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RNC-NIC Questions Ch 8-10 General Assessment and Management Questions and Answers Fully Solved
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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 - answerC. 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 - answerB. 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 - answerC. 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 - answerD. 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. - answerB. 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 - answerC. 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 - answerC. 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 - answerB. 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. - answerB. 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.
B. 10-20 mL/kg/hr.
C. 10-20 mL/kg/day.
D. 30-40 mL/kg/day. - answerC. Minimal enteral feedings should be initiated at a rate of
10-20 mL/kg/day to facilitate postnatal gastrointestinal maturation and to minimize
mucosal atrophy. 5-9 mL/kg/hr would be an inappropriate volume for minimal enteral
feedings. 10-20 mL/kg/hr would be equivalent to 240-480 ml/kg/day, which would be an
inappropriate volume for minimal enteral feedings. A feeding volume of 30-40
mL/kg/day would be representative of advancing enteral nutrition.
Which of the following is a benefit of minimal enteral (trophic) feedings in the preterm
infant?
A. Sufficient calories to sustain somatic growth
B. Promote intestinal maturation with small volumes
C. Enhance villous atrophy
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