RNC-NIC Nutrition Management 2 — Questions and Answers
Question 1: A 28-week preterm infant on parenteral nutrition develops hypertriglyceridemia. Which intervention is most appropriate?
- Increase the lipid infusion rate
- Decrease the lipid infusion rate or hold lipids (Correct answer)
- Switch from 20% to 10% lipid emulsion
- Add heparin to the lipid solution
Correct answer: Decrease the lipid infusion rate or hold lipids
Hypertriglyceridemia in preterm infants on PN requires reducing or temporarily holding the lipid infusion until triglyceride levels normalize.
Question 2: Which amino acid becomes conditionally essential in the stressed or preterm neonate?
- Alanine
- Glycine
- Glutamine (Correct answer)
- Serine
Correct answer: Glutamine
Glutamine is conditionally essential in preterm and critically ill neonates because immature or stressed gut mucosa cannot synthesize adequate amounts.
Question 3: A term neonate with a congenital heart defect requires high-calorie feeding. What is the most appropriate method to increase caloric density of breast milk?
- Add corn syrup solids
- Fortify with human milk fortifier (Correct answer)
- Supplement with medium-chain triglyceride oil only
- Switch to a standard 20 kcal/oz formula
Correct answer: Fortify with human milk fortifier
Human milk fortifier adds protein, calories, calcium, and phosphorus while preserving the benefits of breast milk for high-risk neonates.
Question 4: When assessing tolerance to enteral feeds in a VLBW infant, which finding is LEAST concerning?
- Bilious gastric residual
- Abdominal distension with discoloration
- Gastric residual equal to one feeding volume (Correct answer)
- Bloody stool
Correct answer: Gastric residual equal to one feeding volume
A gastric residual equal to one feeding volume is generally acceptable in VLBW infants and does not alone indicate feed intolerance.
Question 5: A 30-week infant receiving total parenteral nutrition is at risk for metabolic bone disease. Which two minerals are most critical to optimize?
- Sodium and potassium
- Calcium and phosphorus (Correct answer)
- Magnesium and zinc
- Iron and copper
Correct answer: Calcium and phosphorus
Calcium and phosphorus are the primary minerals required for bone mineralization, and preterm infants have limited stores of both.
Question 6: What is the recommended protein intake (g/kg/day) for a stable extremely low birth weight (ELBW) infant to achieve in-utero growth rates?
- 1.5–2.0
- 2.0–2.5
- 3.5–4.5 (Correct answer)
- 5.0–6.0
Correct answer: 3.5–4.5
ELBW infants require 3.5–4.5 g/kg/day of protein to achieve fetal accretion rates and support growth and neurodevelopment.
Question 7: Which clinical sign most strongly suggests necrotizing enterocolitis (NEC) in a preterm infant receiving enteral feeds?
- Soft abdomen with increased borborygmi
- Pneumatosis intestinalis on abdominal X-ray (Correct answer)
- Residuals that are undigested and clear
- Mild increase in stool frequency
Correct answer: Pneumatosis intestinalis on abdominal X-ray
Pneumatosis intestinalis—gas within the bowel wall on X-ray—is a hallmark radiographic finding of NEC and warrants immediate intervention.
RNC-NIC Nutrition Management 2
A 28-week preterm infant on parenteral nutrition develops hypertriglyceridemia.
Which intervention is most appropriate?