RNC-NIC Nutrition Management 3 — Questions and Answers
Question 1: A 26-week infant is started on minimal enteral nutrition (MEN). What is the primary purpose of MEN?
- To meet full caloric needs via the gut
- To stimulate gut hormone release and mucosal development (Correct answer)
- To replace parenteral nutrition within 48 hours
- To prevent hypoglycemia
Correct answer: To stimulate gut hormone release and mucosal development
Minimal enteral nutrition promotes gut maturity by stimulating trophic hormones and mucosal cell proliferation, not to meet caloric needs.
Question 2: An infant with short bowel syndrome following intestinal resection is at highest risk for deficiency of which nutrient when the terminal ileum is resected?
- Vitamin C
- Vitamin B12 (Correct answer)
- Vitamin D
- Thiamine
Correct answer: Vitamin B12
Vitamin B12 (cobalamin) is absorbed exclusively in the terminal ileum, so resection leads to B12 deficiency and megaloblastic anemia.
Question 3: When preparing to wean a VLBW infant from parenteral to enteral nutrition, feeds should be advanced while PN is adjusted to maintain which parameter?
- Total fluid volume (Correct answer)
- Sodium intake
- Calcium-phosphorus ratio
- Bilirubin level
Correct answer: Total fluid volume
Total fluid intake is kept consistent while PN is reduced and enteral feeds are increased, preventing fluid overload or dehydration during the transition.
Question 4: A nurse notes that a 29-week infant's weight has dropped 15% from birth weight by day 5. What is the most appropriate initial action?
- Reassure the family this is normal physiologic weight loss
- Notify the provider and reassess nutrition and fluid intake (Correct answer)
- Restrict fluids to reduce insensible water loss
- Increase kangaroo care frequency only
Correct answer: Notify the provider and reassess nutrition and fluid intake
A weight loss exceeding 10–15% in a VLBW preterm infant warrants provider notification and a thorough review of nutritional adequacy and fluid balance.
Question 5: Which of the following best describes the refeeding syndrome risk in a malnourished neonate restarted on aggressive nutrition?
- Hyperkalemia and hypercalcemia
- Hypophosphatemia, hypokalemia, and hypomagnesemia (Correct answer)
- Hypernatremia and metabolic alkalosis
- Hypoglycemia and hyperlipidemia
Correct answer: Hypophosphatemia, hypokalemia, and hypomagnesemia
Refeeding syndrome is characterized by a rapid intracellular shift of phosphorus, potassium, and magnesium leading to dangerously low serum levels.
Question 6: A 34-week late preterm infant is breastfeeding but losing weight beyond expected limits. What supplementation strategy is preferred?
- Immediately switch to exclusive formula feeding
- Supplement with expressed breast milk or pasteurized donor human milk after feedings (Correct answer)
- Add fortifier to all breast milk immediately
- Begin parenteral nutrition until weight stabilizes
Correct answer: Supplement with expressed breast milk or pasteurized donor human milk after feedings
Supplementing with expressed or donor human milk preserves breastfeeding relationships while addressing weight loss in late preterm infants.
Question 7: Which serum marker is the most sensitive indicator of protein nutritional status and visceral protein synthesis in a neonatal patient?
- Albumin
- Total protein
- Prealbumin (transthyretin) (Correct answer)
- Transferrin
Correct answer: Prealbumin (transthyretin)
Prealbumin has a half-life of 2–3 days, making it the most sensitive acute marker of protein nutritional status compared to albumin (half-life ~20 days).
RNC-NIC Nutrition Management 3
A 26-week infant is started on minimal enteral nutrition (MEN).
What is the primary purpose of MEN?