NNP Hematology and Hyperbilirubinemia 2

Question 1

A neonate is being evaluated for exchange transfusion. Which of the following is an absolute indication for emergency exchange transfusion?

Accepted Answer

Signs of acute bilirubin encephalopathy (ABE) with rapidly rising TSB

Answer

Signs of acute bilirubin encephalopathy (lethargy, hypotonia, high-pitched cry, arching) with a rapidly rising TSB are an absolute indication for emergency double-volume exchange transfusion.

Question 2

What volume of blood is used for a double-volume exchange transfusion in a neonate?

Accepted Answer

160 mL/kg

Answer

A double-volume exchange transfusion uses approximately 160 mL/kg (2 × 80 mL/kg blood volume), which exchanges roughly 85–90% of the neonate's red blood cells.

Question 3

Which type of blood product is MOST appropriate for exchange transfusion in a neonate with Rh hemolytic disease?

Accepted Answer

O-negative irradiated CMV-negative red blood cells reconstituted with AB plasma

Answer

O-negative (Rh-negative) irradiated CMV-negative red blood cells reconstituted with AB plasma avoids further hemolysis from maternal anti-D antibodies and is safe for all neonates regardless of blood type.

Question 4

A neonate receiving intensive phototherapy has a TSB that rises by 1 mg/dL in 6 hours despite treatment. What is the MOST appropriate next action?

Accepted Answer

Begin intravenous immunoglobulin (IVIG) therapy

Answer

IVIG (0.5–1 g/kg) is recommended for isoimmune hemolytic disease (Rh or ABO) when the TSB is rising despite intensive phototherapy, as it reduces hemolysis by blocking Fc receptors on macrophages.

Question 5

Which complication is MOST commonly associated with exchange transfusion in neonates?

Accepted Answer

Thrombocytopenia and metabolic acidosis

Answer

Exchange transfusion commonly causes thrombocytopenia (platelet dilution), metabolic acidosis (citrate in donor blood), as well as hypocalcemia, hypoglycemia, and electrolyte disturbances.

Neonatal Nurse Practitioner Exam Practice Test

Neonatal Nurse Practitioner Exam Practice Test

NNP Hematology and Hyperbilirubinemia 2