Neonatal Intensive Care Nurse Exam Neonatal Nutrition and Feeding 2 — Questions and Answers
Question 1: A neonate with suspected NEC has abdominal X-ray showing pneumatosis intestinalis. This finding represents:
- Gas within the intestinal wall, a pathognomonic sign of NEC (Correct answer)
- Normal bowel gas pattern
- Meconium plug
- Perforation only
Correct answer: Gas within the intestinal wall, a pathognomonic sign of NEC
Pneumatosis intestinalis (intramural gas) is produced by gas-forming bacteria invading damaged intestinal mucosa and is pathognomonic for NEC.
Question 2: Bell's staging criteria classifies NEC into stages I, IIA/B, and IIIA/B. Stage III requires:
- Surgical intervention due to intestinal perforation or severe deterioration (Correct answer)
- Medical management only with antibiotics
- Monitoring alone
- Phototherapy
Correct answer: Surgical intervention due to intestinal perforation or severe deterioration
Bell Stage III NEC involves intestinal perforation or clinical deterioration with peritonitis, requiring surgical management including exploratory laparotomy.
Question 3: The caloric goal for adequate growth in a preterm NICU infant is approximately:
- 110–130 kcal/kg/day (Correct answer)
- 50–60 kcal/kg/day
- 150–200 kcal/kg/day
- 80 kcal/kg/day
Correct answer: 110–130 kcal/kg/day
Preterm infants require 110–130 kcal/kg/day enterally to achieve weight gain of approximately 15–20 g/kg/day comparable to intrauterine growth.
Question 4: Gastroesophageal reflux in the NICU is best managed initially by:
- Positioning, smaller more frequent feeds, and thickening feeds before pharmacotherapy (Correct answer)
- Immediate Nissen fundoplication
- Omeprazole as first-line therapy
- Stopping all oral feeds indefinitely
Correct answer: Positioning, smaller more frequent feeds, and thickening feeds before pharmacotherapy
Conservative non-pharmacological measures are first-line for neonatal GER; evidence for pharmacotherapy in neonates is limited and carries risks.
Question 5: A neonate receiving TPN develops glucose in the urine (glucosuria). The most likely cause is:
- Hyperglycemia exceeding the renal glucose threshold (Correct answer)
- Urinary tract infection
- Renal tubular acidosis
- Normal variant in neonates
Correct answer: Hyperglycemia exceeding the renal glucose threshold
Neonatal glucosuria occurs when blood glucose exceeds the renal tubular threshold (~150–180 mg/dL), causing glucose to spill into urine.
Question 6: Which vitamin deficiency is a NICU nurse most concerned about in infants receiving exclusive breast milk without supplementation?
- Vitamin D deficiency (Correct answer)
- Vitamin C deficiency
- Vitamin B12 deficiency
- Vitamin E deficiency
Correct answer: Vitamin D deficiency
Breast milk contains insufficient vitamin D; all breastfed infants (including NICU graduates) require 400 IU/day supplementation to prevent rickets.
Neonatal Intensive Care Nurse Exam Neonatal Nutrition and Feeding 2
A neonate with suspected NEC has abdominal X-ray showing pneumatosis intestinalis.
This finding represents: