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RNC-NIC QUESTIONS CH 8-10 GENERAL ASSESSMENT AND MANAGEMENT
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RNC-NIC QUESTIONS CH 8-10 GENERAL ASSESSMENT AND MANAGEMENT
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RNC-NIC QUESTIONS CH 8-10 GENERALASSESSMENT AND MANAGEMENT
Which of the following substrates is the most influential to achieve optimal weight gain
for the premature infant?
A. Carbohydrate
B. Fat
C. Protein
D. Sodium
C. Proteins are the driving source for weight gain in the premature infant as the major
functional and structural components of all human cells. Carbohydrates have been used
to augment energy nutrition; however, their benefits do not appear to be independent of
protein supply. Additionally, if carbohydrates exceed desirable amounts, glucose
polymers can lead to hyperosmolality in the gut lumen., resulting in diarrhea. Fat
provides the major source for energy of growing preterm infants; however, the
nutritional value of human milk fat may vary with time and does not always provide a
complete source of nutrients for premature infants. Sodium is an important electrolyte
for cell metabolism, but is not as imperative to growth as protein.
The proteins whey and casein exist in a ratio of 80 (whey) to 20 (casein) in which of the
following?
A. Mature breast milk
B. Colostrum
C. Cow milk-based formula
D. Soy-based formula
B. Colostrum whey:casein ratio is 80:20. Mature breast milk whey:casein ration is
55:45. Cow milk-based formula whey:casein ratio is 60:40. Soy-based infant formula
does not contain whey and casein proteins.
The nurse should anticipate the tapering of parenteral amino acid intake in the
extremely low-birth-weight infant when enteral nutrition reaches how many milliliters per
kilogram per day?
A. 20
B. 40
C. 75
D. 140
C. A minimum of 75 mL/kg/day of enteral nutrition should be achieved before parenteral
amino acids are tapered in the ELBW and VLBW infants. Protein malnutrition can easily
develop in this patient population during the transition from parenteral to enteral
nutrition. Enteral intake of 20mL/kg/day involves hypocaloric low-volume feeds and
,does not supply enough enteral protein to warrant parenteral amino acid tapering. A
significant part of the enteral protein intake does not reach the systemic circulation and
is not immediately available for the growth of other tissues. Enteral intake of 40
mL/kg/day, although greater in volume than trophic feeds, still does not supply enough
enteral protein to warrant parenteral amino acid tapering. Enteral intake of 140
mL/kg/day is approaching a full enteral feeding volume, and the infant will most likely
not require parenteral nutrition.
In extremely premature infants, initial enteral feedings of colostrum will result in which of
the following?
A. Delay induction of many digestive enzymes
B. Prohibit the endocytosis of proteins
C. Deliver low concentrations of secretory IgA
D. Facilitate rapid growth of the intestinal mucosal surface
D. Colostrum contains growth factors, and initial enteral feedings of colostrum in the
premature infant stimulates rapid growth in the intestinal mucosa surface area and
propagation of many digestive enzymes. It also promotes endocytosis of proteins and
delivers high concentrations of secretory IgA.
The predominant disaccharide in human milk is:
A. sucrose.
B. lactose.
C. fructose.
D. glucose.
B. Lactose is the main disaccharide in human milk and is hydrolyzed into glucose and
galactose in the small intestine by the enzyme lactase. Sucrose is a disaccharide and is
hydrolyzed into glucose and fructose in the small intestine. Fructose is a
monosaccharide that is predominately found in plants. Glucose is a monosaccharide
that is predominately found in food as a building block in complex carbohydrates.
The nursing plan of care for the growing preterm infant includes approximately how
many calories per kilogram per day to sustain adequate energy intake?
A. 40
B. 80
C. 120
D. 150
C. The average energy intake for preterm infants to support weight gain is 105-130
kcal/kg/day. 40-80 kcal/kg/day are both lower energy intakes and may not be adequate
to support basal metabolism and net protein/fat balance. 150 kcal/kg/day is a higher
energy intake and can result in greater fat accumulations and does not enhance
neurologic development or achieve proper growth and body composition in comparison
to their normal fetal equivalents.
, Carbohydrates should supply what percent of an infant's total caloric intake?
A. 7-16
B. 25-35
C. 40-50
D. 80-90
C. Carbohydrates are the principal source of energy for the brain and heart and should
supply 40%-50% of an infant's total caloric intake. Values less than the recommended
amount may result in hypoglycemia. Values higher than the recommended amount may
lead to diarrhea and are associated with high-energy diets. Increasing evidence
suggests that high-energy diets in the neonatal period have the potential to result in
rapid adipose gains and may contribute to obesity, insulin resistance, and type 2
diabetes later in life.
The nurse should explain to the parents that their premature infant needs to gain
approximately how may grams per day to achieve adequate growth?
A. 5
B. 15
C. 80
D. 100
B. The infant needs to gain approximately 15 g/day for optimal weight gain. Infants who
do not grow at intrauterine growth rates are vulnerable for energy and protein deficits in
addition to postnatal growth restriction. Infants who grow in excess of intrauterine
growth rates may be vulnerable to later risks of adult chronic diseases such as diabetes,
hypertension, dyslipidemia, and cardiovascular disease.
The purpose of adding carnitine to total parenteral nutrition solutions for preterm infants
who are nothing-by-mouth and receiving intravenous lipids is to:
A. facilitate digestion of lactose.
B. transport long-chain fatty acids.
C. synthesize bile acids.
D. support gut integrity.
B. Carnitine is a carrier molecule needed to transport long-chain fatty acids into
mitochondria for oxidation. Preterm infants less than 34 weeks' gestation are usually
dependent on lipids as an energy source and are at risk of not being able to
appropriately store and synthesize carnitine, therefore, requiring supplementation in
total parenteral nutrition solutions. Lactase is the enzyme necessary for the digestion of
lactose. Cholesterol is a major component of cell membranes and synthesizes bile
acids. Glutamine is a key amino acid, which may play an important role in supporting
gut integrity and acts as a substrate for small intestinal mucosa.
The nurse recognizes that minimal enteral (trophic) feedings with expressed human milk
should be initiated at a rate of:
A. 5-9 mL/kg/hr.
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