate formula substitution; breastfeeding jaundice resolves without intervention

Question 4

How is bilirubin normally processed and eliminated in the newborn?

Accepted Answer

Conjugated by glucuronyl transferase in the liver, excreted in bile, and eliminated in stool

Answer

Filtered by the kidneys and excreted directly into urine in unconjugated form

Answer

Bound to hemoglobin and recycled by the spleen

Answer

Converted to urobilinogen in the bloodstream and filtered by the lungs

Question 5

Which essential nursing intervention must be maintained throughout phototherapy treatment?

Accepted Answer

Applying protective eye shields and keeping them in place during all light exposure

Answer

Wrapping the infant snugly in blankets to maintain temperature

Answer

Positioning the infant prone to maximize skin surface exposure

Answer

Restricting oral fluids to prevent bilirubin reabsorption in the gut

Question 6

A newborn's total serum bilirubin is rising faster than 0.5 mg/dL per hour. This rate of rise is most consistent with:

Accepted Answer

Hemolytic disease requiring urgent evaluation and possible intensive phototherapy or exchange transfusion

Answer

Normal physiologic jaundice in a breastfed infant

Answer

Breast milk jaundice beginning in the second week

Answer

Benign neonatal polycythemia resolving spontaneously

Question 7

What is the enterohepatic recirculation of bilirubin, and why is it clinically significant in neonates?

Accepted Answer

The reabsorption of unconjugated bilirubin from the intestine back into the bloodstream, which is enhanced in neonates due to beta-glucuronidase activity and delayed stooling

Answer

The process by which phototherapy metabolizes bilirubin in the skin, reducing the need for hepatic conjugation

Answer

The circulation of conjugated bilirubin through the bile duct system

Answer

The binding of bilirubin to albumin in hepatic sinusoids