RNC-NIC Nutrition Management 4 — Questions and Answers
Question 1: An ELBW infant on TPN develops cholestatic jaundice (PN-associated cholestasis). Which strategy has the strongest evidence for prevention?
- Adding phenobarbital to PN
- Advancing enteral feeds as early as possible (Correct answer)
- Reducing amino acid concentration in PN
- Increasing lipid dose to spare glucose
Correct answer: Advancing enteral feeds as early as possible
Early and progressive enteral feeding stimulates bile flow and reduces hepatic exposure to PN components, which is the most effective prevention strategy for PN-associated cholestasis.
Question 2: In a neonate with hypocalcemia receiving calcium gluconate IV, which precaution is most important?
- Administer as a rapid IV push over 1 minute
- Ensure IV patency and monitor for bradycardia during infusion (Correct answer)
- Mix calcium gluconate with sodium bicarbonate in the same line
- Use the umbilical arterial catheter for administration
Correct answer: Ensure IV patency and monitor for bradycardia during infusion
Calcium gluconate must be infused slowly with continuous cardiac monitoring because rapid administration can cause life-threatening bradycardia or arrhythmia.
Question 3: A 27-week infant requires iron supplementation. When should enteral iron typically be initiated?
- At birth
- At 2 weeks of age when feeds are established
- At 4–6 weeks of age or when tolerating full enteral feeds (Correct answer)
- At hospital discharge only
Correct answer: At 4–6 weeks of age or when tolerating full enteral feeds
Enteral iron supplementation is typically initiated at 4–6 weeks of age or when the preterm infant is tolerating full enteral feeds to support erythropoiesis.
Question 4: Which type of lipid emulsion is preferred in neonates to reduce the risk of PN-associated liver disease (PNALD)?
- Pure soybean oil-based (SO) emulsion
- Fish oil-based (Omegaven) or mixed lipid (SMOF) emulsion (Correct answer)
- Medium-chain triglyceride (MCT)-only emulsion
- Coconut oil-based emulsion
Correct answer: Fish oil-based (Omegaven) or mixed lipid (SMOF) emulsion
Fish oil-based or mixed lipid emulsions (SMOF) reduce phytosterol burden and provide anti-inflammatory omega-3 fatty acids, lowering PNALD risk compared to pure soybean oil.
Question 5: A term infant with phenylketonuria (PKU) requires a special diet. Which feeding regimen is correct?
- Exclusive breastfeeding indefinitely
- Phenylalanine-free formula exclusively with no breast milk
- Combination of limited breast milk and phenylalanine-free formula to meet but not exceed phenylalanine needs (Correct answer)
- Standard infant formula with dietary enzyme supplements
Correct answer: Combination of limited breast milk and phenylalanine-free formula to meet but not exceed phenylalanine needs
PKU management requires strict phenylalanine restriction using a metabolic formula while allowing limited natural protein (including breast milk) to meet essential but controlled phenylalanine needs.
Question 6: What is the primary reason that preterm human milk is preferred over term donor human milk for VLBW infants in the first weeks of life?
- Preterm milk has lower lactose content
- Preterm milk has higher protein and energy content matching preterm needs (Correct answer)
- Preterm milk has fewer immunoglobulins
- Preterm milk is more easily digested due to lower fat
Correct answer: Preterm milk has higher protein and energy content matching preterm needs
Preterm mothers' own milk naturally contains higher protein, fat, and energy levels during the first weeks, better matching the elevated nutritional requirements of VLBW infants.
Question 7: A nurse calculates that a 1,200 g preterm infant is receiving 85 kcal/kg/day. Which clinical concern does this raise?
- Overfeeding leading to obesity
- Insufficient calories to support growth and neurodevelopment (Correct answer)
- Risk of NEC from excess caloric load
- Hyperglycemia from excess energy
Correct answer: Insufficient calories to support growth and neurodevelopment
Preterm infants require 110–135 kcal/kg/day for adequate growth; 85 kcal/kg/day is insufficient and will lead to growth failure and suboptimal neurodevelopment.
RNC-NIC Nutrition Management 4
An ELBW infant on TPN develops cholestatic jaundice (PN-associated cholestasis).
Which strategy has the strongest evidence for prevention?