Neonatal Nurse Practitioner Exam Nutrition, Fluids, and Metabolic Disorders 2 — Questions and Answers
Question 1: A neonate of a diabetic mother is at increased risk for hypoglycemia primarily because of:
- Low glycogen stores from preterm birth
- Fetal hyperinsulinism from chronic fetal hyperglycemia (Correct answer)
- Decreased glucagon response at birth
- Placental glucose deprivation
Correct answer: Fetal hyperinsulinism from chronic fetal hyperglycemia
Maternal hyperglycemia causes fetal hyperglycemia, leading to pancreatic beta cell hyperplasia and hyperinsulinism, causing hypoglycemia after birth when maternal glucose supply stops.
Question 2: What is the blood glucose threshold below which treatment is recommended for a symptomatic neonate in the US per AAP guidelines?
- 60 mg/dL
- 50 mg/dL (Correct answer)
- 40 mg/dL
- 30 mg/dL
Correct answer: 50 mg/dL
Per AAP guidelines, symptomatic neonates with blood glucose <50 mg/dL should receive IV dextrose, while asymptomatic thresholds vary by age in the first 24-48 hours.
Question 3: A premature neonate develops metabolic bone disease of prematurity. Which supplementation is most important?
- Vitamin A and zinc
- Calcium and phosphorus (Correct answer)
- Iron and folate
- Vitamin C and copper
Correct answer: Calcium and phosphorus
Premature infants miss the third-trimester fetal bone mineralization phase, requiring supplemental calcium and phosphorus to support bone development.
Question 4: Galactosemia, if untreated, can lead to which life-threatening complication in the newborn period?
- Renal failure
- Liver failure, sepsis (especially E. coli), and hypoglycemia (Correct answer)
- Cardiac arrhythmias
- Adrenal crisis
Correct answer: Liver failure, sepsis (especially E. coli), and hypoglycemia
Untreated galactosemia causes hepatocellular damage, coagulopathy, hypoglycemia, and predisposes to E. coli sepsis, which can be rapidly fatal.
Question 5: In the first 24 hours of life, what is the primary reason insensible water loss is high in extremely premature neonates?
- Increased urine output from mature kidneys
- Thin, poorly keratinized skin with large surface area-to-volume ratio (Correct answer)
- High respiratory rate causing pulmonary losses
- Immature sweat glands overproducing sweat
Correct answer: Thin, poorly keratinized skin with large surface area-to-volume ratio
Extremely premature neonates have thin, minimally keratinized skin with a high surface area-to-weight ratio, resulting in dramatically increased transepidermal water loss.
Question 6: Neonatal hypocalcemia is defined as a total serum calcium below which threshold in term neonates?
- 6 mg/dL
- 8 mg/dL (Correct answer)
- 10 mg/dL
- 12 mg/dL
Correct answer: 8 mg/dL
Neonatal hypocalcemia in term infants is defined as total serum calcium <8 mg/dL (or ionized calcium <1.0 mmol/L), requiring evaluation and possible supplementation.
Neonatal Nurse Practitioner Exam Nutrition, Fluids, and Metabolic Disorders 2
A neonate of a diabetic mother is at increased risk for hypoglycemia primarily because of: