RNC-NIC Nutrition Management 4

Question 1

An ELBW infant on TPN develops cholestatic jaundice (PN-associated cholestasis). Which strategy has the strongest evidence for prevention?

Accepted Answer

Advancing enteral feeds as early as possible

Answer

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?

Accepted Answer

Ensure IV patency and monitor for bradycardia during infusion

Answer

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?

Accepted Answer

At 4–6 weeks of age or when tolerating full enteral feeds

Answer

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)?

Accepted Answer

Fish oil-based (Omegaven) or mixed lipid (SMOF) emulsion

Answer

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?

Accepted Answer

Combination of limited breast milk and phenylalanine-free formula to meet but not exceed phenylalanine needs

Answer

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.

(RNC-NIC) Registered Nurse Certified in Neonatal Intensive Care Practice Test

(RNC-NIC) Registered Nurse Certified in Neonatal Intensive Care Practice Test

RNC-NIC Nutrition Management 4