RNC-NIC Nutrition Management 5 — Questions and Answers
Question 1: An infant with galactosemia is identified on newborn screening. Which immediate dietary change is required?
- Switch to a lactose-free cow's milk-based formula
- Eliminate all galactose by using a soy-based or elemental formula (Correct answer)
- Restrict protein intake to 1 g/kg/day
- Begin medium-chain triglyceride supplementation
Correct answer: Eliminate all galactose by using a soy-based or elemental formula
Galactosemia requires complete elimination of galactose (found in lactose in breast milk and standard formulas); soy-based formulas are galactose-free and are the standard treatment.
Question 2: A VLBW infant on full enteral feeds is noted to have low serum zinc levels. Which clinical finding is consistent with zinc deficiency?
- Perioral and perianal dermatitis with poor wound healing (Correct answer)
- Respiratory distress and pulmonary hypertension
- Metabolic alkalosis
- Tetany and QT prolongation
Correct answer: Perioral and perianal dermatitis with poor wound healing
Zinc deficiency classically presents with acrodermatitis enteropathica-like findings including perioral, perianal, and acral dermatitis along with poor wound healing and growth failure.
Question 3: What is the most appropriate caloric density to initiate when concentrating formula for a cardiac neonate with fluid restriction?
- 20 kcal/oz (standard dilution)
- 24 kcal/oz (Correct answer)
- 30 kcal/oz
- 32 kcal/oz
Correct answer: 24 kcal/oz
24 kcal/oz is the typical starting point for concentrated formula in fluid-restricted cardiac neonates, with further increases based on tolerance and growth.
Question 4: A nurse is reviewing a preterm infant's growth chart. Which parameter best reflects chronic nutritional status over weeks rather than days?
- Daily weight
- Weekly length measurement
- Head circumference growth velocity (Correct answer)
- Serum prealbumin
Correct answer: Head circumference growth velocity
Head circumference growth velocity is a reliable indicator of chronic nutritional adequacy and brain growth over weeks, as it reflects sustained protein and energy status.
Question 5: During kangaroo mother care, a 29-week infant begins rooting and showing feeding cues at the breast. What is the safest initial feeding approach?
- Allow full unrestricted breastfeeding immediately
- Offer non-nutritive sucking at the breast only, then supplement by tube (Correct answer)
- Withhold all oral feeding attempts until 34 weeks corrected age
- Switch to bottle feeding to better quantify intake
Correct answer: Offer non-nutritive sucking at the breast only, then supplement by tube
Non-nutritive sucking at the breast promotes oral motor development and milk supply, with gavage supplementation ensuring adequate intake until the infant can coordinate suck-swallow-breathe.
Question 6: Which electrolyte abnormality is most commonly associated with excessive use of loop diuretics (furosemide) in a NICU patient receiving enteral nutrition?
- Hyperkalemia
- Hypokalemia and metabolic alkalosis (Correct answer)
- Hypernatremia and metabolic acidosis
- Hypercalcemia
Correct answer: Hypokalemia and metabolic alkalosis
Loop diuretics cause urinary loss of potassium, sodium, and chloride, commonly resulting in hypokalemia and hypochloremic metabolic alkalosis.
Question 7: A mother of a 31-week infant asks why her expressed breast milk appears bluish-white. The nurse's best response is:
- The milk is contaminated and should be discarded
- This is foremilk, which is higher in lactose and lower in fat, and is normal (Correct answer)
- The baby should receive this milk only after fat separation
- This indicates the mother is dehydrated and should increase fluid intake
Correct answer: This is foremilk, which is higher in lactose and lower in fat, and is normal
Foremilk appears thin and bluish-white due to lower fat content and higher water and lactose content; it is normal and safe for the infant.
RNC-NIC Nutrition Management 5
An infant with galactosemia is identified on newborn screening.
Which immediate dietary change is required?