Question 1

Which of the following is NOT one of the characteristics that make premature infant formula different from standard infant formula?&#10;A) Premature infant formula may provide 24 kcal/oz.&#10;B) Premature infant formula provides more casein than whey protein.&#10;C) Premature infant formula provides MCT oil.&#10;D) Premature infant formula provides more sodium.

Accepted Answer

Preterm infants require more nutrients and more calories than term infants to facilitate growth and help develop the nutrient stores that they lack. To allow for this, some premature formulas provide 24 kcal/oz to facilitate growth at intrauterine rates. MCT oil is one of the types of fat included in premature formula to help increase the calorie concentration of the formula. Also, to prevent potential hyponatremia, additional sodium is provided in premature formula. In regard to the protein content of premature formula, although more total protein is provided, premature formula provides a whey:casein ratio of 60:40, which is similar to that of standard formula.

Question 2

Which of the following is NOT adequately provided to preterm infants through the use of human milk fortifiers?&#10;A) Zinc&#10;B) Calcium&#10;C) Phosphorus&#10;D) Iron

Accepted Answer

Human milk fortifiers are supplements of protein, carbohydrates, fat, mineral, and vitamins that can be added to breastmilk to better meet the nutritional needs of preterm infants. However, iron is not always included as one of the nutrients in human milk fortifiers. Normally, the bioavailability of iron from breastmilk is high compared with formula, but preterm infants need more iron because of incomplete development of iron stores. Iron supplementation is needed.

Question 3

Compared with term infants, preterm infants have an increased need for vitamin&#10;A) A.&#10;B) C.&#10;C) D.&#10;D) E.

Accepted Answer

Preterm infants need more vitamin A compared with term infants. The reasons for this are increased need for facilitating tissue repair and because preterm infants have low vitamin A stores. Vitamin A is suggested for the prevention of BPD.

Question 4

Which of the following procedures should be used in the transition from parenteral to enteral feedings with an LBW infant?&#10;A) Advance to enteral feeding as quickly as possible.&#10;B) Begin full-volume enteral feeding.&#10;C) Stop parenteral feeding until enteral feeding is well established.&#10;D) Maintain parenteral feeding until enteral feeding is well established.

Accepted Answer

Transitioning of feedings must be performed slowly to accommodate the LBW infant's ability to tolerate either feeding modality. If parenteral nutrition is the primary source of nutrition for the infant, parenteral nutrition must be maintained until the infant tolerates an adequate volume of enteral formula to maintain nutritional status. For VLBW infants, this process may take 7 to 10 days for the transition to occur. Stable infants may be able to tolerate enteral feeding advances of 20 to 30 ml/kg/day. Enteral feeding is never started at full volume because prior disuse of the gastrointestinal tract leaves it unprepared for mature digestion and absorption. Stopping parenteral nutrition completely may result in fluid and electrolyte imbalances and hypoglycemia.

Question 5

Because of a preterm infant's decreased ability to concentrate urine, in which of the following should sodium concentration be monitored regularly?&#10;A) Serum&#10;B) Urine&#10;C) Stool and urine&#10;D) Urine and serum

Accepted Answer

Hyponatremia is a potential risk in premature infants because of their immature kidneys. The inability to concentrate urine could cause these infants to excrete excessive amounts of sodium. To safeguard against this, both urinary and serum sodium levels should be monitored. Sodium may be lost in the stool if these infants experience diarrhea.

Question 6

The energy needs of a premature infant fed parenterally differ from those of a premature infant fed enterally because parenterally fed infants&#10;A) require less energy per kilogram of body weight.&#10;B) require an equal amount of energy per kilogram of body weight.&#10;C) require more energy per kilogram of body weight.&#10;D) have very erratic energy requirements.

Accepted Answer

Because parenteral nutrition bypasses the gastrointestinal tract, no loss of energy occurs because of energy cost of digestion and absorption and the inefficiency of absorption. As a result, infants receiving parenteral nutrition require less energy intake than those being fed enterally. Enterally fed premature infants need 105 to 130 kcal/kg, and parenterally fed premature infants need 90 to 100 kcal/kg.

Question 7

The metabolic rate of the premature newborn is _____ kcal/kg/day.&#10;A) 30&#10;B) 50&#10;C) 90&#10;D) 105

Accepted Answer

Preterm infants have a basal metabolic rate of 50 kcal/kg/day. Because premature newborns have little to no fat or carbohydrate energy reserves, without additional energy provision, catabolism of the newborn's protein stores will occur to provide energy. This will limit the survival time of the newborn. A provision of 30 kcal/kg/day with adequate protein is recommended to promote nitrogen balance in VLBW infants during the first 3 days postpartum. If fed enterally, a premature infant may grow by consuming at least 105 kcal/kg/day, but a parenterally fed premature infant will experience growth by receiving at least 90 kcal/kg/day.

Question 8

Which of the following is a fluid loss that is preventable in the care of low birthweight (LBW) infants?&#10;A) Insensible water loss caused by increased permeability of the skin&#10;B) Insensible water loss caused by radiant warmers&#10;C) Sensible water loss caused by an inability to concentrate urine&#10;D) Insensible water loss caused by a larger surface area relative to body weight

Accepted Answer

Insensible water losses occur through the skin of premature infants because of increased permeability of the skin to water and larger body surface area relative to weight. However, these insensible losses can be increased or decreased depending upon how the infant is kept warm. Radiant warmers and phototherapy lights can increase insensible water losses and increase need for fluids. Heat shields, thermal blankets, and humidified incubators can decrease insensible water losses.

Question 9

How much fluid should be provided to an LBW infant during the first day of life?&#10;A) 40 to 85 ml/kg&#10;B) 50 to 100 ml/kg&#10;C) 80 to 105 ml/kg&#10;D) 1000 ml total

Accepted Answer

Usually 80 to 105 ml fluid/kg of body weight is provided to a premature infant to meet insensible fluid losses and renal output on the first day of life. After fluid needs are evaluated, fluids should increase by 10 to 20 ml/kg/day. By the end of the second week of life, the preterm infant may need to receive 140 to 160 ml fluid/kg/day to ensure adequate hydration status.

Question 10

The total of IV lipid in an LBW infant is generally&#10;A) 25% to 40% of nonprotein calories.&#10;B) 10 g/kg/day.&#10;C) 10% to 15% of nonprotein calories.&#10;D) 60% of nonprotein calories.

Accepted Answer

For preterm infants the total lipid load is usually 25% to 40% according to the American Academy of Pediatrics. This can be given in amounts up to 3 g/kg/day. In preterm infants, the use of 20% lipid emulsions is preferred as this promotes lower plasma triglyceride, cholesterol, and phospholipid levels than does 10% emulsion.

Question 11

Which of the following helps promote better feeding of a premature infant after being discharged from the hospital?&#10;A) Attracting the infant's attention with toys&#10;B) Playing with the infant at feeding time&#10;C) Supporting the infant's body during feeding&#10;D) Feeding while playing age-appropriate DVDs

Accepted Answer

The answer of Which of the following helps promote better...

Question 12

Infants begin to gain weight above their birth weight&#10;A) by the end of the first day postpartum.&#10;B) within 48 to 72 hours postpartum.&#10;C) by the end of the first week postpartum.&#10;D) by 2 to 3 weeks postpartum.

Accepted Answer

The answer of Infants begin to gain weight above their...

Question 13

Which of the following may contribute to dehydration in a premature infant?&#10;A) Hypoglycemia&#10;B) Hypercholesterolemia&#10;C) Hyperglycemia&#10;D) Hypovolemia

Accepted Answer

The answer of Which of the following may contribute to...

Question 14

After discharge, most preterm infants need approximately _______ ml/kg/day of breastmilk or standard infant formula.&#10;A) 124&#10;B) 120&#10;C) 180&#10;D) 250

Accepted Answer

The answer of After discharge, most preterm infants need approximately...

Question 15

Human milk&#10;A) has a different composition in the mothers of preterm infants.&#10;B) has zinc and iron that is more readily absorbed.&#10;C) has hormones.&#10;D) all of the above.

Accepted Answer

The answer of Human milk&#10;A) has a different composition in...

Question 16

An infant born at 32 weeks' gestation is now 6 months old. Her adjusted age is _____ months.&#10;A) 6&#10;B) 4&#10;C) 3&#10;D) 2

Accepted Answer

The answer of An infant born at 32 weeks' gestation...

Question 17

Which of the following must be supplemented to preterm infants fed parenterally or fed human milk to prevent the development of osteopenia?&#10;A) Protein&#10;B) Calcium and phosphorus&#10;C) Vitamins A and D&#10;D) All fat-soluble vitamins

Accepted Answer

The answer of Which of the following must be supplemented...

Question 18

Gastric residuals should be checked when feeding an LBW infant by bolus gavage feeding&#10;A) 1 hour after each feeding.&#10;B) before each feeding.&#10;C) once each day at the same time.&#10;D) when abdominal distension is suspected.

Accepted Answer

The answer of Gastric residuals should be checked when feeding...

Question 19

An infant has a birth weight below the 10th percentile, but her linear growth and head growth are between the 10th and 90th percentiles. This infant would be classified as&#10;A) AGA.&#10;B) SGA with asymmetric IUGR.&#10;C) SGA with symmetric IUGR.&#10;D) only SGA.

Accepted Answer

The answer of An infant has a birth weight below...

Deck 42: Medical Nutrition Therapy for Low-Birth-Weight Infants