NNP Hematology and Hyperbilirubinemia 3

Question 1

A term neonate has a central hematocrit of 68% at 12 hours of age and is asymptomatic. What is the MOST appropriate management?

Accepted Answer

Partial exchange transfusion only if symptomatic or hematocrit ≥65% with symptoms

Answer

Partial exchange transfusion is recommended for neonatal polycythemia only when symptomatic (respiratory distress, hypoglycemia, jitteriness) or when the hematocrit exceeds 65–70% with clinical concerns; asymptomatic infants can be monitored.

Question 2

Which of the following is the MOST common cause of anemia in a preterm neonate in the first week of life?

Accepted Answer

Iatrogenic blood loss from phlebotomy

Answer

Iatrogenic anemia from repeated phlebotomy for laboratory testing is the most common cause of anemia in preterm neonates in the NICU, often exceeding the neonate's total blood volume over a hospital stay.

Question 3

What hematocrit threshold typically triggers packed red blood cell (pRBC) transfusion in a clinically stable preterm neonate on minimal respiratory support?

Accepted Answer

Hematocrit < 25% with symptoms or < 21% if asymptomatic

Answer

Current evidence-based guidelines suggest transfusion thresholds of approximately Hct < 25% with symptoms of anemia or Hct < 21% in stable, asymptomatic preterm neonates on minimal support.

Question 4

A neonate born via emergency cesarean section for placental abruption presents at 10 minutes of life with pallor, poor perfusion, and a hematocrit of 28%. Which diagnosis should be suspected?

Accepted Answer

Acute fetal-maternal hemorrhage or abruptio placentae causing hypovolemic anemia

Answer

Placental abruption can cause acute fetal blood loss into the maternal circulation or retroplacental clot, presenting as hypovolemic shock with pallor, poor perfusion, and low hematocrit at birth.

Question 5

Which coagulation profile is most consistent with Disseminated Intravascular Coagulation (DIC) in a neonate?

Accepted Answer

Elevated PT, elevated aPTT, low fibrinogen, low platelets, elevated D-dimers

Answer

DIC is characterized by consumption of clotting factors and platelets, resulting in elevated PT, elevated aPTT, low fibrinogen, thrombocytopenia, and elevated D-dimers from fibrinolysis.

Neonatal Nurse Practitioner Exam Practice Test

Neonatal Nurse Practitioner Exam Practice Test

NNP Hematology and Hyperbilirubinemia 3