Newborn Transition: Practice Test 2 (Units 8-13) - Questions
with Correct Answers
100 questions
1. Under the 2022 AAP guideline, phototherapy thresholds are determined by:
A. The infant's age in hours, gestational age and the presence of neurotoxicity risk factors
B. Only the infant's weight
C. Only the mother's age
D. Only skin color
Correct Answer: A. The infant's age in hours, gestational age and the presence of
neurotoxicity risk factors
Rationale: Hour-specific nomograms adjusted for gestational age and risk factors guide
treatment. Weight, maternal age and color alone are not used.
2. Enterohepatic circulation contributes to newborn jaundice when:
A. Conjugated bilirubin in the intestine is deconjugated and reabsorbed, especially when
stooling is delayed
B. Bilirubin is excreted rapidly in stool
C. The infant feeds frequently
D. Meconium passes early
Correct Answer: A. Conjugated bilirubin in the intestine is deconjugated and reabsorbed,
especially when stooling is delayed
Rationale: Beta-glucuronidase in the newborn gut and delayed meconium passage allow
reabsorption. Frequent feeding and stooling reduce it.
,3. ABO incompatibility causing hemolysis is most likely when the mother has blood type:
A. AB and the infant is O
B. A and the infant is A
C. O and the infant has type A or B
D. B and the infant is B
Correct Answer: C. O and the infant has type A or B
Rationale: Type O mothers have anti-A and anti-B IgG antibodies that can cross the placenta.
Matching types do not cause ABO incompatibility.
4. Rh hemolytic disease of the newborn occurs when:
A. An Rh-positive mother has an Rh-negative infant
B. Both are Rh-positive
C. An Rh-negative mother sensitized to Rh antigen produces antibodies that destroy the
Rh-positive infant's red cells
D. The infant has type O blood
Correct Answer: C. An Rh-negative mother sensitized to Rh antigen produces antibodies that
destroy the Rh-positive infant's red cells
Rationale: Rh immune globulin given to Rh-negative mothers prevents sensitization. The other
combinations do not cause Rh disease.
5. Transitional stools in the first days of life are:
A. Greenish-brown to yellowish-brown and looser, as feeding begins
B. Black and tarry for weeks
C. Clay-colored
D. Always formed
Correct Answer: A. Greenish-brown to yellowish-brown and looser, as feeding begins
Rationale: As milk is digested, stools change from meconium to transitional stools. Clay-colored
stools are abnormal.
,6. Physiologic jaundice in a term newborn occurs partly because:
A. Newborns have too few red cells
B. Newborns have a higher red cell mass, shorter red cell lifespan and immature liver
conjugation
C. The liver is overly mature
D. Bilirubin is not produced
Correct Answer: B. Newborns have a higher red cell mass, shorter red cell lifespan and
immature liver conjugation
Rationale: Increased bilirubin production and reduced clearance combine to cause jaundice. It
is common in healthy infants.
7. Meconium ileus in a newborn is strongly associated with:
A. Down syndrome only
B. Cystic fibrosis
C. Hip dysplasia
D. Hypothyroidism only
Correct Answer: B. Cystic fibrosis
Rationale: Thick meconium obstructs the ileum in many infants with CF, so testing is indicated.
The other conditions are not the typical association.
8. In healthy term newborns, physiologic jaundice typically peaks at about:
A. The first hour
B. Day 3 to 5 of life
C. Day 30
D. Day 60
Correct Answer: B. Day 3 to 5 of life
Rationale: Bilirubin rises after 24 hours, peaks in the first week and declines. Peak timing may
be later in preterm and Asian infants.
, 9. Pale or clay-colored stools and dark urine in a jaundiced infant may indicate:
A. Normal breastfeeding stools
B. Cholestasis such as biliary atresia, requiring urgent evaluation
C. Physiologic jaundice
D. Too much formula
Correct Answer: B. Cholestasis such as biliary atresia, requiring urgent evaluation
Rationale: Biliary atresia must be diagnosed early for surgery to be effective. Stool color cards
help parents recognize pale stools.
10. Conjugated (direct) bilirubin elevation in a newborn is:
A. Normal physiologic jaundice
B. Never physiologic and requires evaluation for liver or biliary disease
C. Caused only by breastfeeding
D. Treated with sunlight
Correct Answer: B. Never physiologic and requires evaluation for liver or biliary disease
Rationale: Elevated conjugated bilirubin indicates cholestasis. Physiologic jaundice is
unconjugated.
11. Ceftriaxone is generally avoided in jaundiced newborns because it:
A. Lowers bilirubin too quickly
B. Causes polycythemia
C. Displaces bilirubin from albumin, increasing free bilirubin that can enter the brain
D. Increases albumin
Correct Answer: C. Displaces bilirubin from albumin, increasing free bilirubin that can enter
the brain
Rationale: Drugs that compete for albumin binding raise the risk of bilirubin toxicity, and
ceftriaxone can also precipitate with calcium in neonates. Other antibiotics are preferred.
with Correct Answers
100 questions
1. Under the 2022 AAP guideline, phototherapy thresholds are determined by:
A. The infant's age in hours, gestational age and the presence of neurotoxicity risk factors
B. Only the infant's weight
C. Only the mother's age
D. Only skin color
Correct Answer: A. The infant's age in hours, gestational age and the presence of
neurotoxicity risk factors
Rationale: Hour-specific nomograms adjusted for gestational age and risk factors guide
treatment. Weight, maternal age and color alone are not used.
2. Enterohepatic circulation contributes to newborn jaundice when:
A. Conjugated bilirubin in the intestine is deconjugated and reabsorbed, especially when
stooling is delayed
B. Bilirubin is excreted rapidly in stool
C. The infant feeds frequently
D. Meconium passes early
Correct Answer: A. Conjugated bilirubin in the intestine is deconjugated and reabsorbed,
especially when stooling is delayed
Rationale: Beta-glucuronidase in the newborn gut and delayed meconium passage allow
reabsorption. Frequent feeding and stooling reduce it.
,3. ABO incompatibility causing hemolysis is most likely when the mother has blood type:
A. AB and the infant is O
B. A and the infant is A
C. O and the infant has type A or B
D. B and the infant is B
Correct Answer: C. O and the infant has type A or B
Rationale: Type O mothers have anti-A and anti-B IgG antibodies that can cross the placenta.
Matching types do not cause ABO incompatibility.
4. Rh hemolytic disease of the newborn occurs when:
A. An Rh-positive mother has an Rh-negative infant
B. Both are Rh-positive
C. An Rh-negative mother sensitized to Rh antigen produces antibodies that destroy the
Rh-positive infant's red cells
D. The infant has type O blood
Correct Answer: C. An Rh-negative mother sensitized to Rh antigen produces antibodies that
destroy the Rh-positive infant's red cells
Rationale: Rh immune globulin given to Rh-negative mothers prevents sensitization. The other
combinations do not cause Rh disease.
5. Transitional stools in the first days of life are:
A. Greenish-brown to yellowish-brown and looser, as feeding begins
B. Black and tarry for weeks
C. Clay-colored
D. Always formed
Correct Answer: A. Greenish-brown to yellowish-brown and looser, as feeding begins
Rationale: As milk is digested, stools change from meconium to transitional stools. Clay-colored
stools are abnormal.
,6. Physiologic jaundice in a term newborn occurs partly because:
A. Newborns have too few red cells
B. Newborns have a higher red cell mass, shorter red cell lifespan and immature liver
conjugation
C. The liver is overly mature
D. Bilirubin is not produced
Correct Answer: B. Newborns have a higher red cell mass, shorter red cell lifespan and
immature liver conjugation
Rationale: Increased bilirubin production and reduced clearance combine to cause jaundice. It
is common in healthy infants.
7. Meconium ileus in a newborn is strongly associated with:
A. Down syndrome only
B. Cystic fibrosis
C. Hip dysplasia
D. Hypothyroidism only
Correct Answer: B. Cystic fibrosis
Rationale: Thick meconium obstructs the ileum in many infants with CF, so testing is indicated.
The other conditions are not the typical association.
8. In healthy term newborns, physiologic jaundice typically peaks at about:
A. The first hour
B. Day 3 to 5 of life
C. Day 30
D. Day 60
Correct Answer: B. Day 3 to 5 of life
Rationale: Bilirubin rises after 24 hours, peaks in the first week and declines. Peak timing may
be later in preterm and Asian infants.
, 9. Pale or clay-colored stools and dark urine in a jaundiced infant may indicate:
A. Normal breastfeeding stools
B. Cholestasis such as biliary atresia, requiring urgent evaluation
C. Physiologic jaundice
D. Too much formula
Correct Answer: B. Cholestasis such as biliary atresia, requiring urgent evaluation
Rationale: Biliary atresia must be diagnosed early for surgery to be effective. Stool color cards
help parents recognize pale stools.
10. Conjugated (direct) bilirubin elevation in a newborn is:
A. Normal physiologic jaundice
B. Never physiologic and requires evaluation for liver or biliary disease
C. Caused only by breastfeeding
D. Treated with sunlight
Correct Answer: B. Never physiologic and requires evaluation for liver or biliary disease
Rationale: Elevated conjugated bilirubin indicates cholestasis. Physiologic jaundice is
unconjugated.
11. Ceftriaxone is generally avoided in jaundiced newborns because it:
A. Lowers bilirubin too quickly
B. Causes polycythemia
C. Displaces bilirubin from albumin, increasing free bilirubin that can enter the brain
D. Increases albumin
Correct Answer: C. Displaces bilirubin from albumin, increasing free bilirubin that can enter
the brain
Rationale: Drugs that compete for albumin binding raise the risk of bilirubin toxicity, and
ceftriaxone can also precipitate with calcium in neonates. Other antibiotics are preferred.
