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

Late preterm infants have immature liver conjugation; hemolytic disease accelerates bilirubin production; prior sibling history and breastfeeding struggles are validated risk factors in AAP guidelines.

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

TcB is a non-invasive screening tool, but TSB is required to confirm elevated results and guide treatment decisions, as TcB can underestimate levels in certain infants.

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

The AAP recommends that newborns discharged before 72 hours be seen within 1–2 days because bilirubin peaks between days 3–5, and early detection prevents progression to dangerous levels.

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

Exchange transfusion is a last-resort intervention reserved for critically elevated bilirubin levels near the encephalopathy threshold or when intensive phototherapy has failed to prevent neurologic injury.

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

Fractionated bilirubin separates total bilirubin into direct (conjugated) and indirect (unconjugated) components; elevated direct bilirubin (>1 mg/dL or >20% of total) indicates cholestasis and requires separate investigation.

Low Risk Neonatal Nurse Exam Practice Test

Low Risk Neonatal Nurse Exam Practice Test

Low Risk Neonatal Nurse Exam Neonatal Jaundice & Hyperbilirubinemia 3