RNC-NIC Hematology & Hyperbilirubinemia 2

Question 1

A neonate born to a type O-positive mother is found to be type A-positive and develops jaundice at 18 hours of life. Which condition is the most likely cause?

Accepted Answer

ABO incompatibility

Answer

Physiologic jaundice

Answer

Rh isoimmunization

Answer

Biliary atresia

Question 2

Which nursing intervention is the highest priority when initiating phototherapy for a neonate with hyperbilirubinemia?

Accepted Answer

Apply opaque eye patches securely to protect the retinas

Answer

Keep the neonate swaddled to prevent temperature instability

Answer

Measure TSB every 12 hours regardless of clinical trajectory

Answer

Apply moisturizing lotion to protect skin from the lights

Question 3

How does breastfeeding jaundice differ from breast milk jaundice?

Accepted Answer

Breastfeeding jaundice peaks at days 2-4 from inadequate milk intake; breast milk jaundice peaks at days 5-15 from substances in mature breast milk

Answer

Breastfeeding jaundice peaks at days 5-15 from breast milk substances; breast milk jaundice peaks at days 2-4 from poor intake

Answer

They are the same condition referred to by two different names

Answer

Breast milk jaundice always requires formula supplementation while breastfeeding jaundice does not

Question 4

Intravenous immunoglobulin (IVIG) is administered to neonates with hemolytic hyperbilirubinemia to achieve which therapeutic effect?

Accepted Answer

Block macrophage Fc receptors to reduce antibody-mediated hemolysis

Answer

Directly bind and neutralize bilirubin in the bloodstream

Answer

Replace deficient clotting factors lost during hemolysis

Answer

Stimulate hepatic conjugation of bilirubin

Question 5

A symptomatic neonate with a venous hematocrit of 72%, jitteriness, and respiratory distress is diagnosed with polycythemia. Which treatment is indicated?

Accepted Answer

Partial exchange transfusion using normal saline to dilute the blood

Answer

Packed red blood cell transfusion to replace lost volume

Answer

Intravenous iron dextran to correct the hematologic imbalance

Answer

Simple phlebotomy without volume replacement

Question 6

G6PD deficiency increases a neonate's risk for severe hyperbilirubinemia primarily through which mechanism?

Accepted Answer

Increased hemolysis of red blood cells vulnerable to oxidative stress

Answer

Impaired hepatic conjugation of bilirubin by glucuronosyltransferase

Answer

Decreased albumin-binding capacity for unconjugated bilirubin

Answer

Enhanced enterohepatic recirculation of excreted bilirubin

Question 7

According to AAP guidelines, when is exchange transfusion indicated for a term neonate with hyperbilirubinemia?

Accepted Answer

TSB at or above the exchange transfusion threshold on the Bhutani nomogram, especially with signs of encephalopathy

Answer

Any TSB of 12 mg/dL or greater within the first 48 hours

Answer

Positive DAT regardless of the current TSB level

Answer

TSB of 15 mg/dL or greater within the first 24 hours