CSP Nutritional Care & Intervention 2 — Questions and Answers
Question 1: A 3-year-old with short bowel syndrome receives parenteral nutrition. Which electrolyte imbalance requires the closest monitoring due to intestinal losses?
- Hyponatremia
- Hypomagnesemia (Correct answer)
- Hyperkalemia
- Hypercalcemia
Correct answer: Hypomagnesemia
Magnesium is extensively lost through the GI tract in short bowel syndrome, making hypomagnesemia a primary electrolyte concern.
Question 2: Which anthropometric measurement is most sensitive for detecting acute malnutrition in children under 5 years?
- Height-for-age z-score
- Weight-for-age z-score
- Mid-upper arm circumference (Correct answer)
- Body mass index-for-age
Correct answer: Mid-upper arm circumference
Mid-upper arm circumference (MUAC) is the most sensitive and practical field measure for identifying acute malnutrition in young children.
Question 3: A hospitalized 8-year-old requires nasogastric tube feeding. Which formula characteristic is most appropriate to prevent aspiration complications?
- High osmolality
- Continuous low-rate delivery (Correct answer)
- Bolus large-volume feeds
- High fiber content
Correct answer: Continuous low-rate delivery
Continuous low-rate infusion reduces gastric residual volume and minimizes aspiration risk in children at risk.
Question 4: When transitioning a preterm infant from parenteral to enteral nutrition, what is the recommended minimum enteral intake considered 'trophic' or 'minimal enteral feeding'?
- 1-2 mL/kg/day
- 10-20 mL/kg/day (Correct answer)
- 50 mL/kg/day
- 100 mL/kg/day
Correct answer: 10-20 mL/kg/day
Trophic feeds of 10-20 mL/kg/day promote gut maturation without imposing significant metabolic demands on preterm infants.
Question 5: A child with cystic fibrosis is failing to gain weight despite adequate pancreatic enzyme supplementation. What is the next most appropriate nutritional intervention?
- Switch to elemental formula
- Increase enzyme dose beyond recommended maximum
- Add oral nutritional supplements with high fat content
- Initiate nocturnal tube feeding (Correct answer)
Correct answer: Initiate nocturnal tube feeding
Nocturnal nasogastric or gastrostomy feeds are recommended when oral supplementation alone fails to achieve adequate weight gain in cystic fibrosis.
Question 6: Which vitamin deficiency is most commonly associated with prolonged exclusive breastfeeding beyond 6 months without supplementation in exclusively breastfed infants?
- Vitamin A
- Vitamin C
- Vitamin D (Correct answer)
- Vitamin E
Correct answer: Vitamin D
Breast milk contains insufficient vitamin D, and exclusively breastfed infants require supplementation of 400 IU/day starting at birth.
Question 7: In refeeding syndrome, which electrolyte shift is the primary life-threatening concern?
- Hyperphosphatemia
- Hypophosphatemia (Correct answer)
- Hyperkalemia
- Hypermagnesemia
Correct answer: Hypophosphatemia
Refeeding causes a rapid intracellular shift of phosphate driven by insulin release, leading to severe hypophosphatemia and potentially fatal cardiac and respiratory complications.
CSP Nutritional Care & Intervention 2
A 3-year-old with short bowel syndrome receives parenteral nutrition.
Which electrolyte imbalance requires the closest monitoring due to intestinal losses?