Low Risk Neonatal Nurse Exam Neonatal Jaundice & Hyperbilirubinemia 3

Question 1

Which newborns are considered at highest risk for developing significant hyperbilirubinemia requiring treatment?

Accepted Answer

Late preterm infants (34–36 6/7 weeks), those with hemolytic disease, a prior sibling with jaundice requiring phototherapy, or exclusive breastfeeding with weight loss >10%

Answer

Term infants born via cesarean section with Apgar scores above 7

Answer

Formula-fed full-term infants with no family history of jaundice

Answer

Infants with birth weights above 3,500 grams and no maternal risk factors

Question 2

What is the recommended initial bilirubin screening approach for healthy newborns prior to hospital discharge?

Accepted Answer

Transcutaneous bilirubinometry (TcB) for screening, followed by total serum bilirubin (TSB) confirmation if TcB is elevated or the infant has risk factors

Answer

Visual skin assessment alone using the Kramer scale is sufficient for all term newborns

Answer

Serum bilirubin drawn from cord blood immediately after delivery

Answer

Urine color assessment combined with feeding frequency documentation

Question 3

Per AAP guidelines, a newborn discharged before 72 hours of age should have a follow-up appointment to assess jaundice within what timeframe?

Accepted Answer

1–2 days after hospital discharge

Answer

5–7 days after hospital discharge

Answer

Only if the parents observe yellowing of the skin or eyes at home

Answer

2 weeks after discharge at the routine well-child visit

Question 4

Exchange transfusion for neonatal hyperbilirubinemia is indicated when:

Accepted Answer

TSB reaches levels associated with acute bilirubin encephalopathy or fails to respond adequately to intensive phototherapy

Answer

TSB exceeds the phototherapy threshold by 2 mg/dL despite only 4 hours of treatment

Answer

Any direct bilirubin exceeds 1.5 mg/dL in a term newborn

Answer

TSB is above 15 mg/dL in any breastfed infant regardless of gestational age

Question 5

Which laboratory test result is most useful in distinguishing conjugated (direct) from unconjugated (indirect) hyperbilirubinemia in a jaundiced newborn?

Accepted Answer

Fractionated bilirubin measuring both direct and indirect components

Answer

Complete blood count with differential and reticulocyte count

Answer

Serum albumin level reflecting bilirubin binding capacity

Answer

Liver function tests including ALT and AST

Question 6

A nurse observes jaundice extending to a term newborn's abdomen and thighs (Kramer Zone 3). What is the appropriate next action?

Accepted Answer

Obtain a total serum bilirubin or transcutaneous bilirubin measurement to guide clinical decision-making

Answer

Document the finding and reassess at the next feeding in 3 hours

Answer

Immediately begin phototherapy without awaiting laboratory confirmation

Answer

Discontinue breastfeeding and initiate formula supplementation

Question 7

Which statement accurately describes the difference between conjugated and unconjugated bilirubin in terms of neurotoxicity?

Accepted Answer

Unconjugated (indirect) bilirubin is neurotoxic because it is fat-soluble and can cross the blood-brain barrier and deposit in brain tissue

Answer

Conjugated (direct) bilirubin is the form responsible for kernicterus because it crosses the blood-brain barrier more easily

Answer

Both forms are equally neurotoxic and cause identical patterns of brain injury

Answer

Conjugated bilirubin causes acute encephalopathy while unconjugated bilirubin causes chronic liver disease