Newborn Jaundice & TORCH Risk Assessment Quiz

1. Congenital herpes simplex virus (HSV) infection most commonly occurs when?

During first trimester maternal infection

During vaginal delivery with primary or recurrent maternal genital HSV

Through transplacental transmission in third trimester

During breastfeeding if mother has labial lesions

2. When educating parents about phototherapy, which statement should the nurse include?

The infant will be completely naked under the lights with eye patches

Phototherapy will cure the underlying cause of jaundice

The infant may have loose, green stools and require frequent diaper changes

Phototherapy must continue for at least 7 days

3. A newborn presents with jaundice, hepatosplenomegaly, and thrombocytopenia on day 2 of life. What is the most likely diagnosis?

Physiologic jaundice

Congenital infection (TORCH)

Breast milk jaundice

ABO incompatibility

4. Which TORCH infection is most commonly transmitted during labor and delivery?

Toxoplasmosis

Rubella

Herpes simplex virus

Cytomegalovirus

5. A newborn's transcutaneous bilirubin (TcB) reading is elevated. When should this be confirmed with serum bilirubin?

Only if the infant appears clinically jaundiced

Within 1 hour if TcB is above the phototherapy threshold for age

After 24 hours of observation

Only if phototherapy is already initiated

6. A newborn with suspected congenital varicella-zoster infection shows vesicular rash at birth. What is the nursing priority?

Initiate contact and airborne precautions immediately

Administer acyclovir and monitor for disseminated disease

Bathe the infant to remove infectious particles

Separate from mother and initiate formula feeding

7. Breastfeeding jaundice differs from breast milk jaundice. Which statement is accurate?

Breastfeeding jaundice is due to poor milk transfer; breast milk jaundice is from breast milk constituents

Both are preventable with formula supplementation only

Breast milk jaundice appears within first 24 hours

Breastfeeding jaundice requires immediate phototherapy

8. A newborn has direct hyperbilirubinemia (conjugated bilirubin >20% of total). What is the priority assessment?

Check for signs of infection and evaluate liver function

Increase phototherapy intensity

Switch to formula feeding

Perform exchange transfusion

9. Which maternal infection carries the highest risk for severe congenital disease in the first trimester?

Toxoplasmosis

Cytomegalovirus

Rubella

Varicella-zoster

10. A mother is positive for hepatitis B surface antigen (HBsAg). What is the immediate action for the newborn?

Separate infant from mother and formula feed

Administer hepatitis B vaccine and HBIG within 12 hours of birth

Delay all feeding for 24 hours

Isolate the infant in a negative pressure room

11. A newborn at 48 hours of life has a serum bilirubin of 15 mg/dL. Using the nomogram, this level is above the phototherapy threshold. What is the primary concern with elevated unconjugated bilirubin?

Risk of kernicterus and permanent neurological damage

Liver failure and coagulopathy

Acute hemolytic anemia

Metabolic acidosis

12. A newborn develops jaundice on day 3 of life with a TSB of 18 mg/dL at 72 hours. What is the most likely etiology?

Physiologic jaundice

Breast milk jaundice from poor latch

Hemolytic disease of the newborn

Biliary atresia

13. Which finding is most consistent with congenital toxoplasmosis?

Cardiac murmur and systolic ejection click

Chorioretinitis and intracranial calcifications

Vesicular rash in a dermatomal distribution

Strawberry hemangioma

14. A preterm infant at 34 weeks gestation is at higher risk for jaundice. Why?

Immature kidneys cannot filter bilirubin

Immature liver conjugation and increased enterohepatic circulation

Decreased hemoglobin production

Increased maternal bilirubin transfer across placenta

15. Phototherapy is initiated for neonatal jaundice. Which nursing intervention is most important during treatment?

Keep the infant fully clothed to prevent heat loss

Monitor eye patches for proper placement and skin integrity

Restrict oral feeding to minimize bilirubin production

Maintain room temperature above 24°C at all times

16. A newborn has suspected congenital cytomegalovirus (CMV). Which diagnostic test is most specific?

Urine culture for CMV

Serum IgM antibody

Maternal serum PCR

Neonatal throat culture

17. Congenital rubella syndrome typically presents with which classic triad?

Cataracts, cardiac defects, sensorineural hearing loss

Microcephaly, seizures, intracranial calcifications

Hepatomegaly, thrombocytopenia, petechial rash

Jaundice, lethargy, poor feeding

18. A mother with untreated syphilis delivers vaginally. What is the priority nursing action for the newborn?

Administer prophylactic antibiotics immediately

Isolate the infant for 24 hours

Perform VDRL testing and initiate penicillin if positive

Delay feeding until maternal serology is confirmed negative

19. Which maternal history is the strongest risk factor for neonatal jaundice?

Maternal age over 35

Rh incompatibility or ABO blood group incompatibility

Gestational diabetes

Maternal hypertension

Newborn Quiz: Can You Spot the Risk?