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

ABO incompatibility most commonly occurs when a type O mother carries a type A or B neonate; maternal anti-A IgG antibodies cross the placenta, cause hemolysis, and result in early-onset jaundice.

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

Opaque eye patches must be applied correctly before starting phototherapy to protect the neonate's retinas from damage caused by the high-intensity light source.

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 (days 2-4) results from insufficient caloric intake causing dehydration and increased enterohepatic circulation, while breast milk jaundice (days 5-15) is caused by substances in mature breast milk that inhibit hepatic glucuronosyltransferase.

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

IVIG occupies Fc receptors on reticuloendothelial macrophages, preventing them from destroying antibody-coated red blood cells and thereby reducing the rate of hemolysis and bilirubin production.

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

Symptomatic polycythemia is treated with a partial exchange transfusion, removing blood and replacing it with normal saline to reduce the hematocrit to approximately 50-55% and decrease blood viscosity.

(RNC-NIC) Registered Nurse Certified in Neonatal Intensive Care Practice Test

(RNC-NIC) Registered Nurse Certified in Neonatal Intensive Care Practice Test

RNC-NIC Hematology & Hyperbilirubinemia 2