Neonatal Nurse Practitioner Practice Exam

What is the primary reason for monitoring serum BUN in neonates on total parenteral nutrition?

1. To assess caloric intake

2. To identify renal function

3. To monitor for excess protein

4. To evaluate hydration status

The correct answer is: To monitor for excess protein

Monitoring serum BUN (blood urea nitrogen) levels in neonates receiving total parenteral nutrition (TPN) is primarily conducted to monitor for excess protein intake. BUN is a byproduct of protein metabolism, and elevated BUN levels can indicate that the amount of protein being provided may be more than the neonate can effectively process. In the context of TPN, where nutrition is delivered intravenously, there is a risk of providing an excessive amount of protein, which can lead to increased nitrogenous waste—reflected by elevated BUN levels. This can guide healthcare providers in adjusting the protein content in TPN to ensure that the neonate receives an appropriate amount without exceeding metabolic tolerances. While it is also important to assess renal function, hydration status, and caloric intake in neonates on TPN, the specific relationship of BUN with protein metabolism makes the monitoring of BUN levels primarily indicative of protein status. Thus, managing protein levels through BUN concentrations is critical in optimizing nutritional support for the neonate's growth and development.