Neonatal Nurse Practitioner Exam Nutrition, Fluids, and Metabolic Disorders 1 — Questions and Answers
Question 1: What is the recommended caloric intake to support adequate growth in a stable premature neonate?
- 60-80 kcal/kg/day
- 110-130 kcal/kg/day (Correct answer)
- 80-100 kcal/kg/day
- 150-180 kcal/kg/day
Correct answer: 110-130 kcal/kg/day
Stable premature neonates require 110-130 kcal/kg/day to achieve intrauterine growth rates of approximately 15-20 g/kg/day.
Question 2: Which carbohydrate is the primary energy source in human breast milk and most neonatal formulas?
- Fructose
- Lactose (Correct answer)
- Maltodextrin
- Sucrose
Correct answer: Lactose
Lactose is the primary carbohydrate in human milk and most standard infant formulas, providing approximately 40% of total caloric intake.
Question 3: A VLBW neonate has a serum sodium of 128 mEq/L on day 3 of life with urine output of 6 mL/kg/hr. What is the most likely cause?
- Syndrome of inappropriate ADH (SIADH)
- Excessive free water administration (dilutional hyponatremia) (Correct answer)
- Pseudohyponatremia from hyperglycemia
- Salt-wasting nephropathy
Correct answer: Excessive free water administration (dilutional hyponatremia)
Excess free water (hypotonic fluids) in premature neonates with high insensible losses creates dilutional hyponatremia; urine output reflects appropriate fluid response.
Question 4: Necrotizing enterocolitis (NEC) is most common in which neonatal population?
- Term infants born by cesarean section
- Premature infants, especially those <32 weeks or <1500g (Correct answer)
- Post-term infants with meconium aspiration
- Large for gestational age (LGA) infants
Correct answer: Premature infants, especially those <32 weeks or <1500g
NEC primarily affects premature infants with immature gut immunity, motility, and mucosal barrier function, with greatest risk in those <32 weeks or <1500g.
Question 5: Which finding on abdominal X-ray is pathognomonic for necrotizing enterocolitis?
- Dilated bowel loops
- Pneumatosis intestinalis (gas in the bowel wall) (Correct answer)
- Absence of bowel gas
- Calcified meconium
Correct answer: Pneumatosis intestinalis (gas in the bowel wall)
Pneumatosis intestinalis—gas produced by bacteria within the bowel wall—is the pathognomonic radiologic sign of NEC.
Question 6: Total parenteral nutrition (TPN) in neonates typically starts with which amino acid concentration to promote anabolism?
- 0.5 g/kg/day
- 3-4 g/kg/day starting on day 1 (Correct answer)
- 1 g/kg/day increasing slowly
- 5 g/kg/day from birth
Correct answer: 3-4 g/kg/day starting on day 1
Current evidence supports early, aggressive protein provision of 3-4 g/kg/day from day 1 to promote positive nitrogen balance and prevent catabolism in preterm neonates.
Neonatal Nurse Practitioner Exam Nutrition, Fluids, and Metabolic Disorders 1
What is the recommended caloric intake to support adequate growth in a stable premature neonate?