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Question: 1
Which of the following additives has the greatest risk over time of destabilizing the intravenous fat emulsion (IVFE) in a total nutrient admixture (TNA)?
1: Sodium chloride
2: Calcium acetate
3: Iron dextran
4: Potassium phosphate
3: Iron dextran
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Question: 2
Which of the following factors has been associated with an increase in prescribing errors related to PN formulations?
1: Standardized PN order form
2: Calculation of PN dosages
3: PN components ordered as amount per day
4: PN components listed in same sequence on order form as PN label
2: Calculation of PN dosages
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Question: 3
According to the A.S.P.E.N. Safe Practices Guidelines, which of the following is the best method to express the dextrose content on the label of a PN formulation in order to avoid misinterpretation?
1: Volume of the percent of original concentration added (e.g., 500 mL of 50% dextrose)
2: Grams per liter (e.g., 250 g/L)
3: Percent of final concentration after admixture (e.g., 35% dextrose)
4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)
4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)
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Question: 4
All of the following are considered to be mandatory for the PN order form EXCEPT
1: general statement warning of the potential for PN formulation incompatibilities.
2: contact number for the person writing the order.
3: hangtime guidelines.
4: recommended PN laboratory tests.
4: recommended PN laboratory tests.
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Question: 5
According to the A.S.P.E.N. Safe Practices Guidelines, the following are strongly recommended for inclusion on the PN label EXCEPT
1: route of administration.
2: dose of macronutrients for 24 hours.
3: dosing weight.
4: location of venous access device.
4: location of venous access device.
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Question: 6
What is the nutritional value of the following PN formula? 1000mL 30% dextrose, 800mL 15% amino acids, 200mL 20% IVFE.
1: 1352 kcal, 200 grams carbohydrate, 68 grams protein, 40 grams fat
2: 1692 kcal, 300 grams carbohydrate, 68 grams protein, 40 grams fat
3: 1900 kcal, 300 grams carbohydrate, 120 grams protein, 40 grams fat
4: 2000 kcal, 300 grams carbohydrate, 120 grams protein, 50 grams fat
3: 1900 kcal, 300 grams carbohydrate, 120 grams protein, 40 grams fat
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Question: 7
A patient is receiving 65 mL/hr of 7.5% amino acids and 17.5% dextrose of a 2-in-1 PN solution in addition to 250 mL of 20% IVFE. What is the daily caloric content of this regimen?
1: 1345 kcal/day
2: 1395 kcal/day
3: 1846 kcal/day
4: 1896 kcal/day
4: 1896 kcal/day
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Question: 8
What significant benefit has hypocaloric PN support shown in ICU patients with obesity?
1: Reduction in mortality
2: Reduction in length of stay in ICU
3: Reduction of days on insulin therapy
4: Reduction in ventilator days
3: Reduction of days on insulin therapy
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Which of the following is an absolute indication for the use of PN?
1: High output fistula
2: Crohn's disease
3: Pancreatitis
4: Hyperemesis gravidarum
1: High output fistula
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Question: 10
In patients with ulcerative colitis, the use of PN as a primary treatment has been shown to be
1: of no benefit in influencing the disease response.
2: effective in reducing the inflammatory response.
3: effective in reducing both operative and mortality rates.
4: more effective than intravenous methylprednisolone in reducing the disease response.
1: of no benefit in influencing the disease response.
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Question: 11
When is PN indicated in severe burn patients?
1: Total body surface area burn exceeds 20%
2: As soon as possible after admission due to extremely high caloric needs
3: EN is contraindicated or unlikely to meet nutrition needs
4: Within 7-10 days after hospital admission
3: EN is contraindicated or unlikely to meet nutrition needs
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Question: 12
The routine use of preoperative PN is indicated for patients who are
1: normally nourished.
2: mildly to moderately malnourished.
3: mildly malnourished with secondary co-morbidities.
4: severely malnourished.
4: severely malnourished.
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Question: 14
Which of the following is an absolute indication for PN support in a cancer patient?
1: Small bowel obstruction for seven days
2: Metastatic cancer, receiving palliative care
3: Receiving concurrent chemotherapy and radiation therapy
4: Mild malnutrition, scheduled for surgery in three days
1: Small bowel obstruction for seven days
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When should PN be used in Crohn's disease?
1: As a primary therapy to rest the bowel
2: Only after failure to tolerate EN
3: To prevent associated malnutrition
4: Preoperatively regardless of nutrition status
2: Only after failure to tolerate EN
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Question: 16
Current recommendations regarding safe administration of intravenous fat emulsion (IVFE) include
1: IVFE hang time up to 24 hours when included as part of a total nutrient admixture (TNA).
2: IVFE hang time up to 24 hours when administered as an infusion separate from PN.
3: Use of a 0.22 micron filter when administering a TNA to remove microorganisms from a contaminated PN.
4: Use of a 1.2 micron filter when administering a TNA to remove microorganisms from a contaminated PN.
1: IVFE hang time up to 24 hours when included as part of a total nutrient admixture (TNA).
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Question: 17
Which of the following is the most appropriate distal catheter tip placement of a peripherally inserted central catheter (PICC)?
1: Cephalic vein
2: Superior vena cava
3: Internal jugular vein
4: Supraclavicular vein
2: Superior vena cava
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Question: 18
Which of the following is a disadvantage of a peripherally-inserted central catheter (PICC)?
1: High rate of catheter malposition
2: High risk of pneumothorax
3: Requires repeated skin puncture
4: Only available with single lumen
1: High rate of catheter malposition
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Question: 19
When is it most appropriate to start PN infusion in a patient with a new central venous catheter inserted at the bedside without fluoroscopy?
1: Immediately
2: After auscultating for catheter tip placement
3: After chest X-ray confirms correct placement of catheter tip
4: After ensuring there were no complications with insertion
3: After chest X-ray confirms correct placement of catheter tip
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Question: 20
According to the Centers for Disease Control and Prevention (CDC), which of the following is true regarding PICC line care?
1: Routine placement is recommended to prevent catheter-related blood stream infections (CRBSIs)
2: Remove the PICC line immediately if fever develops
3: Use routine guidewire exchange of PICC line to prevent catheter-related blood stream infections
4: Remove the PICC line only if it is suspected or known to be the source of infection
4: Remove the PICC line only if it is suspected or known to be the source of infection
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Question: 21
PN solutions containing a final dextrose concentration exceeding 20% should NOT be infused via a catheter inserted in which vein?
1: Basilic
2: Femoral
3: Subclavian
4: Internal jugular
1: Basilic
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Question: 22
Which of the following PN formulas can be safely administered through a peripheral catheter?
1: 10% dextrose and 3% amino acid
2: 20% dextrose and 3% amino acid
3: 10% dextrose and 10% amino acid
4: 20% dextrose and 10% amino acid
1: 10% dextrose and 3% amino acid
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Question: 23
A total nutrient admixture (TNA) contains which macronutrients?
1: Water and amino acids
2: Carbohydrates and amino acids
3: Water, amino acids, and IV fat emulsion (IVFE)
4: Carbohydrates, amino acids, and IVFE
- 4: Carbohydrates, amino acids, and IVFE
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Question: 24
Glutamine supplementation in PN is limited by
1: the presence of intravenous fat emulsion (IVFE) in a total nutrient admixture (TNA) formula.
2: expense of the commercially available product.
3: physical stability after compounding.
4: the presence of calcium in the PN.
3: physical stability after compounding.
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Question: 25
The primary difference between renal and standard intravenous amino acid formulas is that renal formulas contain a higher proportion of which type of amino acids?
1: Non-essential
2: Conditionally essential
3: Essential
4: Branched-chain
3: Essential
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Question: 26
Branched-chain amino acid formulas would be most appropriate for
1: a patient with a recent diagnosis of hepatocellular cancer.
2: prevention of a first episode of hepatic encephalopathy in a patient who has undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
3: initial management of acute hepatic encephalopathy.
4: a cirrhotic patient with chronic encephalopathy who is intolerant of standard protein sources.
4: a cirrhotic patient with chronic encephalopathy who is intolerant of standard protein sources.
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Question: 27
Failure to provide linoleic and alpha linolenic acids with PN will most likely result in
1: metabolic acidosis.
2: hyperglycemia.
3: metabolic bone disease.
4: essential fatty acid deficiency (EFAD).
4: essential fatty acid deficiency (EFAD).
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Question: 28
The adverse effects of intravenous fat emulsion (IVFE) administration in adults is best prevented by
1: supplementing with L-carnitine.
2: avoiding infusion rates >0.1 grams/kg/hour.
3: using 10% IVFE preparations.
4: avoiding serum triglyceride levels >400 mg/dL.
4: avoiding serum triglyceride levels >400 mg/dL.
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Question: 29
Which of the following best describes an intravenous fat emulsion (IVFE) produced by the transesterification of fatty acids to form a composite triglyceride molecule?
1: Single oil
2: Multi-oil
3: Structured
4: Physical mixture
4: Physical mixture
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Question: 30
Which of the following trace elements should NOT be added to the PN for a patient with hepatobiliary disease?
1: Zinc and manganese
2: Zinc and magnesium
3: Copper and manganese
4: Copper and magnesium
3: Copper and manganese
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Question: 31
Which of the following PN components is NOT a source of aluminum contamination?
1: Heparin
2: L-cysteine
3: Potassium phosphate
4: Regular insulin
4: Regular insulin
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Question: 32
A long term PN patient experiences extrapyramidal symptoms. Which trace element toxicity is most likely to present with these symptoms?
1: Manganese
2: Copper
3: Zinc
4: Selenium
1: Manganese
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Question: 33
When compared to the Dietary Reference Intakes (DRIs) for fat-soluble vitamins given orally, the DRIs for parenterally administered fat-soluble vitamins are
1: less.
2: equal.
3: two times greater.
4: four times greater.
1: less.
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Question: 34
When compared to the Dietary Reference Intakes (DRIs) for water-soluble vitamins given orally, the DRIs for parenterally administered water-soluble vitamins are
1: one-third.
2: one-half.
3: equal.
4: greater.
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Question: 35
According to USP Chapter 797, a PN solution prepared from 8.5% amino acid solution with electrolytes and 70% dextrose, with multivitamins, trace elements, and famotidine added would be classified as
1: no risk.
2: low risk.
3: medium risk.
4: high risk.
3: medium risk.
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Question: 36
Which one of the following best describes a safe compounding practice for PN?
1: The physical appearance of a final PN formulation containing amino acids, dextrose, and additives should be visually assessed to detect the presence of particulate matter.
2: Visual assessment of the final formulation of a total nutrient admixture is not recommended as it is not anticipated that problems can be visually detected in an opaque dispersion.
3: Manual methods for compounding PN formulations are no longer recommended; automated methods have been shown to be safer and more cost effective.
4: Using brands of PN components (e.g., amino acids, dextrose, intravenous fat emulsion) from different manufacturers to compound PN formulations is a safe practice that should not raise concerns.
1: The physical appearance of a final PN formulation containing amino acids, dextrose, and additives should be visually assessed to detect the presence of particulate matter.
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Question: 37
Creaming of a total nutrient admixture (TNA) appears as
1: a translucent band at the surface of the emulsion separate from the remaining TNA dispersion.
2: yellow-brown oil droplets at or near the TNA surface.
3: a continuous layer of yellow-brown liquid at the surface of the TNA.
4: marbling or streaking of the oil throughout the TNA.
1: a translucent band at the surface of the emulsion separate from the remaining TNA dispersion.
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Question: 38
Which of the following complications is most likely to occur when transitioning a critically ill patient from parenteral to enteral nutrition?
1: Hypocalcemia
2: Hypercalcemia
3: Hypoglycemia
4: Hyperglycemia
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Question: 39
Rapid intravenous infusion of sodium or potassium phosphate may result in
1: tetany.
2: hypercalcemia.
3: metabolic alkalosis.
4: vitamin D deficiency.
1: tetany.
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Question: 40
Which of the following should be monitored regularly in an adult patient receiving IVFE?
1: Fecal fat
2: Serum osmolarity
3: Prothrombin time
4: Retinol-binding protein
3: Prothrombin time
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Question: 41
A patient receiving PN develops metabolic acidosis. Which serum electrolyte level needs to be monitored most closely?
1: Sodium
2: Chloride
3: Potassium
4: Magnesium
3: Potassium
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Question: 42
Which of the following is a clinical sign of hyperphosphatemia?
1: Tachycardia
2: Tetany
3: Hyperventilation
4: Altered mental status
2: Tetany
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Question: 43
What laboratory findings are diagnostic for essential fatty acid deficiency?
1: A serum triglyceride level < 100 mg/dL
2: A lymphocyte absolute count < 1000/microliter
3: A serum cholesterol level < 100 mg/dL
4: A triene to tetraene ratio greater than 0.4
4: A triene to tetraene ratio greater than 0.4
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Question: 44
Concurrent infusion of IVFE and propofol would most likely cause
1: hyperglycemia.
2: hypertriglyceridemia.
3: azotemia.
4: hypernatremia.
2: hypertriglyceridemia.
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Question: 45
Which component of PN most likely impacts a patient receiving warfarin for anticoagulation?
1: Standard amino acids and electrolytes
2: Dextrose and trace elements
3: Intravenous fat emulsion (IVFE) and vitamins
4: Branched-chain amino acids and electrolytes
3: Intravenous fat emulsion (IVFE) and vitamins
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Question: 46
When initiating a PN regimen that contains regular insulin, how often should capillary blood glucose levels be monitored?
1: Every 6 hours
2: Every 8 hours
3: Every 12 hours
4: Every 24 hours
1: Every 6 hours
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Question: 47
A patient is receiving 120 mL/hr of a cyclic PN solution containing 50 units of regular insulin. How should the PN solution be tapered off?
1: Cut the rate in one quarter for the last two hours prior to discontinuation
2: Cut the rate in one quarter for the last four hours prior to discontinuation
3: Cut the rate in half for the last two hours prior to discontinuation
4: Cut the rate in half for the last four hours prior to discontinuation
3: Cut the rate in half for the last two hours prior to discontinuation
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Question: 48
In adult parenteral nutrition patients, intravenous fat emulsion (IVFE) use should be limited to the provision of essential fatty acids only when serum triglyceride levels rise above
1: 400 mg/dL.
2: 300 mg/dL.
3: 200 mg/dL.
4: 100 mg/dL.
1: 400 mg/dL.
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Question: 49
Long term use of which parenteral nutrition (PN) product would most likely contribute to aluminum accumulation in a person requiring chronic parenteral nutrition?
1: Vitamin K
2: Potassium phosphate
3: 10% intravenous fat emulsion
4: Parenteral amino acids
2: Potassium phosphate
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Question: 50
Commonly reported advantages to cycling parenteral nutrition include all except
1: more rapid restoration of serum albumin levels.
2: prevention of parenteral nutrition-induced fatty infiltration of the liver.
3: prevention of parenteral nutrition-associated hyperglycemia.
4: higher level of social activity and interaction in parenteral nutrition-dependent patients
3: prevention of parenteral nutrition-associated hyperglycemia.
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