RNC-NIC Hematology & Hyperbilirubinemia 3

Question 1

Which condition is one of the most common causes of neonatal thrombocytopenia in the NICU?

Accepted Answer

Neonatal alloimmune thrombocytopenia (NAIT) or maternal immune thrombocytopenia (ITP)

Answer

Polycythemia vera

Answer

Physiologic jaundice

Answer

Anemia of prematurity

Question 2

What is the primary clinical purpose of measuring the reticulocyte count in a neonate with suspected anemia?

Accepted Answer

To assess bone marrow response and differentiate hemolytic from hypoproliferative anemia

Answer

To determine the neonate's blood type and Rh factor

Answer

To measure the total serum bilirubin indirectly

Answer

To evaluate for clotting factor deficiencies

Question 3

A neonate receiving phototherapy develops a gray-brown discoloration of the skin, urine, and serum. Which condition does this indicate?

Accepted Answer

Bronze baby syndrome associated with elevated conjugated bilirubin

Answer

Cyanosis from worsening respiratory status

Answer

A normal expected response to phototherapy

Answer

Meconium staining of the skin from in utero passage

Question 4

Which blood product is preferred for exchange transfusion in a neonate with Rh hemolytic disease of the newborn?

Accepted Answer

O-negative, irradiated, CMV-negative PRBCs reconstituted with AB-positive plasma

Answer

Type-specific fresh frozen plasma alone

Answer

Random donor platelets in normal saline

Answer

Unirradiated type A-positive PRBCs reconstituted with O plasma

Question 5

Which maternal condition most commonly causes neonatal polycythemia through the mechanism of chronic fetal hypoxia?

Accepted Answer

Maternal hypertension with placental insufficiency

Answer

Maternal hypothyroidism

Answer

Poorly controlled maternal diabetes mellitus with macrosomia

Answer

Maternal Group B Streptococcus colonization

Question 6

During a PRBC transfusion, a neonate develops a temperature of 38.3°C and urticarial rash. Which is the nurse's priority action?

Accepted Answer

Stop the transfusion immediately and notify the provider

Answer

Slow the transfusion rate and administer acetaminophen

Answer

Continue the transfusion and obtain a stat CBC

Answer

Administer diphenhydramine and resume the transfusion after 15 minutes

Question 7

Which finding most reliably indicates that intensive phototherapy is effective in a neonate with hyperbilirubinemia?

Accepted Answer

Decrease in total serum bilirubin of at least 1-2 mg/dL within the first 4-6 hours of therapy

Answer

Rising direct bilirubin with a stable indirect bilirubin level

Answer

Stable TSB with no further increase after 12 hours of phototherapy

Answer

Normalization of the reticulocyte count within 24 hours