The following is likely not a tsik for refeeding syndome:
(C) a trauma pt
the least accurate method for assesicng energy requirments is
(B) food intake records
If refeeding is expected the following shoudl be limited initially
C. Dextrose
if a pt w/ short bowel syndrome who has required TPN for 2 years presents w/ dysguesia, diarrheaa and alopecia, which of the following nutrients is most likley deficient?
A. zinc
BMI indicates
C - the presence of obesity
Which of the following is a cuse of hepatic steatosis?
D - Choline deficiency
in premature neonates, the use of adult Mvi is most likely to lead to
B - liver failure
the followign wt loss over 6 mo is considered severe:
D - >10%
the best indicator of recent changes in nut'l intake/status is:
A - tricep skinfold measurment
B - BMI
C- % IBW
D - changes in UBW
D - changes in UBW
a pt suffering from this vitamin deficient us likely to present w/ swollen, inflamed, bleeding gums:
C - Vit C
During the early phase malnutrition, what amt of body pro stores is needed to provide substrate for gluconeogenisis during a 24 hr period?
D - 75 g (unstressed)
which of the following is most closely associated w/ respiratory failure
C - hypophosphatemia
prealbumin is most likely to be elevated in which of the following dz states?
A - renal dz
a cachectic 42yof is readmitted 2 wks s/p exp lap w/ a suspected post-op SBO. She has lost an additional 8% of her body weight since her 1st admission to the hospital. she undergoes surgical repair of the obstruction and has a nasoenteric feeding tube placed in the OR. upon initiaion of nutrition support, which of the following would be a major concern?
A- diarhea
B - narcotic addiction
C - rapid wt gain
D - refeeding syndrome
D - refeeding syndrome
which of the following is the best objective indicator of malnutrition in liver dz when ascites is present?
A - transthyretin
B- serum albumin
C - body weight as a % of ideal weight for height
D - triceps skinfold thickness and MAMC
D - triceps skinfold thickness and MAMC
a pt with mental status changes (dementia), dermatitis, and diarheaa may have the following deficiency:
A - thiamin
B- niacin
C - cyanocobalamin
D - folic Acid
B- niacin (pellegra) 4 D's
which is the follwoing is a conditionally essential AA in a preterm infant?
A- glycine
B- taurine
C- Gln
D - arginine
B- taurine
a pt w/ vit A deficinecy is likely to manifest with the following symptom:
A - alopecia
B- glossitis
C- cheilosis
D- dermatitis
D- dermatitis - also seen w/ EFA deficiency)
the usual parenteral dosage of selenium is:
D- 300-350 mcg
B - 50-100 mcg - 55 mcg = RDA
Pts receiving long term TPN are most likely to have increased requirements above the RDA for:
D - Selenium
in Cancer pts, supplementation w/ zc resulted in:
A - improved taste in pts that were zc deficient
with erythropoetin therapy, supplementation w/ this nutrient is normally required.
B - Fe
A deficiency of this vitamin can cause lactic acidosis and death:
B - Vit B1 AEB Mvi shortage of 1990's
the use of intravenous albumin to correct hypoalbuminemia in pts w/ ESLD results in:
D - increased serum albumin temporarily
in a pt receiving PN w/ Mvi containing vit K, and warfarin, the most appropriate course of action would be to:
C - maintain consistent vit k provision, even after PN stopped and adjusted anti-coag tx as needed
Aluminum toxicity is most likely to occur in a pt with:
A - renal dysfxn - r/t inability to excrete
the following lab [ ] may be adjused for low albumin
B - Ca2+
the adjusted ca2+ for a pt w/ a serum albumin [] of 2.4 and serum Ca2+ of 7.2 is ~ :
D - 8.5 - Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL])
where 4.0 represents the average albumin level in g/dL.
the gallbladder is stimulated by:
A- estrogen
B- leptin
c- pancrease
C- CCK
C- CCK
the following would not be expected to reduce prealbumin levels:
A - renal failure
the following is an inherant contaminant of PN solutions:
A - glycerol
B - aluminum
c- Manganese
D - Fe
B - aluminum - most likely to be seirous in neonatal populations
a pt that is 72 hours post trauma and resusciatation has an albumin of 2.4. the most likely cause is
A - malnutrition
B- trauma
C- renal failure
D - inadequete IV albumin provision
a low prealbumin in a critically ill pt is most often d/t:
A - steroid provision
B- malnutrition
C - inflammatory process
D - inadequete nitrogen provision
C - inflammatory process - prealm is a (-) acute phase reactant
the syndrome of SIADH is likely to present as:
C - hyponatremia
the following best predicts wiynd related complications
B - serum albumin
diabetes insipidus is likely to present as:
C - high urine output from 4-12 L/dm also possibly hypernatremia
Dx EFA deficiency is done by:
C - triene to tetraene ratio
a TAG [ ] grater than ___mg/dL should preclude routine provision of IV lipids:
D - 400
the following is most closely r/t muscle mass:
D - serum creatinine
the mmost common cause of hypernatremia in hospitalized pts is:
D - innapropriate and inadequete provision of fluids
the following lab value is likely to be low in acute pancreatitis:
A - Ca2+ - part of ransom's criteria
a NFPE would include:
A - wt hx or changes
B - presence of edema
C- lab values
D - current oral intake
B - presence of edema
a VLBW infant is defines as
C - <1500 g
a subjective global assesment would include pt hx and which of the following?
A - physical exam
which of the following is a major contributor to the risk of malnutrition in hospitalized pts?
A - immobilization
B- hypothryoidism
C - immunosuppression
D - increased catabolic stress
D - increased catabolic stress
the most appropriaet formaul for a pt w/ SIADH is:
B - concentrated formula
what is the most appropriate daily dose of protein for a pt w/ acute renal failure managed w/ continuous venovenous hemofiltration
C - 1.5-1.8 g/kg
in designing a PN regimen for an adult burn pt, which of the following should be considered?
A - energy needs may be increased to up to twice the basal rate
compared to term infants, premature infants need:
B - additional Ca2+ and phosphorus for bone mineralization
in ARF (acute renal failure), pro loss is most likely r/t whichof the following?
A - hyperkalemia
B- hyponatremia
C - hypercatbolism
D - metabolic alkalosis
C - hypercatbolism
in an infant w/ galactosemia,t he most appropriate formula is
A - milk based
B- Soy based
C - PN
D - fat free PN
B- Soy based
the EFA is:
D- EPA
B - linoelic (~5% of daily req)
the following pt may respond to supplemntal thiamine
A - Guillian Barre
B- Hodgkin's dz
C - Wernicke's encephalopathy
D - Wilson's dz
C - Wernicke's encephalopathy
in peds recieving a formula with high MCT [ ], the following hsoudl be closely monitored:
B - def of fat soluble vitamin
supplemental zc may impair absorption if this nutrient:
A - Ca2+
B- Cu
C - phosphorus
D - K+
B- Cu
the max protein administration in a neonate
C - 3-4 g/kg
achlorrydria in the geriatric n will predispose this group to deficiency:
B - Vit B12 (IF + H+ required for absorption)
the max protein provision in a nomral (pregnant) pt is:
B - 1.5 g/kg
the following vitamin may be restricted in an ESRD pt requiring PN?
D - vit A
the best definition of basel energy expenditure is the amt of energy required to:
C - maintain normal bodily fx at a constant resting state
the following best meets the energy requirements if an elderly, critically ill pt that is 66" and 140#:
D - 1600 kcal 25g/kg always choose this when its an option for non-obese adults
which of the following does NOT occur during stress from injury or infections
B - ketogenesis is accelerated
which of the following would have the least potential for causing malabsorption if a fistula developed in the area?
C - colon
if a plasma AA profile is obtained on a pt with hepatic encephalopathy, which of the following is the most likely result?
A- wnl
B - the ratio of BCAA to aromatic AA would be 4.0
C - phenylalanine and tyrpisne will be increased while valine, leucine, and isoleucine will be decreased
D - phenylalanine and tyrpisne will be decreased while valine, leucine, and isoleucine will be increased
C - phenylalanine and tyrpisne will be increased while valine, leucine, and isoleucine will be decreased
which of the following is not charcteristic of glucagon?
A - is excreted from the pancreas
B- is controlled by plasma glc
C - increases during stress and sepsis
D - stimulates target organs to store glc
C - increases during stress and sepsis
in pts w/ acute or chronic renal failure, which of the following is the most significant factor contributing to increased energy expenditure?
A - concurent sepsis
which of the following is a major contributor to protein cataboluism during the hypermetabolic stress response?
D - utilization of AA for gluconeogenesis
which of the following forms of dialysis is most likely to exacerbate hyperglycemia?
D - intermitant PD
which of the following is not included int he anion gap?
A - Phos
which of the following most accurately describes pro metabolism associated w/ cancer cachexia?
B - inc whole body turnover, inc catabolism, and increased synthesis
Mag depletion can occur in short bowel syndrome b/c mag:
D - complexes with unabsorbed fat and is then excreted
which of the following best describes CHO administration in newborns?
A - premature neonate s(<28 wks) are at risk for hypoglycemia and may need the addition of insulin therapy
severe head injury pts exhibit which of the following?
A - prolonged increase in BEE
Na and water absorption is the most efficient in which segments of the intestine?
C - ileum and colon
Which of the following is most characteristic of the
adaptation that occurs in prolonged malnutrition?
A. Adaptation of brain to use ketones as fuel
In a critically ill pt, lipogenesis is associated w/ which
of the following RQ values?
C – greater than 1.0
Compared to pts w/o a colon, the presence of a colon in
short bowel syndrome will:
B – increase absorption of calories from CHO
In CRF, ___ levels will mobilize Ca++ from bones
D – high PTH
Vitamin D and PTH do not regulate Ca2+ metabolism at
which of the following sites?
D – liver
Which of the following is not an effect of injury on
muscle?
B – oxidation of BCAA by skeletal muscke is decreased
Which of the following the mainstay of tx for pts with cirrhosis and ascites?
B - Na+ restriction w/ diuretics
which of the following feedings has been shown to consistently increase VCO2 and RQ in pts w/ pulmonary dyfxn?
A - excessive caloric intake
in pts w/ systemic inflammatory response syndrome, the body's greatest storage source of potential energy is minimally accesible 2/2:
A - hyperinsulinemia
the TEF increases nutritional needs by:
B - 6 -10%
which of the following is an effect of increased severity of stress in pts receiving nut'l support
A - inc pro synthesis
in pts w/ severe trauma, as the metabolic rate increases, which of the following is most likely to occur?
A - inc in O2 consumption
for a post op pt w/ a proximal small intestine enterocutaneous fistula who is to be enterally fed, what is ocnisdered to be the ideal location for placement of the feeding tube in relation to the fistula site?
B - distal
which of the following is an important metabolite of the conversion of arginine to citruline?
D - urea
hypercapnia in a pt on nutrition support is possibly d/t:
C - excessive total kcal
following small bowel resection, most adult pts will expereince permanent severe malabsorption when the remaining small bowel is less than:
C - 100 cm; 25% of small bowel; ~3 ft
a deficiency of which can result in abnormal prothrombin time?
C - K
Gln may be contraindicated in
C - short gut syndrome
A - hepatic failure
the typical time of onset of regular insulin is
A - 30 min -1 hr -peaks at 2-3 hrs and is effective for up to 6 hr
the primary intracellular cation is:
B - K+
the primary extracellular cation is:
C - Na2+
following a 72 hr fast the following becomes the major source of energy for the skeletal muscles
A - ketone bodies
soluble fiber is metabolized by the colonocytes to _____
D - short chain FA, specifically butyrate, are a significant source of energy for the colonocytes
___ is the primary source of AA mobilized for gluconeogenesis.
C - skeletal muscle
refeeding syndrome is characterized bu an intracellular shift of
D - K+, Mag, phos
the total body water of a normal weight adult is approximately
D - 50-60%
50 female, 60 male, 60 if not asked
the following condition would not be expected to increase one's fluid requirements
B - ventilator requirement
a pt w/ NG suction output exceeding 2L/d is likely to manifest the following way
A - metabolic alkalosis
the following is a measure of oxygenation
D - PaO2
an ilesotomy pt receiving TPN is likely to need supplementation of the following:
C - Na + and acetate
a pt on POD1 hass a bp of 90/50 on high dose casopressors and 100% fi02 has a TF order of standard formula to begin at 15 mL/hr via NG tube. the HOB cannot be elevated d/t hypotension. the most appropriate course of action is:
A - hold TF until hemodynamically stable
a pt w/ chronic or ESRD is most liekly to manifest w the following acid/base d/o:
A - metabolic acidosis
insulin, particularly high levels, would
A - supress lipolysis
the following best characterizes the metabolic repsonse to stress
B - inc emergy expenditure, increased nitrogen losses
long chain TAG are absorbed into the ___, MCT are absorbed into the____
B - lymphatics; portal system
LCT forms micelles w/ bile salts to lymphatics
in a pt w/ pronounced fat malabsorption, which of the following is false?
D - MCT should be given to prevent EFA deficiency
for a pt w/ renal failure requiring intermittant peritoneal dialysis, which of the following must be considered when selecting an enteral feeding formulation?
B - AA asborbed from the dialysate
loss of 50 cm of terminal ileaum often results in diarrhea d/t
A - effect of bile H+ on the colon
which of the following is associated w/ an increased incidence of metabolic bone dz in premature neonates?
A - prolonged use of PN
w/ fat malabsorption, as in short gut, the following may need to be restricted:
D - oxalate (at high risk for kidney stones as this is absorbed more in SBS)
in a premature infant, evidence of metabolic bone dz is strongly suggested by which of the following?
D - elevation in alk phos levels
the following is not a component of ketone bodies:
A - oxalacetic H+
B- acetone
C - B-hysdroxybutric H+
D - acetoacetic H+
A - oxalacetic H+
the following should be the primary foal in an acute trauma pt ay 89% IBW w/ an albumin of 2.4:
D - minimize nitrogen losses
the most important foal in initial post-op management of a pt who has undergone extensive small bowel resection is to:
A - replace fluid and 'lytes
diabetes may compromise wound healing by:
B - reducing O2 deliver b/c of altered microvasculature
which of the following is reccomended in the mgmt of decubitus ulcers:
B - promotoion of tissue oxygenation by elimination of pressure
hypomagnesiumemia and/or hyperkalemia following a transplant are likely d/t:
C - cyclosporine
PN solutions for bone marrow transplant pts often have to be concentrated b/c of:
A - fluid overload
in a neonatal pt, the following may not be a reasonable goal for nutrition support:
B - provide 100% of estimated nutritional needs
the following pt may be a candidate for PN:
C - hyperemesis gravidarum
to dec post-op complication by ~10%, severely malnourished pts who require surgery should recieve pre-op PN for a minimum of how many days prior to surgery:
C - 7-10
in trauma pts, early enteral compared to PN is:
C - useful in decreasing septic complications
which of the following are risk factors associated with aspiration pna?
D - decreased conciousnessm decreased gag reflec, mechanical ventilation
a pt w/ acute pancreatities may benefit from:
B - enteral feeding distal to ligament of treitz
most enteral feeding tubes are made of:
B -polyurethane
which of the following is a method of transpyloric feeding tube placement?
D - endoscopy , fluoroscopy, or intubation w/ guidewire in place
which of the following is an advantage of small bowel TF over gastric TF?
B - more appropriate for pts w/ delayed gastric emptying
which of the following is not a complication of percuatenous gastrostomy:
C - sinusitis
the preffered oral rehydration solution should be:
D - isotonic w/ Na+ and CHO replacement
which of the following PN additives may cause thrombocytopenia
A - insulin
b- heparin
c - folic H+
d - L-cysteine
b- heparin
when maintained slightly above normal serum [], whcih of the following 'lytes reduces the amount of K+ required in critically ill pts?
D - Mag
supplementation of which of the following AA could cause hyperammonemia
C - Glutamine
which of the following vitamins is most likely to suffer extensive photodegredation if the PN bag is left exposed to light?
A - vitamin A
replacement of a portion of long chain FA w/ omega 3 (marine oil derived) fatty acids will result in :
A- reducing all systemic cytokine levels
B- reducing the systemic level of IL6
C - leukocytes generating significantly high amts of the proinflammatory leukotriene B4
D - leukocytes generating significantly high amts of the less biologically active leukotirene B5
D - leukocytes generating significantly high amts of the less biologically active leukotirene B5
a pt undergoing chemo/rad for cancer in the region of the mediastinum is receiving TPN and complains of wt loss as well as pain and swelling in her neck and right arm. The likely cause of this is
C - catheter related complication
Which of the following is best suited for growth of
specific bacteria and yeasts?
A - lipid emulsion only
Which of the following is the recommended maximal hang
time in hours for lipid emulsions when they are infused alone?
B - 12
When added to PN regimens, which of the following
therapies have demonstrated therapeutic effects in pts w/ bone marrow
transplants?
B - Gln supplementation
In hypoalbuminemic pts, the use of albumin w/ PN solutions
has consistently demonstrated which of the following?
D - improved serum albumin []
The most appropriate parental AA solution for the
undialyzed pt w/ ARF contains:
B - a balance of essential and non-essential AA
Which of the following d/n characterize immune enhancing formulas?
C - they are high in linoleic H+
Which of the following best characterizes use of 3-1
total nutrient admixtures?
A - increased risk of precipitations of calcium salts
Which of the following is least characteristic of the fat
source in enteral nutrition?
D - MCT from coconut oil are added to prevent EFA
deficiency
Which of the following is least characteristic of the fat
source in enteral nutrition?
A - MCT from coconut oil are added to prevent EFA deficiency
The most appropriate formula for a pt w/ CHF or liver dz is likely to be:
A - concentrated low Na+ formula
B - Concentrated low CHO formula
C - standard isotonic formula
D - low Cho/high fat formula
A - concentrated low Na+ formula
What is the suggested adult parental thiamine daily dose mg - ? A - 1.5
B - 3.0
C - 5.0
D - 8.0
B - 3.0
Which of the following is not characteristic of elemental formulas?
A - are rarely taken orally d/t unpleasant taste
B - less $$ than polymeric formulas
C - are made of free AA
D - are indicated in pts w/ short bowel syndrome
B - less $$ than polymeric formulas
Which of the following enteral formulations would most likely reduce fecal energy loss in pt w/ short bowel syndrome and an intact colon?
A - high fat, low sodium
B - high fat, low CHO
C - high protein, low sodium
D - High CHO, low fat
D - High CHO, low fat
A standard 1 kcal/mL formula w/ 55 g pro/L delivered at 75 mL/hr will provide
A - 1800 kcal, 99 g pro
the most appropriate enteral formula for an infant w/ a chest tube is
D - formula with high [ ] of MCT and low LCT
what is one advantage to using structured lipids?
A - enhanced glc metabolism
B - lower serum [TAG]
C - prevention of carnitine deficiency
D - prevention of EFA deficiency
B - lower serum [TAG]
diluting enteral formulas to reduce osmolality has been shown to result in
A - improved GI tolerance
B - improved GI tolerance in pts w/ hx of GI surgery
C - a decrease in total energy and protein delivered D - reduced GI tolerance
C - a decrease in total energy and protein delivered
which of the following would approximate 100 kcal/kg in a 3.5 kg infant?
A - 523 mL of a 20 kcal/oz formula
B - 553 mL of a 20 kcal/oz formula
C - 523 mL of a 24 kcal/oz formula
D - 553 mL of a 24 kcal/oz formula
A - 523 mL of a 20 kcal/oz formula
in order to provide 1 mL H20 per kcal w/ a standard 1 kcal/mL formula at 80 mL/hr, approximately how much free water would be needed?
A - 200 mL
B - 300 mL
C - 400 mL
D - 500 mL
B - 300 mL
for pts w/ CF the following is most appropriate –
A - elemental formula alone
B - elemental formula w/ pancreatic enzyme supplementation
C - parental nutrition
D - standard, isotonic formula w/ pancreatic enzyme supplementation
D - standard, isotonic formula w/ pancreatic enzyme supplementation
the following is most likely to be supplemented in a dialysis pt:
A - selenium
B - Water soluble vitamins
C - selenium
D - vitamin A
B - Water soluble vitamins
A PN formula contains dextrose 16.5%, AA 4.25% at 80 mL/hr w/225 mL of 20% lipids. The calories and protein provided are:
A - 1623 kcal w/ 65 g pro
B - 1733 kcal w/ 77 g pro
C - 1853 kcal w/ 82 grams pro
D - 1913 kcal w/ 87 gm pro
C - 1853 kcal w/ 82 grams pro
Which of the following is a clinical benefit observed by adding gln-depeptide to a PN solution?
A - unaltered intestinal permeability
B - reduced glycemic complications
C - increaser serum [prealbumin]
D - reduced duration of PN
A - unaltered intestinal permeability
A PN formula contains dextrose 16.5%, AA 4.25% at 80 mL/hr w/225 mL of 20% lipids. Calculate the approximate osmolarity:
A - 1150 mOSM
B - 1250 mOSM
C - 1375 mOSM
D - 1450 mOSM
B - 1250 mOSM There are 2 ways to do this calculation: 1 - 50 mOSMS per % dextrose/100 mOSM per % AA or 2 - the # of gm x 5 divided by the liters of dextrose and the # of AA x 10 divided by the liters of AA; remember lipids are isotonic. ‘lytes are negligible
A PN formula contains dextrose 16.5%, AA 4.25% at 80 mL/hr w/225 mL of 20% lipids. If the solution is provided to a 55 kg man, the glc utilization rate would be in mg/kg/min -
A - 3.5
B - 4.0
C - 4.5
D - 5.0
B - 4.0
Which of the following best characterizes the source of CHO in enteral formulas?
A - formulas intended for oral use may add sorbital
B - most starches are derived from hydrolysis of cornstarch
C - maltodextrin contributes more to mOsm than corn syrup
D - Cho provide a smaller proportion of total kcal than fat in most formulas
B - most starches are derived from hydrolysis of cornstarch
The maximum glc utilization rate in adults in mg/kg/min is
A - 4.0
B - 4.5
C - 5.0
D - 5.5
C - 5.0
Which of the following is an adverse effect of excessive IV lipid emulsions?
A - mitral stenosis
B - thrombocytopenia
C - abnormal brain development
D - scaly eczematous dermatitis
B - thrombocytopenia
Because of the way that phosphorus dissociates, for every 12 mmol of phosphorus released form K+ phosphate ___ mEq of K+ are released
A - 13.2
B - 14.6
C - 17.6
D - 18.2
C - 17.6 For every 3 mmol of phos = 4.4 mEq of K for K phos, 4 mEq Na for Na phos
A pt is receiving NS at 75 mL/hr w/ 20 mEq KCl/L. this provides:
A - 277 mEQ Na; 36 mEq KCL
B - 139 mEQ Na; 36 mEq KCL
C - 283 mEQ Na; 36 mEq KCL
D - 283 mEQ Na; 40 mEq KCL
A - 277 mEQ Na; 36 mEq KCL
How man mL/L of fat emulsion are needed to provide a final [] of %% when using 20% intralipid as stock solutions?
A - 200
B - 500
C - 325
D - 250
D - 250
The normal daily Ca2+ requirements in mEq for a pt on PN w/ normal renal fx is
A - 15
B - 35
C - 45
D - 60
A - 15
In general, the following is true concerning IV lipids and pancreatitis:
A - IV lipids should not be given as it may stimulate pancreatic stimulations
B - IV lipids may be given up to 2x a week
C - IV lipids are not routinely contraindicated provided TAG are wnl
D - enteral lipids would stimulate the pancreas less than PN
C - IV lipids are not routinely contraindicated provided TAG are wnl
The following provides inherent vit K:
A - IV gln
B - IV lipids
C - IV AA
D - IV meds
B - IV lipids
The following best describes the available enteral modulars:
A - intact pro, dextrose, and MUFA
B - crystalline AA, glc polymers and MCT
C - intact pro, glc polymers, PUFA and MCT D - hydrolyzed pro, dextrose and MCT
C - intact pro, glc polymers, PUFA and MCT
A critically ill pt receiving PN with an insulin gtt at 4u/ht blood glc ranging 125-150 mg/dL - has been started on enteral feeding following resumption of GI fx. Glucose is trending upwards, what is the most appropriate response?
A - titrate insulin gtt prn to promote normal glc [] and decrease PN as EN is tolerated
B - d/c EF
C - begin sliding scale insulin
D - begin long acting insulin
A - titrate insulin gtt prn to promote normal glc [] and decrease PN as EN is tolerated
The following should preclude initiation of EN;
A - abdominal distention w/ ileus indicated on x-ray
B - NG suction of >50 ml/day
C - lack of bowel sounds
D - sinus infection
A - abdominal distention w/ ileus indicated on x-ray
Nutrition support is indicated in which of the following pts?
A - pt w. cervical carcinoma
B - pt w/ permanent oropharyngeal dysfxn
C - pt w/ superficial burns to lower extremities
D - well nourished pt unable to eat 3-4 day
B - pt w/ permanent oropharyngeal dysfxn
In a pt w/ severe head injury, the following is likely to be best tolerated:
A - NG feeding
B - OG feeding
C - NG feeding w/ prokinectic agents
D - NJ feeding
D - NJ feeding
In a home PN pt displaying signs of liver impairments, the most appropriate course of action would be to:
A - decrease CHO and fat kcal
B - decrease pro and fat kcal
C - increase fat kcal
D - d/c fat kcal
A - decrease CHO and fat kcal
To be considered for PN reimbursement under medicate guidelines, the solution must contain:
A - dextrose and lipids
B - AA and lipids
C - AA and dextrose
D - ‘lytes
C - AA and dextrose
What is the major cause of morbidity in home PN pts?
A - septicemia
B - hyperkalemia
C - hyperglycemia
D - EFA deficiency?
A - septicemia
The most common hepatic complication of PN is
A - choleostasis
B - steatatosis
C - fulminant liver failure D - hepatic encephalopathy
B - steatatosis
Under which of the following conditions will medicate reimburse enteral TF formulas and associated supplies for home use?
D - anatomic or motility d/o will interfere w/ oral intake for >90 d
A common complication of a home PN is:
A - catheter occlusion
B - venous thrombosis
C - pulmonary embolism
D - catheter related infection
D - catheter related infection
In addition to QOL, cycling PN may provide the following in home PN pts
A - decrease the risk of heart dz
B - decreased risk of infection
C - decrease risk of hepatic complications
D - decrease risk of catheter occlusions
C - decrease risk of hepatic complications
w/ prolonged hyperbilirubinemia, a prudent step is to avoid routine:
A - Cu, Mn
B - Vit A, Cu,
C - Chromium, vit D,
D - Zc, chromium
A - Cu, Mn
home EN reimbursement is based on the following
A - formula composition and number of kcal
the largest single payor of home EN and PN is
A - medicare
B - tricare
C - Medicaid
D - blue cross
A - medicare
in pts w/ small bowel resection, home PN will be covered if required for longer than ___ and if < ___ feet remaining post ligament of treitz
A - 60; 6
B - 90;2
C - 90; 8
D - 120; 6
B - 90;2
in a stable home EN pt, it would be most appropriate to routinely monitor
A - ‘lytes, prealb
B - UUN, wt
C - LFT’s, prealb
D - wt, I’s and o’s, bowel fx
D - wt, I’s and o’s, bowel fx
in a home PN pt 3-1 solution - the following should be added immediately before infusion
A - fat
B - Fe
C - mvi
D - pro
C - mvi
for an enterally fed home pt, a pump will be covered if
A - intolerance to gravity feeds is demonstrated
B - jejunal delivery of nutrients id required
C - PEG delivery of nutrients is required
D - it is requested by ordering physician
A - intolerance to gravity feeds is demonstrated
in a home PN pt displaying signs of metabolic bone dz, the following adjustment would be most appropriate:
C - dec pro
a pt is receiving PN that provides NaCL 50mEq/L, KCl 20 mEq/L, Kphos 30 mEq/L. lab values are Na 140; K 4.0 Cl- 119; CO2 11 an appropriate adjustment would be to
D - change the KCl to NaCL
A - change the NaCL to NA acetate
elevated LFT observed w/ initiation of PN occurs after a minimum of __
A - 5d
B - 1-4 wk
C - 5-7 wks
D - 3 mo
B - 1-4 wk
which of the following is not a nursing responsibility for monitoring jejuna tube feeding?
A - examination of the abdomen
B - measurement of residuals
C - accurate intake and output records
D - records of frequency, consistency and volume of stools
B - measurement of residuals
to minimize infections EF pts open system - should have bags and tubes changed q hours?
A - 8
B - 12
C - 24
D - 48
C - 24
an enterally fed pt suffering from constipation may benefit from
A - increasing formula
B - additional h20
C - changing to bolus feeding
D - routine enemas
B - additional h20
which of the following nutrition assessment measurements may be helpful in weaning a nutrition support pt from the ventilator?
A - daily wts
B - triceps skinfold
C - BIA
D - IC
D - IC
a pt receiving a standard EF consistently has a mag level of 3.0 mEq/dL a prudent first step would be to
C - ensure that meds w/ supplement Mg have been held
EN supplementation in cancer pts w/ normal nutrition status has resulted in
A - improved tolerance to cancer tx
B - significantly improved endurance
C - no benefit
D - increased survival
C - no benefit
Blue food coloring should be used when
A - pts are at risk for aspiration
B - pts have hx of aspiration pna
C - raising the HOB is contraindicated
D - should not routinely be used in critically ill pts
D - should not routinely be used in critically ill pts
The following pt is most likely to have an accurate nitrogen balance assessment:
A - fistula
B - thermal injury
C - respiratory failure
D - renal failure
C - respiratory failure
Which of the following groups of pts I known to have the highest incidence of cholestasis during PN?
A - trauma
B - elderly
C - IBD
D - neonatal
D - neonatal
Using the nitrogen balance equation, what is the expected nitrogen balance is a pt w/ high insensible losses receiving 100 gm AA w/ 19 g urine nitrogen/24 hours?
A - +1 gm
B - +3 gm
C - -3 gm
D - -7 gm
D - -7 gm
The following parental catheter site has the highest infection risk:
A - subclavian
B - femoral
C - basilic picc -
D - internal jugular
B - femoral
Which of the following factors is not implicated in the development of thrombophelbitis w/ PN
A - properties and size of the vein
B - CA+ and K+ content
C - [lipid emulsion]
D - osmolarity of solution
C - [lipid emulsion]
GI mucosal edema, 2/2 hypoalbuminemia may result in
A - excess fluid retention
B - severe diarrhea
C - microbial infection
D - mucosal sloughing
B - severe diarrhea
Bolus, intermittent or continuous feeding may be employed with:
A - gastrostomy tube
B - nasoduodenal tube
C - NJ tube D - jejunostomy
A - gastrostomy tube
Which of the following is most likely to slow gastric emptying:
A - low fat enteral feeding
B - IV zc
C - elevated plasma insulin
D - hyperglycemia
D - hyperglycemia
Which of the following is an advantage of peripherally inserted over centrally inserted central venous catheters:
A - have fewer mechanical complications
B - are used for extended period
C - cab use lower extremity veins
D - are higher in cost but do not require MD to insert
A - have fewer mechanical complications
Which of the following precautions is required to percent central venous catheterization related infections during insertion?
A - aseptic techniques only
B - use of OR suite
C - sterile gloves and small fenestrated drape
D - sterile gloves, gown, large drape and mask
D - sterile gloves, gown, large drape and mask
Which of the following is the most significant risk factor for catheter related infections?
A - catheter composition
B - catheter location
C - pt dx
D - catheter care technique
D - catheter care technique
The following d/n help determine renal solute load:
A - pro
B - Na+
C - K+ D - Ca2+
D - Ca2+
Which of the following is most likely to contribute to PN associated alterations in renal tubular fx?
A - hyperoxularia
B - Selenium toxicity
C - Gln deficiency
D - Bacteremia/fungemia episodes
D - Bacteremia/fungemia episodes
Which of the following is a common contributor of occlusion to small bore feeding tubes?
A - aspiration for measurement of gastric residuals
it is difficult to compare studies on aspiration pna b/c:
A - gastric residuals are not consistent in volume
B - the is inconsistency in defining aspiration
C - not all hospitals have nutrition services to compare the feedings
D - some studies compare gastrosotomy to jejunostomy feedings
B - the is inconsistency in defining aspiration
contamination of enteral feeding is likely to be d/t:
A - contamination occurring during manufacturing process
B - organisms on hands of healthcare worker
C - inherent flora on enteral access device
D - respiratory infection of pt
B - organisms on hands of healthcare worker
in a preterm infant, ___ is conditionally essential and may also help w/ Ca2+ and phos solubility:
A - carnitine
B - cysteine
C - taurine D - tryptophan
B - cysteine
a pt undergoing chemo/rad for cancer in the region of the mediastinum is receiving TPN and complains of wt loss as well as pain and swelling in her neck and right arm. The likely cause of this is
A - low albumin and fluid shifts
B - malnutrition
C - pneumothorax at time of catheter infection
D - catheter related complication
D - catheter related complication
The following should be performed to assess feeding tube placement prior to initiation of enteral feeding:
A - radiographic confirmation
B - auscultation
C - pH assesment D - blue dye test
A - radiographic confirmation
The following is not a complication of ventral venous access?
A - air embolus
B - vein thrombosis
C - occlusion
D - HTN
D - HTN
A pt has a NG tube placed and is immediately started on a standard formula at 10 mL/hr. the pt develops coughing, an inability to speak and decrease 02 sat. what should be done?
A - r/o lung placement of NG tube
B - d/c EN
C - continue to increase enteral feed per protocol while monitoring
D - start PN
A - r/o lung placement of NG
A - Rapid administration of feeding
B - lack of soluble fiber
C - medications
D - gravity feeding
C - medications
A generally accepted guideline to decrease the risk of aspiration in enterally fed pts is to:
A - routinely add prokinetic medication
B - avoid gastric feeding in all pts, and only use post-pyloric
C - check residuals q4hr and hold if >40 min
D - maintain HOB >30 degrees at all times
D - maintain HOB >30 degrees at all times
The most common cause of hyponatremia is
A - insufficient Na provision
B - insufficient H2O provision
C - excessive Na provision
D - excessive H2O provision
D - excessive H2O provision
The following medications can provide a significant amt of kcal:
A - propofol
B - propanolol
C - ativan
D - steroids
A - propofol
Sulfasalazine will increase requirements for
A - thiamine
B - carnitine
C - B12
D - folic acid
D - folic acid
Loop diuretics cause urinary losses of
A - Cu
B - Ca2+
C - bicarb D - vit C
B - Ca2+
In the kidney, spironolactone can modulate the excretion of which ions?
A - Na, Cl
B - Na, K+
C - Phos, Ca2+,
D - K+, Mag
B - Na, K+
Fe should not be provided via jejuna access b/c
A - it may cause dumping
B - an acidic environment is needed for absorption
C - it requires IF D - Fe absorption begins in stomach
B - an acidic environment is needed for absorption
Which of the following medications may cause carnitine deficiency?
A - caffeine
B - phenytoin
C - Pheonbarbital D - Valproic Acid
D - Valproic Acid
Azathioprine will predispose one to a deficiency in
A - folic H+
B - thiamine
C - vit B6
D - Ca2+
A - folic H+
This drug, used in the tx of tuberculosis, forms a complex with pyridoxine:
A - neomycin
B - phenylpropanolamine
C - isoniazid
D - colchicine
C - isoniazid
This drug, used in the tx of tuberculosis, forms a complex with pyridoxine:
A - neomycin
B - phenylpropanolamine
C - isoniazid
D - colchicine
C - isoniazid
The additional of aluminum hydroxide based medication may lower
A - K+
B - phos
C - Mag
D - Ca2+
B - phos
The following medication will decrease folate []:
A - metoclopramide
B - methotrexate
C - calproic acid
D - cisapride
B - methotrexate
A low albumin may be a concern when providing:
A - phenytoin
B - lorazapam
C - oxycodone D - roxicodone
A - phenytoin
Dehydration and malnutrition resulting from withholding or withdrawing artificial nutrition and hydration in the terminal pt is most likely to :
A - be grounds for malpractice
B - facilitate comfort in the dying process
C - cause a painful and agonizing death
D - result in s/s including thirst, hunger, cramping, nausea, seizures
B - facilitate comfort in the dying process
Which of the following best describes the use of artificial nutrition and hydration?
A - ethically speaking, withholding is equivalent to withdrawing
B - it is ethically permissible to withhold from certain pts but, once started, may never be withdrawn
C - it is considered ordinary tx and may never be withheld or withdrawn
D - professional organization share the opinion that, if a dying pt cannot eat or drink appropriately it should always be initiated
A - ethically speaking, withholding is equivalent to withdrawing
Which of the following is the primary ethical principle underlying the decision to forgo nutrition support for the terminally ill?
A - neurological brain death
B - level of physical suffering
C - right of self determination
D - level of psychological suffering
C - right of self determination
In a terminally ill cancer pt, use of EN or PN is most likely to provide
A - increased QOL
B - decreased QOL
C - fewer medical complications
D - enhanced physical and emotional well being
B - decreased QOL
In the dilemma of whether to continue or withdraw nutrition support in a pt who is in a permanently unconscious states, which of the following is the most important factor in the decision making process
A - attending MD order
B - federal laws that prohibit the withdrawal of nutrition support once ins instituted
C - individual state laws
D - pt’s advance direction and consultation w/ family about what the pts wishes are
D - pt’s advance direction and consultation w/ family about what the pts wishes are
Which of the following is a purpose of an advanced direction?
A - to prohibit the withdrawal or withholding of artificial nutrition or hydration
B - to allow a durable power of attorney to be appointed for a pt to make all medical decisions for the pt
C - to provide an outline of each states laws re: withdrawal or withholding of artificial nutrition
D - to provide MD with guidance from the pt as to tx and non-tx preference in the event the pt loses decision making capacity
D - to provide MD with guidance from the pt as to tx and non-tx preference in the event the pt loses decision making capacity
The following agency regulates medical foods:
A - ADA
B - ASPEN
C - FDA
D - dept of health
