Cnsc Study

Front 1

Which of the following best describes the utility of aluminum in parenteral solutions?

1: Potentiates the action of insulin
2: Has no known biologic function
3: Decreases the incidence of bone fractures
4: Is necessary for normal erythropoiesis

Back 1

2: Has no known biologic function

Front 2

A patient with alcoholism is admitted with small bowel obstruction and is started on PN providing 400 grams of dextrose. If, after 3 days, the patient develops Wernicke's encephalopathy it is most likely due to a deficiency of

1: pyridoxine.
2: thiamine.
3: folic acid.
4: vitamin C.

Back 2

2: thiamine.

Front 3

A previously well-nourished patient with persistent fever is admitted to the hospital. His laboratory tests reveal: albumin, 2.1 g/dL; C-reactive protein, 12 mg/L; serum calcium of 7.2 mg/dL. Which of the following is the most likely reason of the hypoalbuminemia?

1: Caloric intake is below the recommendations
2: Protein intake is below the recommendations
3: Hypocalcemia
4: Inflammatory response

Back 3

4: Inflammatory response

Front 4

The risk of metastatic calcification of calcium phosphate in soft tissues increases when the product of phosphorus and calcium in the serum (serum phosphorus x serum total calcium) exceeds

1: 25.
2: 35.
3: 45.
4: 55

Back 4

4: 55

Front 5

Which of the following is associated with adaptation to starvation?

1: Hyperthermia
2: Reduced muscle mass
3: Lipogenesis
4: Increased cardiac capacity

Back 5

2: Reduced muscle mass

Front 6

Which of the following is a characteristic of kwashiorkor malnutrition?

1: Splenomegaly
2: Hypoalbuminemia
3: Hypoglycemia
4: Cachexia

Back 6

2: Hypoalbuminemia

Front 7

Which of the following predictive equations has demonstrated the greatest accuracy in estimating actual resting metabolic rate in obese and nonobese adults?

1: Owen using adjusted body weight
2: Harris-Benedict using actual body weight
3: Harris-Benedict using adjusted body weight
4: Mifflin-St. Jeor using actual body weight

Back 7

4: Mifflin-St. Jeor using actual body weight

Front 8

Which of the following is an aromatic amino acid?

1: Valine
2: Leucine
3: Tyrosine
4: Isoleucine

Back 8

3: Tyrosine

Front 9

Copper deficiency is associated with

1: leukocytosis.
2: macrocytic anemia.
3: microcytic hypochromic anemia.
4: erythrocytosis.

Back 9

3: microcytic hypochromic anemia

Front 10

A respiratory quotient (RQ) of .95 most likely suggests

1: primarily fat oxidation.
2: mixed substrate utilization
3: underfeeding.
4: overfeeding..

Back 10

2: mixed substrate utilization

Front 11

Which of the following has been shown to reduce plasma homocysteine concentrations?

1: Folic acid
2: Vitamin E
3: L-carnitine
4: Ascorbic acid

Back 11

1: Folic acid

Front 12

Iron is primarily absorbed in the

1: distal ileum.
2: distal jejunum.
3: proximal ileum.
4: proximal jejunum.

Back 12

4: proximal jejunum.

Front 13

Malnutrition is most common in which of the following forms of inflammatory bowel disease?

1: Crohn's disease
2: Ulcerative colitis
3: Microscopic colitis
4: Collagenous colitis

Back 13

1: Crohn's disease

Front 14

Arginine supplementation should be used most cautiously in which of the following patients?

1: Trauma patients
2: Surgical patients
3: Septic shock patients
4: Immunocompromised patients

Back 14

3: Septic shock patients

Front 15

Which of the following methods of nutrition assessment evaluate subcutaneous fat and muscle wasting at multiple body sites to determine nutritional status?

1: Nutritional risk index (NRI)
2: Prognostic nutrition index (PNI)
3: Subjective Global Assessment (SGA)
4: Prognostic inflammatory and nutritional index (PINI)

Back 15

3: Subjective Global Assessment (SGA)

Front 16

Zinc deficiency caused by malnutrition is most likely to result in

1: diarrhea.
2: carotenemia.
3: coagulopathy disorder.
4: increased absorption of nutrients.

Back 16

1: diarrhea.

Front 17

What vitamin absorption is most likely to be impaired with the use of proton pump inhibitor therapy?

1: Vitamin A
2: Vitamin C
3: Vitamin B6
4: Vitamin B12

Back 17

4: Vitamin B12

Front 18

Which of the following IV fluids most closely resemble jejunal and ileal electrolyte content?

1: Lactated Ringer
2: 0.9% Sodium chloride (normal saline)
3: 0.45% Sodium chloride (1/2 normal saline)
4: D5 0.45% Sodium chloride

Back 18

1: Lactated Ringer

Front 19

Dietary fat is predominately absorbed in what part of the intestine?

1: Ileum and colon
2: Stomach and duodenum
3: Distal jejunum and ileum
4: Duodenum and proximal jejunum

Back 19

4: Duodenum and proximal jejunum

Front 20

In a patient with nonhealing wounds suspected of having a vitamin A deficiency, supplementation of vitamin A (25,000 IU/day) should usually be given for a MAXIMUM of

1: 2 days.
2: 10 days.
3: 45 days.
4: 60 days.

Back 20

2: 10 days

Front 21

Which of the following amino acids is most crucial in small intestinal structure and function?

1: Alanine
2: Leucine
3: Aspartate
4: Glutamine

Back 21

4: Glutamine

Front 22

What is the approximate normal length of small intestine in adults?

1: 100 cm
2: 150 cm
3: 200 cm
4: 600 cm

Back 22

4: 600 cm

Front 23

Which of the following is the best indicator of risk for malnutrition?

1: Serial tricep skinfold remaining at the 20th percentile
2: Voluntary body mass index change from 30 to 25 over 6 months
3: Involuntary weight loss of 10% usual body weight over six months
4: Albumin decrease from 4.0 to 3.5

Back 23

3: Involuntary weight loss of 10% usual body weight over six months

Front 24

Which of the following conditions is most likely to result in malnutrition?

1: Cancer
2: Pneumonia
3: Gastric ulcer
4: Multiple sclerosis

Back 24

1: Cancer

Front 25

Gastrectomy patients are at risk for a deficiency of which vitamin?

1: B12
2: Folic Acid
3: Thiamine
4: B6

Back 25

1: B12

Front 26

In persons with phenylketonuria, tyrosine becomes an essential amino acid due to

1: an increase in the tyrosine hydroxylase enzyme.
2: a deficiency in the phenylalanine hydroxylase enzyme.
3: an increase in the phenylalanine hydroxylase enzyme.
4: a decrease in the tyrosine hydroxylase enzyme.

Back 26

2: a deficiency in the phenylalanine hydroxylase enzyme.

Front 27

Which of the following compromises the reliability of urinary urea nitrogen to calculate nitrogen balance?

1: protein intake <0.5 g/kg/day
2: creatinine clearance <50 mL/min
3: diuresis >2.5 L
4: fecal nitrogen >1g

Back 27

2: creatinine clearance <50 mL/min

Front 28

What is the fluid requirement for patients during critical illness and sepsis?

1: 15-25 mL/kg/day
2: 30-40 mL/kg/day
3: 45-55 mL/kg/day
4: 60-70 mL/kg/day

Back 28

2: 30-40 mL/kg/day

Front 29

Hepatic encephalopathy is most likely to be improved by which of the following trace elements?

1: Selenium
2: Copper
3: Zinc
4: Chromium

Back 29

3: Zinc

Front 30

Valproic acid (Depakene) has been shown to induce a deficiency in which of the following nutrients?

1: Copper
2: Carnitine
3: Fatty acids
4: Essential amino acids

Back 30

2: Carnitine

Front 31

Which of the following has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients?

1: Albumin
2: Prealbumin
3: Transferrin
4: Retinol-binding protein

Back 31

1: Albumin

Front 32

An end stage liver disease patient with refractory ascites is awaiting liver transplantation and is intolerant to tube feeding. His serum sodium is 128 mEq/L. Which of the following would be most appropriate to recommend?

1: No parenteral nutrition
2: Restrict fluid, restrict sodium , provide 0.5 g/kg per day protein
3: restrict fluid, restrict sodium, provide 1.5 g/kg per day protein
4: Restrict fluid, supplement sodium, provide 1.0 g/kg per day protein

Back 32

3: restrict fluid, restrict sodium, provide 1.5 g/kg per day protein

Front 33

Which of the following is the most appropriate fluid requirement for a healthy adult?

1: 15-20 ml fluid/kg/day
2: 20-25 ml fluid/kg/day
3: 30-35 ml fluid/kg/day
4: 40-45 ml fluid/kg/day

Back 33

3: 30-35 ml fluid/kg/day

Front 34

What is the primary fuel of the colonocytes?

1: Medium chain fatty acids
2: Glucose
3: Glutamine
4: Short chain fatty acids

Back 34

4: Short chain fatty acids

Front 35

Which of the following enzymes initiates the digestive process of carbohydrates in the mouth?

1: Lipase
2: Lactase
3: Maltase
4: Amylase

Back 35

4: Amylase

Front 36

Which of the following amino acids is most crucial in small intestinal structure and function?

1: Alanine
2: Leucine
3: Aspartate
4: Glutamine

Back 36

4: Glutamine

Front 37

In assessing the caloric goal for patients receiving nutrition support, the measured resting energy expenditure determined from indirect calorimetry should be

1: reduced by 10% if respiratory quotient exceeds 1.0.
2: increased by a stress factor of 1.2-1.5 for sepsis or trauma.
3: adjusted by a thermogenesis factor for enterally fed patients.
4: used as the caloric target without addition of stress or activity factors.

Back 37

4: used as the caloric target without addition of stress or activity factors

Front 38

Which of the following anatomic structures is LEAST important to the function of a massively resected gastrointestinal tract?

1: Colon
2: Ileum
3: Jejunum
4: Ileocecal valve

Back 38

3: Jejunum

Front 39

A patient receiving PN with a high ileostomy output is likely to require

1: increased sodium and increased fluid volume.
2: decreased water and decreased sodium.
3: increased sodium and decreased protein.
4: decreased sodium and increased fluid volume.

Back 39

1: increased sodium and increased fluid volume.

Front 40

Copper toxicity is associated with

1: liver disease.
2: kidney disease requiring hemodialysis.
3: aggressive zinc supplementation.
4: lung disease.

Back 40

1: liver disease.

Front 41

Cheilosis is a physical symptom associated with a deficiency of

1: vitamin D.
2: folic acid.
3: riboflavin.
4: vitamin C.

Back 41

3: riboflavin.

Front 42

A previously well-nourished patient with persistent fever is admitted to the hospital. His laboratory tests reveal: albumin, 2.1 g/dL; C-reactive protein, 12 mg/L; serum calcium of 7.2 mg/dL. Which of the following is the most likely reason of the hypoalbuminemia?

1: Caloric intake is below the recommendations
2: Protein intake is below the recommendations
3: Hypocalcemia
4: Inflammatory response

Back 42

4: Inflammatory response

Front 43

Which of the following are examples of conditionally indispensable amino acids?

1: Leucine and Isoleucine
2: Phenylalanine and Valine
3: Glutamine and Arginine
4: Histidine and Tryptophan

Back 43

3: Glutamine and Arginine

Front 44

Lactic acidosis can be a result of which vitamin deficiency?

1: Folic acid
2: Vitamin E
3: Thiamine
4: Vitamin C

Back 44

3: Thiamine

Front 45

The Subjective Global Assessment used to evaluate the nutritional status of patients includes

1: dietary intake, delayed hypersensitivity skin testing, and weight history.
2: weight history, dietary intake, and gastrointestinal symptoms.
3: laboratory indices, weight history, and gastrointestinal symptoms.
4: arm anthropometry, dietary intake, and laboratory indices.

Back 45

2: weight history, dietary intake, and gastrointestinal symptoms

Front 46

Methotrexate acts by interfering with the normal intracellular metabolism of which of the following nutrients?

1: Thiamine
2: Folate
3: Carnitine
4: Vitamin D

Back 46

2: Folate

Front 47

Which of the following can result in an invalid indirect calorimetry measurement?

1: Enterocutaneous Fistula
2: Chest tube leak
3: Hemodynamic stability
4: Inspired oxygen (FiO2) less than 60%

Back 47

2: Chest tube leak

Front 48

Which of the following is most characteristic of metabolism in both stress- and starvation-related malnutrition?

1: Ketosis
2: Hypoglycemia
3: Lipolysis
4: Hypermetabolism

Back 48

3: Lipolysis

Front 49

An NPO post-operative patient has been on 2-in-1 parenteral nutrition (PN) for three weeks. He develops a diffuse scaly dermatitis, hair loss, anemia and thrombocytopenia. Which of the following is the probable cause?

1: He has not been receiving IV fat emulsion (IVFE) for three weeks.
2: He has been receiving trace elements 3 times per week due to a national shortage.
3: He is receiving 20 kcal/kg per day from PN because of hyperglycemia.
4: He has PN related cholestasis and is experiencing fat malabsorption.

Back 49

1: He has not been receiving IV fat emulsion (IVFE) for three weeks

Front 50

Which of the following clinical situations would best describe a critically ill patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

1: Appears euvolemic but is total body water overloaded because there is inappropriate concentration of the urine
2: Appears hypervolemic and is total body water overloaded because there is inappropriate dilution of the urine
3: Appears hypovolemic but is total body water overloaded because there is inappropriate fluid resorption in the kidneys
4: Appears euvolemic but is total body water overloaded because there is inadequate production and release of anti-diruetic hormone from the adrenal glands

Back 50

1: Appears euvolemic but is total body water overloaded because there is inappropriate concentration of the urine

Front 51

Which of the following is the most appropriate indicator of malnutrition?

1: Involuntary weight loss of 5% of usual body weight over three months
2: Involuntary weight loss of 10% of usual body weight over six months
3: Weight less than 10% of ideal body weight
4: Weight less than 15% of ideal body weight

Back 51

2: Involuntary weight loss of 10% of usual body weight over six months

Front 52

In addition to aggressive refeeding, which of the following places a patient at high risk for hypophosphatemia?

1: Diabetic ketoacidosis, chronic alcoholism
2: Parkinson disease, tumor lysis syndrome
3: Pancreatitis, Fanconi syndrome
4: Acute renal failure, SIADH

Back 52

1: Diabetic ketoacidosis, chronic alcoholism

Front 53

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

Back 53

1: Manganese

Front 54

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

Back 54

3: Prothrombin time

Front 55

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

Back 55

1: 10% dextrose and 3% amino acid

Front 56

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.

Back 56

4: avoiding serum triglyceride levels >400 mg/dL.

Front 57

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

Back 57

2: Only after failure to tolerate EN

Front 58

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.

Back 58

4: greater.

Front 59

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.

Back 59

3: prevention of parenteral nutrition-associated hyperglycemia

Front 60

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.

Back 60

1: a translucent band at the surface of the emulsion separate from the remaining TNA

Front 61

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

Back 61

4: Remove the PICC line only if it is suspected or known to be the source of infection

Front 62

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

Back 62

2: Potassium phosphate

Front 63

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

Back 63

3: After chest X-ray confirms correct placement of catheter tip

Front 64

Which of the following PN components is NOT a source of aluminum contamination?

1: Heparin
2: L-cysteine
3: Potassium phosphate
4: Regular insulin

Back 64

4: Regular insulin

Front 65

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

Back 65

1: Small bowel obstruction for seven days

Front 66

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.

Back 66

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.

Front 67

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

Back 67

2: Superior vena cava

Front 68

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

Back 68

1: High rate of catheter malposition

Front 69

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

Back 69

4: A triene to tetraene ratio greater than 0.4

Front 70

Concurrent infusion of IVFE and propofol would most likely cause

1: hyperglycemia.
2: hypertriglyceridemia.
3: azotemia.
4: hypernatremia.

Back 70

2: hypertriglyceridemia.

Front 71

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.

Back 71

1: IVFE hang time up to 24 hours when included as part of a total nutrient admixture (TNA)

Front 72

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

Back 72

3: Potassium

Front 73

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

Back 73

4: Hyperglycemia

Front 74

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

Back 74

1: Every 6 hours

Front 75

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

Back 75

4: Carbohydrates, amino acids, and IVFE

Front 76

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

Back 76

3: Iron dextran

Front 77

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

Back 77

3: Copper and manganese

Front 78

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.

Back 78

3: medium risk

Front 79

The routine use of perioperative 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.

Back 79

4: severely malnourished.

Front 80

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

Back 80

3: 1900 kcal, 300 grams carbohydrate, 120 grams protein, 40 grams fat

Front 81

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

Back 81

3: Essential

Front 82

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.

Back 82

3: physical stability after compounding.

Front 83

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

Back 83

4: 1896 kcal/day

Front 84

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.

Back 84

4: a cirrhotic patient with chronic encephalopathy who is intolerant of standard protein sources.

Front 85

Rapid intravenous infusion of sodium or potassium phosphate may result in

1: tetany.
2: hypercalcemia.
3: metabolic alkalosis.
4: vitamin D deficiency.

Back 85

1: tetany.

Front 86

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.

Back 86

1: 400 mg/dL

Front 87

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

Back 87

2: Only after failure to tolerate EN

Front 88

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)

Back 88

4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)

Front 89

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).

Back 89

4: essential fatty acid deficiency (EFAD).

Front 90

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.

Back 90

4: recommended PN laboratory tests.

Front 91

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

Back 91

3: Reduction of days on insulin therapy

Front 92

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

Back 92

1: Basilic

Front 93

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

Back 93

1: High output fistula

Front 94

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.

Back 94

1: less.

Front 95

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

Back 95

3: Intravenous fat emulsion (IVFE) and vitamins

Front 96

PN has traditionally been used in patients with hyperemesis gravidarum, but current research is establishing EN as a viable treatment option. Which of the following is NOT an indication for the use of PN in patients with hyperemesis gravidarium?

1: Vomiting cannot be controlled with hydration, bowel rest, and/or antiemetics within 48 hours
2: EN tube displacement due to repeated episodes of vomiting
3: Severe fluid and electrolyte imbalances
4: PPN (peripheral parenteral nutrition) cannot meet nutritional requirements

Back 96

4: PPN (peripheral parenteral nutrition) cannot meet nutritional requirements

Front 97

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

Back 97

3: EN is contraindicated or unlikely to meet nutrition needs

Front 98

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

Back 98

3: Structured

Front 99

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

Back 99

3: Cut the rate in half for the last two hours prior to discontinuation

Front 100

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.

Back 100

4: location of venous access device.

Front 101

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

Back 101

2: Calculation of PN dosages

Front 102

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.

Back 102

1: of no benefit in influencing the disease response.

Front 103

Which of the following is a clinical sign of hyperphosphatemia?

1: Tachycardia
2: Tetany
3: Hyperventilation
4: Altered mental status

Back 103

2: Tetany

Front 104

Acetate is added to PN formulas when a patient experiences

1: metabolic acidosis.
2: metabolic alkalosis.
3: respiratory acidosis.
4: respiratory alkalosis.

Back 104

1: metabolic acidosis.

Front 105

A 70-kg adult patient receiving PN providing 3000 kcal/day presents with mild to moderate elevations of serum aminotransferases and small elevations of bilirubin and serum alkaline phosphatase. This patient is most likely exhibiting what type of PN-associated liver disease (PNALD)?

1: Hepatic steatosis
2: Cholestasis
3: Gallbladder sludging
4: Fulminant hepatic failure

Back 105

1: Hepatic steatosis

Front 106

A 75-year-old female status-post ileoconduit with poor intravenous access weighing 50 kg is initiated on 3L of peripheral parenteral nutrition (PPN) daily. The PPN formula is written as 7% dextrose, 3.5% amino acids and 1.5% IVFE. Which of the following complications is she at greatest risk for developing?

1: Fluid overload
2: Hypertriglyceridemia
3: Azotemia
4: Hyperglycemia

Back 106

1: Fluid overload

Front 107

Which of the following are the most common electrolyte imbalances observed in patients with refeeding syndrome?

1: Hypokalemia, hyperphosphatemia, hypoglycemia
2: Hyperkalemia, hyperphosphatemia, hypoglycemia
3: Hypokalemia, hypophosphatemia, hypermagnesemia
4: Hypokalemia, hypophosphatemia, and hypomagnesemia

Back 107

4: Hypokalemia, hypophosphatemia, and hypomagnesemia

Front 108

Failure to remove manganese from PN in a patient with hepatobiliary disease results in accumulation of manganese in the

1: brain.
2: liver.
3: kidney.
4: red blood cells.

Back 108

1: brain.

Front 109

What are the major symptoms of acute thrombosis due to central venous catheterization?

1: Pain and difficulty breathing
2: Pain and swelling in the arm and neck
3: Fever and inability to aspirate blood from the catheter
4: Pain while attempting to infuse fluids through the catheter

Back 109

2: Pain and swelling in the arm and neck

Front 110

All of the following are examples of nonthrombotic catheter occlusions EXCEPT

1: catheter migration during use.
2: lipid deposits.
3: calcium-phosphate precipitate.
4: fibrin sheath.

Back 110

4: fibrin sheath.

Front 111

Which one of the following factors is most likely to contribute to metabolic bone disease in PN-dependent patients?

1: Aluminum toxicity
2: Calcium supplementation
3: Low amino acid intake in PN
4: Balanced acetate load in PN

Back 111

1: Aluminum toxicity

Front 112

A patient receiving PN is afebrile, has negative blood cultures, but presents with redness and purulence at the catheter exit site. How is this infection best managed?

1: Remove CVC
2: Exchange catheter over a guidewire
3: Initiate empiric antimicrobial therapy with vancomycin
4: Apply topical antibiotic ointment

Back 112

3: Initiate empiric antimicrobial therapy with vancomycin

Front 113

The use of 0.1N hydrochloric acid is most effective for clearing catheter occlusions due to precipation of

1: calcium-phosphate.
2: tobramycin.
3: phenytoin.
4: lipid residue.

Back 113

1: calcium-phosphate.

Front 114

Use of nutrition support teams with patients receiving PN has been shown to DECREASE

1: morbidity due to hyperglycemia.
2: morbidity due to hypophosphatemia.
3: mortality due to metabolic complications.
4: length of stay in the intensive care unit.

Back 114

3: mortality due to metabolic complications.

Front 115

All of the following are risk factors for the development of rebound hypoglycemia in a patient receiving PN EXCEPT

1: chronic starvation.
2: liver failure.
3: hypertension.
4: hypothyroidism.

Back 115

3: hypertension

Front 116

The use of 70% ethyl alcohol is most effective for clearing catheter occlusions due to precipitation of

1: calcium-phosphate.
2: lipid residue.
3: phenytoin.
4: tobramycin.

Back 116

2: lipid residue.

Front 117

A 40-year-old male receiving chronic PN therapy (initiated 15 years ago) secondary to massive bowel resection develops metabolic bone disease. His current 12-hour cyclic PN formula provides 5 g/kg/day dextrose, 2 g/kg/day protein and 1 g/kg/day of fat. What is the most appropriate intervention to reduce hypercalciuria?

1: Increase calcium gluconate
2: Decrease phosphorus supplementation
3: Shorten PN infusion time to 10 hours
4: Decrease amino acid content of PN solution

Back 117

4: Decrease amino acid content of PN solution

Front 118

During long-term PN administration, hepatobiliary complications can best be prevented by

1: adding carnitine to the PN formula.
2: discontinuing IV fat emulsion (IVFE).
3: converting to cyclic administration.
4: administering IVFE twice weekly.

Back 118

3: converting to cyclic administration.

Front 119

Which of the following is an evidence-based intervention for reducing the risk of central venous catheter-related infections?

1: Administering antibiotics prior to catheter insertion
2: Using minimal barrier technique during catheter insertion
3: Cleansing insertion sites with 2% alcohol preparation
4: Training nurses who maintain central venous catheters

Back 119

4: Training nurses who maintain central venous catheters

Front 120

The most accurate method of diagnosing PN-associated metabolic bone disease is to measure

1: bone density.
2: serum calcium concentrations.
3: serum phosphate concentrations.
4: serum parathyroid hormone concentrations.

Back 120

1: bone density.

Front 121

If a ventilated patient with a history of chronic renal insufficiency is receiving PN that provides 40 kcal/kg, 2 g/kg protein, 5 mg/kg/min of dextrose, and 1.5 g/kg fat, which of the following is most likely to occur?

1: Negative nitrogen balance along with a decline in prealbumin levels
2: Increased urine output, decreased specific gravity, and change in urine pH
3: Improvement in hepatic protein stores, weight gain, and improved immune function
4: Hypercapnia, elevated liver function studies, and alterations in BUN/creatinine values

Back 121

4: Hypercapnia, elevated liver function studies, and alterations in BUN/creatinine values

Front 122

The most effective strategy to DECREASE the risk of catheter-associated sepsis is use of

1: povidone-iodine as a skin preparation.
2: antibiotic ointment at catheter exit site.
3: antibiotic prophylaxis during catheter insertion.
4: full-barrier precautions during catheter insertion.

Back 122

4: full-barrier precautions during catheter insertion.

Front 123

All of the following are risk factors for the development of hyperglycemia in a patient receiving PN EXCEPT

1: cirrhosis.
2: obesity.
3: pancreatitis.
4: hypothyroidism.

Back 123

4: hypothyroidism.

Front 124

The best approach to prevent PN-induced cholelithiasis is administration of

1: choline.
2: CCK-octapeptide (CCK-OP).
3: ursodiol.
4: oral or enteral feeding.

Back 124

4: oral or enteral feeding.

Front 125

The most common route of infection for a tunneled central venous catheter (CVC) is

1: extraluminal colonization of the catheter.
2: contamination of the catheter hub.
3: infusate contamination.
4: hematogenous seeding from another focus of infection.

Back 125

2: contamination of the catheter hub.

Front 126

Hyperkalemia is most likely to be associated with

1: pregnancy.
2: hyperinsulinemia.
3: respiratory failure.
4: metabolic acidosis.

Back 126

4: metabolic acidosis.

Front 127

Acetate is added to PN formulas when a patient experiences

1: metabolic acidosis.
2: metabolic alkalosis.
3: respiratory acidosis.
4: respiratory alkalosis.

Back 127

1: metabolic acidosis.

Front 128

A patient arrives in your clinic complaining of intermittent catheter malfunction. You identify that the catheter malfunction is relieved by raising the patient’s arm where the catheter is located. Which condition should be suspected?

1: Fibrin sheath
2: Pinch-off syndrome
3: Superior vena cava syndrome
4: Catheter migration

Back 128

2: Pinch-off syndrome

Front 129

A patient presents to clinic with a suspected catheter occlusion. All of the following are appropriate initial actions EXCEPT to

1: determine if the occlusion is relieved with postural changes.
2: remove the dressing and check for kinks in the tubing.
3: replace the catheter over a guidewire.
4: review recent flushing techniques with the patient.

Back 129

3: replace the catheter over a guidewire.

Front 130

A 45-kg patient receiving chronic PN therapy develops an intraluminal clot in their central venous access device. What is the most appropriate pharmacological intervention to clear this access device?

1: Heparin 100 units/mL
2: Alteplase 2mg/2mL
3: Argatroban 350 mcg/kg bolus over 3-5 minutes
4: Reteplase 10 units

Back 130

2: Alteplase 2mg/2mL

Front 131

What feature of a Groshong PICC reduces the risk of catheter occlusion?

1: Pressure sensitive three-way valve
2: Large lumen(s) size
3: Heparin coated tip
4: Soft grade medical silicon tubing

Back 131

1: Pressure sensitive three-way valve

Front 132

Which of the following would be the most likely complication of hypertriglyceridemia?

1: Azotemia
2: Pancreatitis
3: Polyuria
4: Peripheral neuropathy

Back 132

2: Pancreatitis

Front 133

Which of the following is most likely responsible for elevated serum bicarbonate levels in a home parenteral (PN) patient?

1: Excess chloride salts in the PN
2: Diarrhea
3: Excess acetate salts in the PN
4: ARF

Back 133

3: Excess acetate salts in the PN

Front 134

All of the following conditions predispose a patient to the refeeding syndrome EXCEPT

1: chronic starvation and chronic alcoholism.
2: anorexia or malabsorption.
3: morbid obesity with weight loss.
4: bulimia nervosa.

Back 134

4: bulimia nervosa.

Front 135

A critically ill 75-year-old male receiving PN has the following arterial blood gas (ABG) results: pH=7.32, PaCO2=49 mm Hg, and serum bicarbonate=29 mEq/L. What is the most appropriate PN intervention?

1: Do nothing
2: Decrease calorie content of PN
3: Decrease acetate concentration
4: Decrease chloride concentration

Back 135

2: Decrease calorie content of PN

Front 136

After placement of a central line, discovery of a pneumothorax during PN administration should be viewed as a

1: sentinel event.
2: process indicator.
3: resource indicator.
4: structural indicator.

Back 136

1: sentinel event.

Front 137

Patients at risk for refeeding syndrome often require supplementation of

1: vitamin A.
2: vitamin K.
3: thiamine.
4: vitamin C.

Back 137

3: thiamine.

Front 138

To reduce the risk of infection, the preferred site for catheter insertion is

1: subclavian.
2: internal jugular.
3: femoral.
4: umbilical artery.

Back 138

1: subclavian.

Front 139

Hyperglycemia is associated primarily with what type of sodium/fluid imbalance?

1: Hypertonic hyponatremia
2: Hypotonic hyponatremia
3: Isotonic hypernatremia
4: Hypertonic hypernatremia

Back 139

1: Hypertonic hyponatremia

Front 140

A patient with hypokalemia should be assessed for what electrolyte disorder?

1: Hyperglycemia
2: Hyponatremia
3: Hyperphosphatemia
4: Hypomagnesemia

Back 140

4: Hypomagnesemia

Front 141

A patient receiving PN that has chills, fever, positive blood cultures, and no redness or purulence at the catheter exit site probably has which of the following types of catheter infection?

1: Tunnel
2: Exit site
3: Catheter-related phlebitis
4: Catheter-related bloodstream

Back 141

4: Catheter-related bloodstream

Front 142

A critically ill 68-year-old female receiving PN has the following arterial blood gas (ABG) results: pH=7.31, PaCO2=36 mm Hg, and serum bicarbonate=20 mEq/L. What is the most appropriate PN intervention?

1: Do nothing
2: Increase PN chloride concentration
3: Increase PN acetate concentration
4: Decrease calorie content of PN

Back 142

3: Increase PN acetate concentration

Front 143

In order to prevent rebound hypoglycemia upon discontinuation of PN, the infusion rate of PN should be reduced by

1: 25% for the last 1 hour of infusion.
2: 25% for the last 2 hours of infusion.
3: 50% for the last 1 hour of infusion.
4: 50% for the last 2 hours of infusion.

Back 143

4: 50% for the last 2 hours of infusion.

Front 144

Inability to aspirate blood through a central vascular catheter when there is no obstruction to the infusion of fluid suggests

1: pinch-off syndrome.
2: intraluminal thrombus.
3: calcium precipitate occlusion.
4: fibrin sleeve formation at the catheter tip.

Back 144

4: fibrin sleeve formation at the catheter tip.

Front 145

All of the following may be short-term complications of home parenteral nutrition EXCEPT

1: dehydration.
2: metabolic bone disease.
3: refeeding syndrome.
4: catheter malposition.

Back 145

2: metabolic bone disease.

Front 146

Which of the following is a risk factor for the development of PN-associated liver complications in PN-dependent patients?

1: Short bowel syndrome
2: Cyclic infusion of PN
3: Supplemental trophic enteral feeding
4: Medication therapy with ursodiol

Back 146

1: Short bowel syndrome

Front 147

A rise in which of the following laboratory values would most likely indicate cholestasis?

1: Prothrombin time
2: Asparate aminotransferase/Alanine aminotransferase ratio
3: Cholesterol and gamma glutamyltransferase
4: Alkaline phosphatase and total bilirubin

Back 147

4: Alkaline phosphatase and total bilirubin

Front 148

The clinical presentation of refeeding syndrome includes all of the following EXCEPT

1: pulmonary edema.
2: seizures.
3: cardiac decompensation.
4: dehydration.

Back 148

4: dehydration.

Front 149

Discontinuation of IVFE is recommended treatment of catheter-related bloodstream infection due to

1: coagulase-negative staphylocci.
2: staphylococcus aureus.
3: pseudomonas aeruginosa.
4: malassezia furfur.

Back 149

4: malassezia furfur.

Front 150

A long-term PN patient presents with involuntary movements, tremor, and rigidity. Which of the following etiologies may explain these symptoms?

1: Manganese deficiency
2: Manganese toxicity
3: Selenium deficiency
4: Selenium toxicity

Back 150

2: Manganese toxicity

Front 151

Which one of the following co-morbidities is NOT a risk factor for the development of metabolic bone disease?

1: Crohn's disease
2: Malignancy
3: Short bowel syndrome
4: Hypothyroidism

Back 151

4: Hypothyroidism

Front 152

Fibrin that builds up on the wall of blood vessels may also adhere to the catheter creating a

1: fibrin sheath.
2: fibrin tail.
3: intraluminal thrombus.
4: mural thrombus.

Back 152

4: mural thrombus.

Front 153

A 60-year-old female (45 kg) is receiving PN for a rectovaginal fistula. The PN formula consists of the following components: 700 mL Dextrose 70%, 600 mL Aminosyn II® 15%, and 125 mL of 20% IV Fat Emulsion. Which one of the following complications is she at greatest risk for developing? (24-hour continuous PN infusion; Total PN Volume with electrolytes and additives is 1.5 L)

1: Hypertriglyceridemia
2: Azotemia
3: Hyperglycemia
4: Pulmonary edema

Back 153

3: Hyperglycemia

Front 154

A patient with acute respiratory distress syndrome may benefit from a feeding formula containing supplemental

1: arginine.
2: glutamine.
3: nucleic acids.
4: omega 3 fatty acids.

Back 154

4: omega 3 fatty acids.

Front 155

Which of the following is not an accepted means for estimating daily fluid requirements in enterally-fed adult patients?

1: 0.5 mL/kg/min
2: 35 mL/kg/day
3: 1500 mL/m2/24 hrs
4: 1 mL/kcal consumed

Back 155

1: 0.5 mL/kg/min

Front 156

During placement of a nasogastric feeding tube in an alert patient, which of the following is an appropriate step to avoid inadvertent tube placement into the airway?

1: Administer IV metoclopramide.
2: Keep patient NPO during insertion.
3: Position patient with head bent forward, chin toward the chest.
4: Measure distance from the tip of the patient's nose to the earlobe and mark on tube with tape.

Back 156

3: Position patient with head bent forward, chin toward the chest.

Front 157

Which of the following is least likely to be problematic for placement of a percutaneous endoscopic gastrostomy (PEG) tube in a patient with liver disease?

1: Ascites
2: Coagulopathy
3: Gastric varices
4: Hepatitis B

Back 157

4: Hepatitis B

Front 158

Which of the following surgically placed feeding tubes can result in a thoracic duct injury?

1: Witzel gastrostomy
2: Stamm gastrostomy
3: Cervical esophagostomy
4: Needle catheter jejunostomy

Back 158

3: Cervical esophagostomy

Front 159

The use of tube feeding formulas enriched with branched-chain amino acids is best used for patients with

1: cirrhosis.
2: hepatic failure.
3: liver transplantation.
4: intractable encephalopathy.

Back 159

4: intractable encephalopathy.

Front 160

Modular products are added to the tube-feeding regimen to

1: prevent bacteria translocation.
2: increase the respiratory quotient.
3: increase calorie and protein content.
4: alter the ratio of vitamins to minerals.

Back 160

3: increase calorie and protein content.

Front 161

Which of the following patient populations would most likely have difficulty tolerating a polymeric enteral formula?

1: Crohn's disease
2: Intestinal lymphangiectasia
3: Gastroparesis
4: Celiac disease

Back 161

2: Intestinal lymphangiectasia

Front 162

Enteral nutrition may be contraindicated in the early post-transplant period in adult patients with hematopoietic cell transplants because of

1: increased incidence of sinusitis with enteral feedings.
2: lack of benefit from enteral feedings in allogeneic patients.
3: gastrointestinal toxicities related to the conditioning regimen.
4: improved survival seen in autologous patients receiving parenteral nutrition.

Back 162

3: gastrointestinal toxicities related to the conditioning regimen

Front 163

The use of enteral formulas with intact protein has been shown to be as effective as use of free amino acid-based formulas in promoting remission of

1: Crohn's disease.
2: gastrointestinal cancer.
3: pancreatitis.
4: hepatic encephalopathy.

Back 163

1: Crohn's disease.

Front 164

Which of the following best describes the initiation of a hypertonic formula for gastric feeding?

1: Formula can safely be initiated at full strength at a low rate
2: Formula should be diluted to an isotonic formula and initiated at goal rate
3: Formula should be co-administered with an anti-diarrheal agent
4: Formula should be switched to an isotonic formula at a low rate

Back 164

1: Formula can safely be initiated at full strength at a low rate

Front 165

Percutaneous endoscopic gastrostomy (PEG) placement in esophageal cancer patients prior to surgery may place the patient at risk for all of the following, EXCEPT:

1: Constipation
2: Delayed gastric emptying
3: Leakage at PEG site
4: Impaired wound healing

Back 165

1: Constipation

Front 166

Which of the following best describes the rationale for initiating specialized nutrition support?

1: It may be implemented in patients who cannot, should not, or will not eat adequately
2: It may be implemented in patients who are well nourished with an intact GI tract
3: It should be implemented on an emergency basis, regardless of patient's hemodynamic status
4: It is commonly used to treat specific disease manifestations

Back 166

1: It may be implemented in patients who cannot, should not, or will not eat adequately

Front 167

Which of the following is a CONTRAINDICATION to a percutaneous endoscopic jejunostomy tube?

1: Gastroparesis
2: Partial gastrectomy
3: Refractory celiac disease
4: End-jejunostomy

Back 167

4: End-jejunostomy

Front 168

Which of the following is an indication to surgically place a jejunostomy feeding tube?

1: Hyperemesis gravidarum
2: Dysphagia
3: Gastroesophageal reflux
4: Diabetic gastroparesis

Back 168

4: Diabetic gastroparesis

Front 169

Which of the following is the preferred method of feeding tube placement when post pyloric feeding is required for less than 4 weeks?

1: Laparoscopic
2: Open surgical
3: Nasal jejunal tube
4: Percutaneous endoscopic jejunostomy

Back 169

3: Nasal jejunal tube

Front 170

What is the gold standard for determining proper position of a feeding tube placed at the bedside?

1: Radiographic confirmation
2: pH testing for acidity of aspirates
3: Aspiration of obvious gastric contents
4: Air sufflation and auscultation over the gastric bubble

Back 170

1: Radiographic confirmation

Front 171

Which of the following is the best method to place a gastrostomy feeding tube in a patient with head and neck cancer?

1: Radiologically
2: Laparoscopically
3: Surgical laparotomy
4: Percutaneous endoscopically

Back 171

1: Radiologically

Front 172

Which of the following parameters is not useful in assessing the efficacy of enteral nutrition in pregnancy?

1: Maternal dry weight gain
2: Fetal growth
3: Urinalysis
4: Nitrogen balance

Back 172

3: Urinalysis

Front 173

Which of the following best describes the absorption of small peptides and free amino acids contained in hydrolyzed enteral formulas?

1: The majority of small peptides and amino acids are absorbed through active transport across the gastric mucosa
2: Free amino acid absorption occurs more rapidly than an equivalent mixture of small peptides
3: Small peptide formulations have a higher osmolality and thereby less efficient absorption than free amino acid formulas
4: Although absorption may differ, there are no established clinical advantages to the use of small peptide over free amino acid formulas or vice-versa.

Back 173

4: Although absorption may differ, there are no established clinical advantages to the use of small peptide over free amino acid formulas or vice-versa.

Front 174

Tube feedings can be effectively used in which of the following conditions?

1: Intractable nausea and vomiting
2: High output proximal fistula
3: Open peritoneal cavity
4: Short bowel syndrome (<50cm) without colon

Back 174

3: Open peritoneal cavity

Front 175

Lactose is a common ingredient in which type of enteral formula?

1: Semi-elemental formula
2: Standard adult formula
3: Standard infant formula
4: Elemental formula

Back 175

3: Standard infant formula

Front 176

Which of the following alterations to the enteral formula most often reduces the risk for physical interaction between the formula and medications?

1: Switch to a free amino acid enteral formula
2: Add fiber to the enteral formula
3: Reduce fat content of the enteral formula
4: Increase total free water in the enteral formula

Back 176

1: Switch to a free amino acid enteral formula

Front 177

How long should T-fasteners be left in place after placing a gastrostomy or jejunostomy feeding tube laparoscopically or radiologically?

1: 4-5 days
2: 10-14 days
3: 21-24 days
4: 28-31 days

Back 177

2: 10-14 days

Front 178

Which of the following feeding formulas is most likely to be contaminated?

1: Pasteurized
2: Blenderized
3: Ready to feed
4: Ready to hang

Back 178

2: Blenderized

Front 179

In patients with pancreatitis, which of the following parameters would be LEAST important in predicting tolerance of enteral feedings?

1: Disease severity
2: Duration of NPO
3: Abdominal pain
4: Triglyceride level

Back 179

4: Triglyceride level

Front 180

Which of the following is the most invasive method used to assist in placement of a nasoenteric feeding tube?

1: Corkscrew method
2: Direct fluoroscopic guidance
3: Endoscopic assistance
4: Pharmacologic stimulation

Back 180

3: Endoscopic assistance

Front 181

An isotonic formula has an osmolality of

1: 150 mOsm/kg.
2: 300 mOsm/kg.
3: 450 mOsm/kg.
4: 600 mOsm/kg.

Back 181

2: 300 mOsm/kg.

Front 182

Which of the following methods is usually the most successful in the transpyloric placement of a nasoenteric feeding tube?

1: pH sensor tubes
2: Metoclopramide
3: Fluoroscopic placement
4: Weighted tube at bedside

Back 182

3: Fluoroscopic placemen

Front 183

Which of the following is an advantage of a gastrostomy-placed feeding tube compared to a nasogastric feeding tube?

1: Reduced incidence of aspiration
2: Less nasal irritation
3: More successful delivery of calories
4: Reduced incidence of gastric perforation

Back 183

2: Less nasal irritation

Front 184

Tube feeding with a standard enteral formula is often held before and after administration of all the following medications EXCEPT

1: Theophylline
2: Nitroglycerin
3: Ciprofloxacin
4: Phenytoin

Back 184

2: Nitroglycerin

Front 185

The enteral formula for individuals with pulmonary disease requiring mechanical ventilation should always be

1: based on individual tolerance and needs.
2: low fat, high carbohydrate.
3: fluid concentrated, low fat.
4: high fat, low carbohydrate.

Back 185

1: based on individual tolerance and needs.

Front 186

What is the primary advantage of a direct percutaneous endoscopic placed jejunal tube versus a percutaneous endoscopic transgastric-placed jejunal tube?

1: Easier to place
2: Reduced incidence of bleeding
3: Reduced incidence of migration
4: Reduced incidence of gastric outlet obstruction

Back 186

3: Reduced incidence of migration

Front 187

Drugs in microencapsulated bead, enteric-coated granule or pellet form are most effectively administered through feeding tubes when mixed with

1: orange juice.
2: gingerale.
3: oral electrolyte solution.
4: warm water.

Back 187

1: orange juice.

Front 188

Which of the following is NOT a perceived benefit of early enteral feeding in critically ill patients?

1: Prevents the occurrence of translocation of gut bacteria
2: Reduces atrophy of intestinal villae
3: Fewer infectious complications than PN-fed patients
4: Increases intestinal permeability

Back 188

4: Increases intestinal permeability

Front 189

Evidence exists to show which of the following enteral formulas to be most efficacious in a patient with diabetic gastroparesis?

1: Concentrated
2: Glutamine-supplemented
3: Hydrolyzed
4: Low fat

Back 189

4: Low fat

Front 190

Hospital-prepared enteral nutrition formulas should be stored at what temperature?

1: 4° C (39.2° F)
2: 6° C (42.8° F)
3: 8° C (46.4° F)
4: 10° C (50.0° F)

Back 190

1: 4° C (39.2° F)

Front 191

A 51.5 kg afebrile 55-year-old female with dysphagia is started on a standard 1.0 kcal/mL enteral formula with 85% water at 180 mL/hr over 10 hours nightly. Which of the following water flush regimens would best meet her daily estimated fluid requirements?

1: 0 mL
2: 60 mL every 8 hours
3: 90 mL every 8 hours
4: 120 mL every 8 hours

Back 191

3: 90 mL every 8 hours

Front 192

Which of the following is most characteristic of a skin-level device or a button for enteral feeding?

1: Can only be used with gastrostomies
2: Does not contain an antireflux valve
3: Can be capped at skin level when not in use
4: Can only be placed in the operating room

Back 192

3: Can be capped at skin level when not in use

Front 193

Compared to gastric feeding, small bowel feeding is associated with which of the following outcomes in critically ill patients?

1: Longer time to achieve target nutrition
2: Increased nutrient delivery
3: Increased gastroesophageal regurgitation
4: Increased rate of ventilator-associated pneumonia

Back 193

2: Increased nutrient delivery

Front 194

Which of the following types of enteral formulas is MOST likely to increase splanchnic blood flow in a critically ill patient?

1: High fat
2: High carbohydrate
3: High fiber
4: High osmolarity

Back 194

1: High fat

Front 195

Which of the following patients is most likely to benefit from immunonutrition?

1: Septic trauma patient
2: Trauma patient with isolated orthopedic injuries
3: Medical intensive care unit patient
4: Trauma patient with abdominal and torso injuries

Back 195

4: Trauma patient with abdominal and torso injuries

Front 196

In studies comparing EN to PN in patients with severe acute pancreatitis, which of the following potential benefits of EN over PN has not been documented?

1: Decrease hospitalization length
2: Decrease mortality
3: Decrease trend of organ failure
4: Decrease infection rate

Back 196

2: Decrease mortality

Front 197

Once the enteral formula is opened, how long may it be stored in a refrigerator?

1: Up to 24 hours
2: Up to 36 hours
3: Up to 48 hours
4: Up to 72 hours

Back 197

3: Up to 48 hours

Front 198

Length of stay and postoperative infection rates have been shown to DECREASE in surgical patients receiving tube-feeding formulas enriched with

1: arginine.
2: nucleotides.
3: ascorbic acid.
4: branched-chain amino acids.

Back 198

1: arginine.

Front 199

Which of the following would be the most appropriate tube feeding formula for a patient with extensive second and third degree burns?

1: High fat
2: High nitrogen
3: Concentrated
4: High fiber

Back 199

2: High nitrogen

Front 200

Which of the following is a CONTRAINDICATION to percutaneous endoscopic gastrostomy tube placement?

1: Ascites
2: Partial gastrectomy
3: Obesity
4: Stroke

Back 200

1: Ascites

Front 201

Which of the following medications has NOT been shown to lead to diarrhea in a patient receiving enteral nutrition?

1: Sorbitol elixirs
2: Alpha-2 adrenergic agonists
3: Antibiotics
4: Magnesium-containing preparations

Back 201

2: Alpha-2 adrenergic agonists

Front 202

Early commencement of enteral feeding has been suggested to benefit ICU patients, reducing infectious complications, length of hospital stay and even possibly reducing mortality. Which group of patients might be at significant risk from early enteral feeding?

1: Post surgical patients whose surgery involved the gastrointestinal tract
2: Post surgical patients who have experienced a significant blood loss during surgery and who have a poor urine output postoperatively
3: Trauma patients with head trauma that may include a fractured base of skull
4: Patients admitted with acute pancreatitis

Back 202

2: Post surgical patients who have experienced a significant blood loss during surgery and who have a poor urine output postoperatively

Front 203

Which of the following is NOT pre-procedure care of a patient undergoing placement of a percutaneous endoscopic gastrostomy tube?

1: Obtaining informed consent
2: Obtaining an abdominal X ray
3: Administering an antibiotic on call
4: Confirming normal INR

Back 203

2: Obtaining an abdominal X ray

Front 204

A 55-year-old female afebrile patient is receiving a 1 kcal/mL enteral formula at 70 ml/hr continuous feed. Based on the formula of providing 1 mL per calorie, the patient needs approximately 1680 mL of fluid per day. How much additional water from flushes is needed to meet the approximate fluid needs?

1: about 350mL
2: about 700 mL
3: about 1200 mL
4: no added flushes are needed

Back 204

1: about 350mL

Front 205

One method of minimizing the complications associated with refeeding syndrome is to initiate an electrolyte replacement protocol before nutrition therapy begins. Which of the following is true regarding such a plan?

1: Potassium, magnesium, and calcium should be closely monitored
2: Patients considered not-at-risk should also be included in the protocol
3: The protocol should replete all electrolytes ONLY via the feeding tube
4: Feeding should be delayed until the risk of electrolyte imbalance is eliminated

Back 205

2: Patients considered not-at-risk should also be included in the protocol

Front 206

Which of the following types of feeding delivery methods is most commonly used for patients with a jejunal feeding tube?

1: Bolus feeding
2: Gravity feeding
3: Intermittent feeding
4: Continuous pump feeding

Back 206

4: Continuous pump feeding

Front 207

Which of the following tubes requires immediate replacement if it becomes dislodged?

1: Jejunostomy tube
2: Nasogastric tube
3: Gastrostomy tube
4: Nasoduodenal tube

Back 207

1: Jejunostomy tube

Front 208

Which of the following individuals would best benefit from cyclic tube feeding?

1: Status post CVA who has initiated oral foods during the day
2: Critically ill motorcycle accident victim in the ICU
3: Critically ill diabetic with hyperglycemia
4: Post-operative bowel surgery patient who has an ileus

Back 208

1: Status post CVA who has initiated oral foods during the day

Front 209

Approximately 20% of enterally fed patients report nausea and/or vomiting. If delayed gastric emptying is suspected as the causative factor, which of the following is LEAST likely to improve the patient's symptoms?

1: Reduce or discontinue narcotic medications
2: Switch to a low fat enteral formula
3: Provide enteral formula as a small bolus of 50 to 100 mL per feeding
4: Use a more concentrated enteral formula

Back 209

4: Use a more concentrated enteral formula

Front 210

Which type of insulin should be used when initiating enteral nutrition in a hospitalized diabetic patient?

1: 70/30 (70% insulin protamine suspension / 30% insulin aspart injection)
2: regular insulin
3: insulin suspension, isophane or insulin-zinc suspension
4: insulin glargine

Back 210

2: regular insulin

Front 211

Which of the following is a potential advantage of using an open system for delivery of tube feedings?

1: Less nursing time
2: Longer hang time
3: Less contamination
4: Less formula wastage

Back 211

4: Less formula wastage

Front 212

Which of the following is most likely to improve tolerance of enteral feeding in a postoperative patient with documented high gastric residuals receiving bolus tube feedings?

1: Holding every other feeding
2: Putting the patient in the prone position
3: Starting the patient on cisapride to aid with motility
4: Placing a small bowel feeding tube for continuous feeding

Back 212

4: Placing a small bowel feeding tube for continuous feeding

Front 213

Constipation in the enterally fed patient is most often associated with all EXCEPT

1: rapid or bolus infusion.
2: obstruction.
3: lack of adequate hydration.
4: prolonged bed rest.

Back 213

1: rapid or bolus infusion.

Front 214

Which of the following tube feeding orders best reflects the use of an intermittent schedule?

1: Polymeric formula, 240 mL administered over one hour, five times per day
2: Pre-digested formula administered at 50 mL per hour over 24 hours
3: Fiber-containing formula administered at 100 mL per hour over 12 hours
4: 2 kcal/mL concentrated formula, 120 mL administered over 30 minutes one time per day

Back 214

1: Polymeric formula, 240 mL administered over one hour, five times per day

Front 215

A patient with oral cancer, who has gained 10 pounds since starting home bolus enteral feedings via gastrostomy tube complains of pain and pressure on the \" inside of his stomach\" but no redness or drainage at the exterior gastrostomy site. Which of the following is the most appropriate response for the clinician?

1: Tell the patient to take over the counter pain medication and rotate the G tube 180 degrees each day.
2: Refer the patient to the gastroenterologist or enterostomal nurse.
3: Decrease the infusion volume of the formula to half of the current volume to avoid excessive distention of the stomach.
4: Change to a slower tube feed infusion by using a gravity bag for feedings.

Back 215

2: Refer the patient to the gastroenterologist or enterostomal nurse.

Front 216

Which of the following is most appropriate for maintaining patency of a feeding tube?

1: Administer medications through feeding tube with 5mL of water
2: Use a 20 mL or smaller syringe to flush small-bore feeding tubes
3: Flush feeding tube with 10-30 mL of water every 4-6 hours during continuous feeding
4: Change feeding tube every 72 hours

Back 216

3: Flush feeding tube with 10-30 mL of water every 4-6 hours during continuous feeding

Front 217

An occluded feeding tube is most likely caused by a

1: low fat formula.
2: low fiber formula.
3: peptide based formula.
4: high viscosity formula.

Back 217

4: high viscosity formula.

Front 218

Which of the following interventions has NOT been proven effective in reducing the risks associated with enteral tube feeding in critically ill patients?

1: Elevating the head of the bed
2: Frequent checking of gastric residual volumes
3: Placing the distal end of the tube into the small bowel
4: Using motility agents for patients with high gastric residual volumes

Back 218

2: Frequent checking of gastric residual volumes

Front 219

What is the optimal sodium concentration of an oral rehydration solution for patients with short bowel syndrome?

1: 40 mmol/liter
2: 60 mmol/liter
3: 70 mmol/liter
4: 90 mmol/liter

Back 219

4: 90 mmol/liter

Front 220

Which of the following is true regarding the use of magnet tracking for non-invasive verification of nasogastric tube placement?

1: pH can be monitored
2: Checks the tip position related to the pylorus
3: Provides a 3-dimensional localization
4: Shows a time-delayed perspective of the tube tip location

Back 220

3: Provides a 3-dimensional localization

Front 221

When implementing early enteral feeds (EN) in critically ill patients, which of the following factors is most likely to increase success in moving patients toward target feeding rate?

1: Degree of adherence to physicians orders
2: Combined use of EN and parenteral nutrition
3: Use of gastric feeding
4: Implementation of an interdisciplinary infusion protocol

Back 221

4: Implementation of an interdisciplinary infusion protocol

Front 222

Which of the following metabolic alterations is NOT associated with the development of tube feeding syndrome?

1: Ketonemia
2: Dehydration
3: Azotemia
4: Hypernatremia

Back 222

1: Ketonemia

Front 223

The initiation of enteral tube feeding should be delayed when the patient is

1: hemodynamically unstable.
2: at a decreased level of consciousness
3: post-operative day 2.
4: scheduled for discharge.

Back 223

1: hemodynamically unstable.

Front 224

Which of the following is an appropriate situation for nutrition support nurses to insert a nasogastric feeding tube without physician supervision?

1: Pre-operatively just prior to transfer to the operating room (OR)
2: Under fluoroscopy in an endoscopy suite
3: In a patient with head and neck trauma admitted to the ICU
4: Post CVA on the inpatient medical unit

Back 224

4: Post CVA on the inpatient medical unit

Front 225

While a patient is receiving speech therapy, oral foods have been introduced during the daytime hours. Polymeric tube feeding is required during the night at a rate of 75 mL per hour over 8 hours. The night feeding is an example of

1: bolus feeding.
2: intermittent feeding.
3: cyclic feeding.
4: continuous feeding.

Back 225

3: cyclic feeding

Front 226

Which of the following is most likely to be a benefit of a closed system enteral formulation?

1: Less costly
2: Shorter hang time
3: Ability to develop modular feedings
4: Less nursing time required for administration

Back 226

4: Less nursing time required for administration

Front 227

In addition to a physical exam, which of the following is an appropriate clinical measurement that can be performed at the bedside to assess gastric emptying?

1: Radionuclide scintigraphy
2: Paracetamol absorption test
3: Measurement of gastric reflux
4: Measurement of gastric residual volume

Back 227

4: Measurement of gastric residual volume

Front 228

Which of the following should appear on the label of an enteral feeding product given to a patient in the hospital?

1: Product name, rate, volume, additives, caloric density, expiration date, and time
2: Patient's name, product name, strength, additives, volume, expiration date, and time
3: Patient's name, product name, rate, strength, osmolality, expiration date, and volume
4: Patient's name, room number, strength, additives, volume, time, and expiration date

Back 228

2: Patient's name, product name, strength, additives, volume, expiration date, and time

Front 229

In the patient with a newly placed gastrostomy or jejunostomy tube, observation of which of the following conditions at the tube exit site would signal concern for infection?

1: Serosanguineous drainage
2: Foul-smelling drainage
3: Coffee-ground drainage
4: Greenish-yellow drainage

Back 229

2: Foul-smelling drainage

Front 230

Most enteral formulas designed for oral consumption are composed primarily of

1: carbohydrates.
2: protein.
3: fat.
4: vitamins.

Back 230

1: carbohydrates.

Front 231

What is the enteral nutrition feeding method in which 240-480 mL of formula flows into the stomach over 10-15 minutes through the barrel of a 50 mL syringe attached to the end of the feeding tube?

1: Gravity feeding
2: Cyclic feeding
3: Bolus feeding
4: Continuous feeding

Back 231

3: Bolus feeding

Front 232

Which of the following best describes the use of oral rehydration solutions in a patient with short bowel and an end-jejunostomy?

1: A glucose-free oral rehydration solution is preferred
2: Sodium and water should be fairly well absorbed from hypertonic solutions
3: Supplementation of iron will likely be required in addition to the oral rehydration solution
4: Optimal sodium concentration of an oral rehydration solution is higher than commercially available solutions

Back 232

4: Optimal sodium concentration of an oral rehydration solution is higher than commercially available solutions

Front 233

In transitioning from enteral tube to oral feeding, tube feeding may be discontinued when adequacy of oral intake meets at least

1: 30% of nutrient needs.
2: 40% of nutrient needs.
3: 50% of nutrient needs.
4: 60% of nutrient needs.

Back 233

4: 60% of nutrient needs.

Front 234

Which of the following best describes the addition of blue dye to enteral feedings?

1: It prevents aspiration of enteral formula
2: Its use in detection of aspiration is highly sensitive
3: It should be added only in small amounts
4: It is no longer recommended for the detection of aspiration of enteral formula

Back 234

4: It is no longer recommended for the detection of aspiration of enteral formula

Front 235

If a postoperative trauma patient develops new onset diarrhea in the intensive care unit, the first intervention should be to

1: change to an elemental feeding.
2: obtain an order for a bile-sequestering agent.
3: obtain a Clostridium difficile toxin stool assay.
4: obtain an order for an antidiarrheal medication.

Back 235

3: obtain a Clostridium difficile toxin stool assay.

Front 236

Infusion of a predetermined volume of formula over 12 hours is an example of this method.

1: Bolus
2: Cyclic
3: Continuous
4: Needle Catheter

Back 236

2: Cyclic

Front 237

When initiating and advancing enteral feedings in the hospitalized patient, which of the following is most appropriate?

1: 1/2 strength formula at 25cc per hour, advance to goal rate and strength over 5-7 days
2: 240 cc bolus feeds of full strength hypertonic formulas every 4 hours
3: full strength formula at 10-40 mL/hour and advance by 10-20 mL/hr every 8-12 hours until goal rate is achieved
4: 1/4 strength formula at goal rate. Advance to full strength over 3-5 days.

Back 237

3: full strength formula at 10-40 mL/hour and advance by 10-20 mL/hr every 8-12 hours until goal rate is achieved

Front 238

Which of the following is true regarding infectious complications associated with enteral feedings?

1: Bacterial contamination may originate from the patient's throat, lung, and stomach
2: Length of enteral product hang time is not correlated with bacterial contamination
3: Open systems typically have less exogenous bacterial contamination
4: Bacterial counts at the enteral tube site should be cultured routinely

Back 238

1: Bacterial contamination may originate from the patient's throat, lung, and stomach

Front 239

Which of the following is an appropriate enteral tube feeding administration technique that will not pose an increased risk of contamination of enteral formulas?

1: Mix or reconstitute enteral formulations at bedside just prior to administration
2: Change the feeding administration set every 48 hours
3: Limit hang time of canned, ready-to-use formulas to no more than 24 hours
4: Use tap water to reconstitute enteral formulations in most adult patient populations

Back 239

4: Use tap water to reconstitute enteral formulations in most adult patient populations

Front 240

Which of the following methods of enteral nutrition delivery is most commonly used in hospitalized patients?

1: Bolus feeding
2: Cyclic feeding
3: Intermittent feeding
4: Continuous infusion

Back 240

4: Continuous infusion

Front 241

Which of the following is NOT a research-based method used to successfully restore patency to clogged enteral feeding tubes?

1: Water flush
2: Cranberry juice flush
3: Mechanical declogging devices
4: Sodium bicarbonate and pancrelipase

Back 241

2: Cranberry juice flush

Front 242

Your patient has been discharged home to hospice with end-stage ALS (amyotrophic lateral sclerosis). He is receiving enteral feedings and complains of nausea. A decision is made to discontinue enteral feeding. Which of the following is true regarding the dying patient.

1: Intravenous hydration should be used to reduce symptoms of nausea, vomiting, diarrhea and respiratory distress
2: Dehydration, starvation, and ketosis produces a euphoric state that enhances the perception of hunger
3: The most common symptom when nutrition and hydration are witheld is dry mouth
4: Electrolyte imbalance should be expected and may produce a degree of analgesia

Back 242

3: The most common symptom when nutrition and hydration are witheld is dry mouth

Front 243

Which of the following is a primary cause of oozing stools in a tube fed patient?

1: Bowel impaction
2: Fluid restriction
3: Physical inactivity
4: Narcotic usage

Back 243

1: Bowel impaction

Front 244

Which of the following feeding schedules would be most appropriate for a critically ill patient with labile and poorly controlled blood glucose concentrations?

1: Bolus
2: Continuous
3: Gravity drip
4: Nocturnal infusion

Back 244

2: Continuous

Front 245

In the adult enterally-fed patient, watery diarrhea and bloating are most often the result of

1: lactose content of the enteral formula.
2: sorbitol content of liquid medications
3: sorbitol content of the enteral formula
4: lactose content of liquid medications

Back 245

2: sorbitol content of liquid medications

Front 246

Which would NOT be appropriate management of hypergranulation around the PEG site?

1: Keep the area dry
2: Tube stabilizing device
3: Occlusive dressing
4: Silver nitrate cauterization

Back 246

3: Occlusive dressing

Front 247

Mrs. Jones suffered from a stroke two weeks ago and has significant dysphagia. A PEG was placed and an isotonic enteral formula has been infusing continuously at goal rate for two days. The tube is being flushed with 30mL free water three times daily. Mrs. Jones begins to complain of bloating and is mildly distended (to 4 cm from baseline) upon examination. Which of the following interventions would be the best initial strategy to reduce her unpleasant symptoms?

1: Determine when last bowel movement occurred and consider a cathartic if constipation is evident
2: Hold the tube feedings and initiate a pain reliever
3: Switch to a higher fiber formula
4: Use a more concentrated formula administered through bolus feeding

Back 247

1: Determine when last bowel movement occurred and consider a cathartic if constipation is evident

Front 248

Which of the following is a major risk factor for aspiration in critically ill patients?

1: Gastric residual volume <150 mL
2: Decreased level of consciousness
3: Age
4: Small diameter feeding tube

Back 248

2: Decreased level of consciousness

Front 249

In order to prevent clogged feeding tubes, before checking gastric residuals, what should occur?

1: Tube should be flushed with 20-30 mL of water.
2: Patient should be placed in Trendelenburg position.
3: Enteral feedings should be held one hour.
4: A 60 mL syringe of air should be instilled into the tube.

Back 249

1: Tube should be flushed with 20-30 mL of water.

Front 250

The osmolality of an isotonic enteral formula is approximately

1: 200 mOsm/kg of water.
2: 300 mOsm/kg of water.
3: 400 mOsm/kg of water.
4: 500 mOsm/kg of water.

Back 250

2: 300 mOsm/kg of water.

Front 251

When administering multiple medications via enteral feeding tubes, medications should be

1: crushed, dissolved, and administered separately, followed by a 15-30 mL water flush.
2: mixed together in a 30 mL slurry and flushed together.
3: delivered in liquid form without extra water flushes.
4: mixed directly into the feeding formulations, delivered by syringe, gravity bag or feeding pump.

Back 251

1: crushed, dissolved, and administered separately, followed by a 15-30 mL water flush.

Front 252

The chronic use of steroids in premature infants has been associated with

1: osteopenia.
2: cholestasis.
3: nephrolithiasis.
4: hypoglycemia.

Back 252

1: osteopenia.

Front 253

The dietary reference intake for calcium for adolescents is based on the amount of calcium

1: needed to maintain serum calcium levels in normal range during rapid growth.
2: needed to achieve maximal accretion during rapid growth.
3: consumed by upper quartile in calcium intake studies.
4: consumed by adolescents who later in life show no osteopenia based on epidemiologic data.

Back 253

2: needed to achieve maximal accretion during rapid growth.

Front 254

What is the daily maintenance fluid requirement for a 5 kg infant?

1: 300 mL
2: 500 mL
3: 700 mL
4: 1000 mL

Back 254

2: 500 mL

Front 255

Which of the following is considered to be an upper limit for the osmolality of infant formulas to avoid tolerance issues?

1: 460 mOsm/kg
2: 360 mOsm/kg
3: 260 mOsm/kg
4: 560 mOsm/kg

Back 255

1: 460 mOsm/kg

Front 256

Nipple feeding and/or nonnutritive oral stimulation should be used in the neonate less than 32 weeks corrected gestational age while being fed enterally to promote

1: mother/child bonding.
2: appropriate swallowing response.
3: correct development of facial and jaw muscles.
4: ability to feed orally when developmentally appropriate.

Back 256

4: ability to feed orally when developmentally appropriate.

Front 257

Which of the following trace elements has been used in the treatment of infantile diarrhea?

1: Iron
2: Zinc
3: Copper
4: Selenium

Back 257

2: Zinc

Front 258

Approximately how many calories are needed enterally to achieve adequate growth in an infant with congenital heart disease?

1: 120-170 kcal/kg/day
2: 100-120 kcal/kg/d
3: 80-100 kcal/kg/d
4: unknown

Back 258

1: 120-170 kcal/kg/day

Front 259

Which of the following is true regarding use of the Curreri junior formula to estimate calorie needs in the burned pediatric patient?

1: It typically overestimates needs for patients with burns >50% TBSA (total body surface area)
2: It typically overestimates needs for patients with burns <50% TBSA
3: It typically underestimates needs for patients with burns >50% TBSA
4: It underestimates needs for patients with burns <50% TBSA

Back 259

3: It typically underestimates needs for patients with burns >50% TBSA

Front 260

Which of the following therapies would be considered most appropriate in the nutritional management of bronchopulmonary dysplasia?

1: Use of concentrated formula
2: Use of a high fat, low carbohydrate formula
3: Use of a hydrolyzed protein formula
4: Use of an MCT oil predominant formula

Back 260

1: Use of concentrated formula

Front 261

On radiographic examination, a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum laboratory results show: Calcium: low. Phosphorus: low. Creatinine: normal. Alkaline phosphatase: high. 25-OH vitamin D: Low. 1,25 (OH)2 vitamin D: Low. PTH: high. Which of the following is the most likely diagnosis?

1: Renal tubular acidosis
2: Osteogenesis imperfecta
3: Vitamin D deficiency rickets
4: Vitamin D dependent rickets type 2

Back 261

3: Vitamin D deficiency rickets

Front 262

How often does the American Academy of Pediatrics recommend screening for iron deficiency anemia?

1: Once between the age of 9 and 12 months for all infants
2: Once between the ages of 2 and 6 years in all children
3: Once a year in all adolescents
4: Yearly if a child drinks >24 ounces of milk per day

Back 262

1: Once between the age of 9 and 12 months for all infants

Front 263

Which of the following is FALSE regarding regurgitation in infants?

1: Regurgitation is rare in infants
2: Regurgitation in neonates is related to relaxation of the lower esophaleal sphinter
3: Regurgitation may occur if enteral nutrition is infused too quickly
4: Regurgitation is associated with delayed gastric emptying

Back 263

1: Regurgitation is rare in infants

Front 264

The biochemical defect in phenylkenonuria (PKU) is a functional deficiency of the liver enzyme phenylalanine hydroxylase, which catalyzes the para-hydroxylation of phenylalanine to yield what amino acid?

1: Threonine
2: Phenylacetic acid
3: Phenylethylamine
4: Tyrosine

Back 264

4: Tyrosine

Front 265

Which of the following is recommended to prevent vitamin D deficiency in a 1-month-old breastfed infant?

1: Supplement with 100 IU vitamin D per day
2: Supplement with 200 IU vitamin D per day
3: Supplement with 300 IU vitamin D per day
4: Supplement with 400 IU vitamin D per day

Back 265

2: Supplement with 200 IU vitamin D per day

Front 266

Which of the following is the BEST indication for use of a soy-based infant formula?

1: Diarrhea
2: Cow's milk protein allergy
3: Galactosemia
4: Regurgitation with feeds

Back 266

3: Galactosemia

Front 267

In a preterm infant, which of the following amino acids is separately added to parenteral nutrition solutions due to solubility concerns?

1: Glycine
2: Cysteine
3: Methionine
4: Phenylalanine

Back 267

2: Cysteine

Front 268

In an infant with adequate energy intake, what is the MINIMUM amount of fat emulsion containing long chain fatty acids needed to prevent essential fatty acid deficiency?

1: 0.2-0.4 g/kg/day
2: 0.5-1.0 g/kg/day
3: 1.1-1.5 g/kg/day
4: 1.8-2.0 g/kg/day

Back 268

2: 0.5-1.0 g/kg/day

Front 269

Which of the following is NOT associated with a delayed bone age in a child with short stature?

1: Hypothyroidism
2: Precocious puberty
3: Cushing syndrome
4: Growth hormone deficiency

Back 269

2: Precocious puberty

Front 270

The nutrient content of preterm follow-up formula is approximately halfway between

1: term formulas and pediatric formulas.
2: preterm formulas and elemental formulas.
3: preterm formulas and term infant formulas.
4: milk-based term formulas and soy formulas.

Back 270

3: preterm formulas and term infant formulas.

Front 271

A 13-year-old boy whose body mass index (BMI) is at the 97th percentile on the Centers for Disease Control and Prevention growth chart for age and sex would be classified as

1: underweight.
2: normal weight.
3: at risk for becoming overweight.
4: obese.

Back 271

4: obese.

Front 272

When used in assessment of critically ill children, how do predictive equations compare to indirect calorimetry?

1: No consistent comparison can be found
2: Equations typically overestimate needs
3: Equations typically underestimate needs
4: Equations correlate well with indirect calorimetry

Back 272

1: No consistent comparison can be found

Front 273

A 2-month-old infant, who has been exclusively fed with cow's milk based formula develops a full body rash. Which of the following would be the most appropriate next step?

1: Switch to a soy protein based formula
2: Supplement the feedings with lactase
3: Switch to a protein hydrolysate based formula
4: Switch to a lactose free cow's milk based formula

Back 273

3: Switch to a protein hydrolysate based formula

Front 274

Which of the following preterm growth charts allows for comparison for preterm infants from 22 weeks gestational age up through 10 weeks post term age?

1: Fenton
2: Ehrenkranz
3: Dancis
4: Lubchenco

Back 274

1: Fenton

Front 275

Using the Waterlow criteria, weight for length is evaluated as an index of which of the following?

1: Wasting due to acute malnutrition
2: Wasting due to chronic malnutrition
3: Wasting caused by illness
4: Wasting caused by hypoalbuminemia

Back 275

1: Wasting due to acute malnutrition

Front 276

Which of the following is NOT a common clinical symptom of celiac disease in childhood?

1: Malabsorption
2: Failure to thrive
3: Constipation
4: Anemia

Back 276

3: Constipation

Front 277

Standard parenteral amino acid solutions available for neonates differ from standard adult parenteral amino acid solutions by having a higher content of

1: cysteine.
2: phenylalanine.
3: taurine and tyrosine.
4: methionine and glycine.

Back 277

3: taurine and tyrosine.

Front 278

Which of the following methods of estimating energy requirements in critically ill children is LEAST accurate when compared to resting energy expenditure measurement by indirect calorimetry?

1: Mayo Clinic nomogram
2: Harris-Benedict equations
3: World Health Organization equations
4: Recommended Dietary Allowance (RDA) for energy

Back 278

4: Recommended Dietary Allowance (RDA) for energy

Front 279

Which of the following children is at greatest risk for iron deficiency anemia?

1: 4 month-old exclusively breast fed term infant
2: 4 month corrected gestational age, former preemie on a transitional formula
3: 10 month-old switched from formula to whole milk
4: 17 month-old "picky eater"

Back 279

3: 10 month-old switched from formula to whole milk

Front 280

A 4-month-old male has acute onset of diarrhea for 48 hours. His parents noticed that he hasn't been wetting as many diapers and his mucous membranes are slightly dry. His anterior fontanel is soft and not depressed. He normally ingests breast milk ad lib. Which of the following is the most appropriate nutrition intervention for this infant?

1: 1/2 strength infant formula
2: Oral rehydration therapy
3: Full strength soy formula
4: Short course of parenteral nutrition

Back 280

2: Oral rehydration therapy

Front 281

What is the suggested daily amount of potassium required for maintenance in an infant receiving parenteral nutrition?

1: 0.8-1 mEq/kg
2: 2-4 mEq/kg
3: 5-6 mEq/kg
4: 7-8 mEq/kg

Back 281

2: 2-4 mEq/kg

Front 282

An infant has a complete ileal resection with preservation of the ileo-cecal valve. The primary nutrition-related concern will be

1: fluid and electrolyte loss.
2: water soluble vitamin malabsorption.
3: dumping syndrome.
4: protein malabsorption due to decreased cholecystokinin secretion.

Back 282

1: fluid and electrolyte loss.

Front 283

What should be the MAXIMUM parenteral dextrose infusion rate for a preterm infant?

1: 4 mg/kg/min
2: 6 mg/kg/min
3: 10 mg/kg/min
4: 12 mg/kg/min

Back 283

4: 12 mg/kg/min

Front 284

Nutrition therapy for pediatric patients with <20% total body surface area (TBSA) burn typically includes

1: oral intake of high calorie, high protein diet.
2: enteral nutrition therapy.
3: parenteral nutrition therapy.
4: enteral and parenteral nutrition therapy.

Back 284

1: oral intake of high calorie, high protein diet.

Front 285

A morbidly obese 12 year old female is admitted to the hospital for an evaluation of sleep apnea. A diet history reveals that she drinks six 10 ounce sodas per day. What mineral may she be deficient in?

1: Calcium
2: Phosphorus
3: Magnesium
4: Potassium

Back 285

1: Calcium

Front 286

Which of the following is NOT a contraindication to nasogastric tube feedings in a pediatric patient with cystic fibrosis?

1: Chronic sinusitis
2: Chronic otitis
3: NGT feedings cannot be absorbed when pancreatic insufficiency is present
4: Need for long term nutrition support

Back 286

3: NGT feedings cannot be absorbed when pancreatic insufficiency is present

Front 287

What is the recommended intake of selenium for infants receiving parenteral nutrition?

1: 1.3 - 4.5 mcg/kg/day
2: 3.3 - 6.5 mcg/kg/day
3: 5.3 - 8.5 mcg/kg/day
4: There is no recommended intake of selenium for infants receiving parenteral nutrition.

Back 287

1: 1.3 - 4.5 mcg/kg/day

Front 288

Which of the following is considered to be diagnostic of infantile anorexia?

1: Failure to eat adequately with poor weight gain for > = 1 month
2: Failure to eat adequately associated with childhood depressive disorder
3: Failure to gain weight associated with a malabsorptive disorder
4: Chronic weight loss associated with a malabsorptive disorder

Back 288

1: Failure to eat adequately with poor weight gain for > = 1 month

Front 289

What is the hang time for breast milk when used for continuous enteral feedings?

1: 2 hours
2: 4 hours
3: 8 hours
4: 12 hours

Back 289

2: 4 hours

Front 290

What distinguishes Gastroesophageal Reflux (GER) from Gastroesophageal Reflux Disease (GERD) in infants?

1: GERD is characterized by the presence of significant complications
2: GER is associated with failure to thrive
3: GER does not typically resolve spontaneously
4: GERD typically requires surgical fundoplication

Back 290

1: GERD is characterized by the presence of significant complications

Front 291

Which of the following best describes the appropriate use of powdered infant formula in healthcare facilities?

1: Freeze open containers and discard after 30 days from opening
2: Refrigerate open containers and discard after 30 days from opening
3: Use interchangeably with comparable sterile liquid formulations
4: Use only when comparable sterile liquid formulations are not available

Back 291

4: Use only when comparable sterile liquid formulations are not available

Front 292

The use of Lactobacillus GG in pediatric practice has been found to be MOST effective in

1: treating infectious diarrhea.
2: reducing the incidence of NEC.
3: prolonging time to remission in children with Crohn’s.
4: eradicating heliobacter pylori infection.

Back 292

1: treating infectious diarrhea.

Front 293

Biliary atresia in infancy is most frequently associated with which of the following?

1: Fat malabsorption
2: Chylothorax
3: Zinc Deficiency
4: Essential fatty acid deficiency

Back 293

1: Fat malabsorption

Front 294

A child with cerebral palsy is admitted to the hospital for a fundoplication and a gastric feeding tube. Together, these procedures are used to treat

1: gastroesophageal reflux.
2: oral/motor dysfunction
3: malnutrition.
4: esophagitis.

Back 294

1: gastroesophageal reflux.

Front 295

Pancreatic enzymes supplemented at high doses in children with cystic fibrosis could result in

1: steatorrhea.
2: meconium ileus.
3: fibrosing colonopathy.
4: cystic fibrosis related diabetes.

Back 295

3: fibrosing colonopathy.

Front 296

What is the recommended daily enteral iron dose for preterm infants?

1: 0.5-1 mg/kg/d
2: 1-2 mg/kg/d
3: 2-4 mg/kg/d
4: 5-6 mg/kg/d

Back 296

3: 2-4 mg/kg/d

Front 297

Which of the following is TRUE regarding aspiration in critically ill children?

1: The incidence of aspiration directly caused by enteral nutrition is difficult to determine due to a lack of good clinical research
2: Formula should be colored with blue food dye if aspiration is suspected
3: Children have strong coordination of pharyngeal muscles, making aspiration less likely than in adults
4: Children have strong cough reflex which helps protect them from aspiration

Back 297

1: The incidence of aspiration directly caused by enteral nutrition is difficult to determine due to a lack of good clinical research

Front 298

Which of the following is characteristic of hypermetabolism in pediatric oncology patients?

1: Incidence of hypermetabolism is very rare
2: Infection is not a cause of hypermetabolism
3: Children with acute leukemia receiving maintenance chemotherapy are likely to be hypermetabolic
4: The basal metabolic rate of children with solid tumor may be significantly higher than the estimated basal metabolic rate at diagnosis

Back 298

4: The basal metabolic rate of children with solid tumor may be significantly higher than the estimated basal metabolic rate at diagnosis

Front 299

A 7 month-old infant fed ready-to-feed infant formula and other age-appropriate complementary foods may benefit from supplementation with which of the following?

1: Vitamin A
2: Fluoride
3: Vitamin E
4: Iron

Back 299

2: Fluoride

Front 300

In children with active and recently diagnosed Crohn's disease, which of the following is more effective than corticosteroids in inducing healing of gut inflammatory lesions?

1: polymeric formula as the sole source of nutrition
2: antibiotic therapy
3: elemental formula administered as enteral feedings
4: parenteral nutrition

Back 300

1: polymeric formula as the sole source of nutrition

Front 301

Which of the following does NOT describe the use of minimum enteral feeds in preterm neonates?

1: Prevents gut atrophy
2: Increases the risk of necrotizing enterocolitis
3: Improves feeding tolerance and time to full enteral feeds
4: Should be started as soon as medically feasible

Back 301

2: Increases the risk of necrotizing enterocolitis

Front 302

The decision to terminate enteral feeding in a patient in a persistent vegetative state whose wishes have been made known through an advance directive is based on the ethical principle of

1: justice.
2: autonomy.
3: beneficence.
4: nonmalfeasance.

Back 302

2: autonomy.

Front 303

If a 68-year-old woman with encephalopathy is receiving a tube feeding due to recent gastrointestinal surgery and develops elevated ammonia levels, which of the following should be tried first?

1: Decrease in amount of protein given to 0.6 g/kg of body weight
2: Medium-chain triglyceride added to tube feeding
3: Formula enriched with branched-chain amino acids
4: Lactulose and neomycin therapy

Back 303

4: Lactulose and neomycin therapy

Front 304

Which of the following medication classes used in the older population will least likely contribute to anorexia?

1: Narcotic analgesics
2: Antihistamines
3: H-2 receptor antagonists
4: Antihypertensive agents

Back 304

2: Antihistamines

Front 305

Which of the following is most likely to be observed first if a non-diabetic older patient is overfed?

1: Hepatobiliary effects
2: Hyperglycemia
3: Weight gain
4: Accumulation of CO2

Back 305

2: Hyperglycemia

Front 306

The Short-Form Mini-Nutritional Assessment (MNA-SF) was derived from the Mini-Nutritional Assessment (MNA) in order to

1: adapt the MNA for use in pediatric patients.
2: eliminate the need to obtain height and weight data for nutrition assessment.
3: allow patients to generate their own nutrition assessment with a questionnaire method.
4: obtain high diagnostic accuracy for detecting nutritional problems in geriatric patients with a brief screening tool.

Back 306

4: obtain high diagnostic accuracy for detecting nutritional problems in geriatric patients with a brief screening tool.

Front 307

A decrease in food intake in older adults is most likely attributable to

1: changes in taste and flavor sensations.
2: delayed satiety.
3: fear of incontinence.
4: enhanced olfaction.

Back 307

1: changes in taste and flavor sensations.

Front 308

When using cyclic parenteral nutrition solutions for nonstressed, nondiabetic patients, age should be taken into account because compared to the middle-aged, the elderly have

1: lower fat oxidation and lower glucose oxidation.
2: lower fat oxidation and higher glucose oxidation.
3: higher fat oxidation and lower glucose oxidation.
4: higher fat oxidation and higher glucose oxidation.

Back 308

3: higher fat oxidation and lower glucose oxidation.

Front 309

Which of the following medications is most likely to contribute to hyponatremia in an elderly patient?

1: furosemide
2: digoxin
3: omeprazole
4: ciprofloxacin

Back 309

1: furosemide

Front 310

A 65 year old female had complications associated with GI surgery, and was admitted to the intensive care unit with pneumonia and septic shock. After she became hemodynamically stable, she was started on parenteral nutrition secondary to a prolonged ileus. Prior to surgery, she was at her ideal weight. Currently her labs include albumin 2.0 mg/dL and creatinine 1.0 mg/dL. Her urine output is adequate. Which of the following best estimates her protein needs for initiation of parenteral nutrition therapy?

1: 0.6 grams/kg
2: 0.8 grams/kg
3: 1.5 grams/kg
4: 2.5 grams/kg

Back 310

3: 1.5 grams/kg

Front 311

Which of the following best describes typical changes in body composition with age that contribute to a decrease in energy requirements?

1: Decreased fat mass and increased lean body mass
2: Increased fat mass and decreased lean body mass
3: Increased fat mass and increased lean body mass
4: Decreased fat mass and decreased lean body mass

Back 311

2: Increased fat mass and decreased lean body mass

Front 312

Which of the following is NOT a component of geriatric nutritional assessment?

1: Exercise level
2: Anthropometry
3: Quality of life
4: Biochemical markers

Back 312

1: Exercise level

Front 313

The threshold for initiating PN support in the elderly as compared with a younger adult would be

1: lower because age-related decreases in muscle mass and organ function render the elderly population with diminished reserves and impaired compensatory mechanisms.
2: about the same because the patient either has an indication or not.
3: higher because of the increased risks associated with PN.
4: significantly higher because PN should generally be avoided in the elderly.

Back 313

1: lower because age-related decreases in muscle mass and organ function render the elderly population with diminished reserves and impaired compensatory mechanisms.

Front 314

Which of the following complications of EN is the most potentially dangerous in the elderly?

1: Diarrhea
2: Abdominal distension
3: Leaking around the insertion site
4: Aspiration

Back 314

4: Aspiration

Front 315

A patient receiving digoxin and parenteral nutrition who is experiencing signs of digoxin toxicity should be assessed for

1: hyperkalemia.
2: hypercalcemia.
3: hypermagnesemia.
4: hyperphosphatemia.

Back 315

2: hypercalcemia.

Front 316

What is the most widely used tool to measure generic health status?

1: Katz's ADL
2: Lawton & Brody's IADL
3: FIM
4: SF-36

Back 316

4: SF-36

Front 317

An elderly nursing home resident with a history of constipation has a newly placed PEG tube. Which of the following formulas would most likely be the best choice?

1: Concentrated 2 kcal/mL formula
2: Standard 1 kcal/mL formula with fiber
3: High nitrogen formula
4: Predigested formula

Back 317

2: Standard 1 kcal/mL formula with fiber

Front 318

Which of the following is evidenced by a gradual wasting of body fat and somatic muscle with preservation of visceral proteins?

1: Marasmus
2: Mixed state
3: Kwashiorkor
4: Hypoalbuminemia

Back 318

1: Marasmus

Front 319

A 75 year old male admitted to the hospital for aspiration pneumonia. He was previously on a feeding devilered via NG tube. Which of the following long-term feeding options would be the most appropriate?

1: Withdraw support
2: PEG feeding
3: PEJ feeding
4: Parenteral Nutrition (PN)

Back 319

3: PEJ feeding

Front 320

Which of the following is most likely to occur as the result of an age-related functional change in the gastrointestinal tract?

1: Increased anorectal tone
2: Enhanced IgA responsiveness
3: Increased calcium absorption
4: Decreased gastric emptying

Back 320

4: Decreased gastric emptying

Front 321

An assessment of functional status may aid in determining nutrition risk. Which of the following provides an assessment of functional status?

1: IQ exam
2: Handgrip strength assessment
3: Measurement of fat mass
4: Visual exam

Back 321

2: Handgrip strength assessment

Front 322

An older adult with poor oral intake over a two month period requires specialized nutrition support. Which of the following electrolyte abnormalities is associated with aggressive refeeding?

1: Hyperkalemia
2: Hyponatremia
3: Hypermagnesemia
4: Hypophosphatemia

Back 322

4: Hypophosphatemia

Front 323

Vitamin D (25, hydroxyvitamin D) deficiency can manifest as

1: Muscle weakness.
2: Decreased production and excretion of parathyroid hormone (PTH) levels.
3: Hypotension.
4: Less than normal serum lipid levels.

Back 323

1: Muscle weakness.

Front 324

According to the Administration on Aging, what percentage of older adults in hospitals or nursing homes are malnourished and may be discharged malnourished back into the community?

1: 10%
2: 25%
3: 50%
4: 90%

Back 324

3: 50%

Front 325

Which one of the following vitamin deficiencies is most likely to occur in an older adult who consumes alcohol on a regular basis?

1: Vitamin K
2: Vitamin A
3: Vitamin D
4: Thiamine

Back 325

4: Thiamine

Front 326

An 87-year-old woman underwent a total abdominal colectomy. Her ileostomy output is 1.5-2.0 liters per day. Supplementation of which of the following micronutrients should be considered?

1: Zinc
2: Copper
3: Vitamin E
4: Chromium

Back 326

1: Zinc

Front 327

An 80 year old, living alone at home, has experienced a weight loss of 15 pounds over a year and a half. The clinician assessing his nutrition status finds that he has inadequate intake. Which of the following risk factors for diminished intake most likely contributed most significantly to his weight loss?

1: Poor oral health
2: Mental health issues.
3: Alcohol use
4: Functional limitations.

Back 327

1: Poor oral health

Front 328

The Plan/Do/Study/Act (PDSA) cycle is employed as a

1: quality improvement problem-solving model.
2: medical nutrition protocol.
3: tool for measuring trends in older Americans.
4: benchmarking tool used to compare institutions.

Back 328

1: quality improvement problem-solving model.

Front 329

An elderly patient requires bowel rest for 6 weeks. Which of the following feeding delivery methods should be employed?

1: PN through a port
2: PN through a PICC line
3: Peripheral PN
4: PN through a short-term central venous catheter

Back 329

2: PN through a PICC line

Front 330

The Omnibus Budget Reconciliation Act (OBRA) of 1987 provides the total assessment and process for facilities certified to participate in Medicare or Medicaid programs. Which of the following represents the core set of clinical and functional status elements which form the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid?

1: Minimum Data Set (MDS)
2: Resident Assessment Protocols (RAP)
3: Utilization Guidelines
4: Trigger Legend

Back 330

1: Minimum Data Set (MDS)

Front 331

In which of the following patient populations is toxicity with fat soluble drugs most likely?

1: Obese elderly
2: Sedentary elderly
3: Malnourished elderly
4: Physically active elderly

Back 331

1: Obese elderly

Front 332

Vitamin D (25, hydroxyvitamin D) deficiency is defined as a serum level of less than

1: 100 ng/mL.
2: 20 ng/mL.
3: 50 ng/mL.
4: 120 ng/mL.

Back 332

2: 20 ng/mL.

Front 333

Which of the following best describes the use of artificial nutrition and hydration (ANH) in terminally ill patients?

1: Those who receive ANH have a more comfortable death
2: Those who have dysphagia survive longer with ANH
3: Those who receive ANH have a decrease in abnormal electrolytes
4: Those who receive no ANH survive as long or longer than those who do

Back 333

4: Those who receive no ANH survive as long or longer than those who do

Front 334

Which of the following medications is LEAST likely to cause diarrhea in a tube-fed patient?

1: Clindamycin
2: Kayexalate
3: Codeine
4: Magnesium oxide

Back 334

3: Codeine

Front 335

In an older adult who requires long term EN, which of the following complications is most often overlooked?

1: Tube leaking
2: Tube clogging
3: Decreased urination
4: Skin problems at tube site

Back 335

3: Decreased urination

Front 336

Levodopa is often used in the treatment of Parkinson Disease. Which of the following vitamins has been demonstrated to reverse the effects of levodopa?

1: Vitamin B-6
2: Vitamin B-12
3: Vitamin C
4: Vitamin K

Back 336

1: Vitamin B-6

Front 337

Enteral nutrition products supplemented with fiber are often used in the elderly to prevent constipation. Which of the following considerations is most important if this type of formula is chosen?

1: Addition of a prokinetic agent
2: Avoidance of lactose
3: Lowering feeding rate to prevent bloating
4: Provision of adequate water

Back 337

4: Provision of adequate water

Front 338

In an afebrile person with intact skin, insensible fluid loss is approximately

1: 10 mL/kg/d.
2: 20 mL/kg/d.
3: 30 mL/kg/d.
4: 40 mL/kg/d.

Back 338

1: 10 mL/kg/d.

Front 339

JD is an 85 year old male whose height is 63 inches and who weighs 45kg. His weight 10 years ago was 55kg. His weight loss has been non-volitional and gradual, and he has no major health problems. Which of the following statements most appropriately describe JD's weight loss?

1: JD demonstrates a decrease in lean body mass known as sarcopenia, which occurs during the aging process.
2: JD's weight loss is not a normal phenomenon. He should be evaluated for an underlying disease process.
3: JD demonstrates a decrease in fat mass, which occurs with the aging process.
4: JD should be placed on a specialized nutrition support regimen to replace the weight he has lost.

Back 339

1: JD demonstrates a decrease in lean body mass known as sarcopenia, which occurs during the aging process.

Front 340

A patient has an advanced directive stating a desire to forego medical technology, including nutrition and hydration, in order to prolong life. The patient is now incompetent and in an irreversible vegetative state. In deciding whether to continue nutrition and hydration by medical means, the patient's surrogate decision-maker must

1: consult with a lawyer.
2: have a psychiatric evaluation to be declared competent to make any decisions in the patient's care.
3: honor the patient's expressed wish to withdraw nutrition and hydration by medical means.
4: decide, based upon own values, to make a decision to withdraw the patient's nutrition and hydration by medical means.

Back 340

3: honor the patient's expressed wish to withdraw nutrition and hydration by medical means.

Front 341

What is the recommended daily energy intake for patients over 65 who are receiving hemodialysis or peritoneal dialysis?

1: 25 kcal/kg on nondialysis days and 35 kcal/kg on dialysis days
2: 30-35 kcal/kg
3: 35 kcal/kg on nondialysis days and 25 kcal/kg on dialysis days
4: 40-45 kcal/kg

Back 341

2: 30-35 kcal/kg

Front 342

Which of the following best reflects the use of specialized nutrition support (SNS) in patients with a Do Not Resuscitate (DNR) status?

1: The DNR status is a contraindication to the provision of SNS
2: The DNR status should not preclude the initiation of SNS if the indications exist
3: The provision of SNS to a patient with a DNR status is based on individual state laws
4: SNS cannot be withheld or withdrawn in a patient with a DNR order, even if all agree that SNS is no longer meeting the desired goal

Back 342

2: The DNR status should not preclude the initiation of SNS if the indications exist

Front 343

In an older adult receiving parenteral nutrition as well as anticoagulation therapy, which of the following vitamin considerations is most important?

1: Vitamin D should be removed with metabolic bone disease
2: Vitamin A losses increase with kidney impairment
3: Vitamin K is a component of multivitamin preparations and intravenous lipid solutions
4: Vitamin E increases the risk of kidney stones

Back 343

3: Vitamin K is a component of multivitamin preparations and intravenous lipid solutions

Front 344

Which of the following is not a common change in the body composition of healthy older adults?

1: Increased body water
2: Decreased bone mineral mass
3: Decreased lean body mass
4: Redistributed fatty tissue

Back 344

1: Increased body water

Front 345

Sarcopenia, a loss of lean body mass that occurs with aging, is also associated with

1: excess growth hormone.
2: decreased cytokine activity.
3: decreased bone density.
4: decreased total body fat.

Back 345

3: decreased bone density.

Front 346

An 85 year old nursing home resident was transferred to the hospital with anorexia, malnutrition, and probable aspiration pneumonia. On admission, his WBC was 14K, creatinine 1.3. Which of the following nutrition plans would be most appropriate for this patient?

1: Start the patient on a regular oral diet with supplements
2: Establish central access with a PICC line and initiate parenteral feedings
3: Establish peripheral access and initiate peripheral parenteral nutrition until enteral feedings can be established
4: Determine the most appropriate enteral feeding route and establish tube feeding

Back 346

4: Determine the most appropriate enteral feeding route and establish tube feeding

Front 347

Which of the following is NOT appropriate to tell a family regarding nutrition at the end of life?

1: Dying patients rarely feel hungry or thirsty
2: Fewer calories are needed at the end of life
3: The experience of eating remains unchanged at the end of life
4: Patients should not be made to feel guilty if they do not wish to eat

Back 347

3: The experience of eating remains unchanged at the end of life

Front 348

The majority of dietary folate is reabsorbed via which of the following mechanisms?

1: Oncotic pressure
2: Enterohepatic circulation
3: Plasma hydrostatic pressure
4: Passive diffusion

Back 348

2: Enterohepatic circulation

Front 349

Which of the following are examples of monosaccharides?

1: Galactose, sucrose, and amylopectin
2: Maltose, fructose and lactose
3: Glucose, fructose, and galactose
4: Lactose, maltose, and sucrose

Back 349

3: Glucose, fructose, and galactose

Front 350

Medium-chain trigycerides (MCT) do not require the formation of micelles or bile salts because they are

1: fat-soluble.
2: 2-5 carbons in length.
3: water-soluble.
4: anti-inflammatory.

Back 350

3: water-soluble.

Front 351

Which water-soluble vitamins do not require Na+ co-transporters for absorption?

1: Vitamin C and Vitamin B6
2: Vitamin E and Vitamin D
3: Vitamin B12 and Folic acid
4: B1 and Choline

Back 351

3: Vitamin B12 and Folic acid

Front 352

Glucose and galactose gain access to enterocytes via

1: glucose-dependent insulinotropic polypeptide (GIP).
2: glucokinase.
3: enterokinase.
4: sodium-glucose transporter 1 (SGLT-1)

Back 352

4: sodium-glucose transporter 1 (SGLT-1)

Front 353

Which of the following is a practical biochemical test for assessing Vitamin A status?

1: Plasma carotenoid level
2: Serum retinol concentration
3: Plasma transthyretin-retinol binding protein (TTR-RBP) concentration
4: Serum retinol binding protein level

Back 353

2: Serum retinol concentration

Front 354

Potential metabolic causes for a respiratory quotient (RQ) greater than 1 include all of the following EXCEPT

1: overfeeding.
2: hypoventilation.
3: excess CO2 production.
4: provision of excess buffering agents (e.g., sodium bicarbonate).

Back 354

2: hypoventilation.

Front 355

Albumin has a half-life of approximately

1: 3 days.
2: 8 days.
3: 12 days.
4: 20 days.

Back 355

4: 20 days.

Front 356

Triglycerides that require bile acids to facilitate enzymatic digestion and absorption are typically

1: 3 carbons in length.
2: 6 carbons in length.
3: 9 carbons in length.
4: 12 carbons in length.

Back 356

4: 12 carbons in length.

Front 357

When determining nitrogen balance, urea accounts for what percentage of total urine nitrogen losses?

1: 50%
2: 60%
3: 70%
4: 80%

Back 357

4: 80%

Front 358

Measurement of which of the following reflects the functional status of the trace element selenium?

1: Plasma selenium level
2: Erythrocyte concentration
3: Plasma glutathione peroxidase
4: Methionine

Back 358

3: Plasma glutathione peroxidase

Front 359

A 50-year-old male weighs 80 kg. Calculate the estimated volume of his intravascular space.

1: 4 L
2: 8 L
3: 12 L
4: 16 L

Back 359

1: 4 L

Front 360

Underfeeding is associated with

1: poor wound healing.
2: hepatic steatosis.
3: azotemia.
4: hypertriglyceridemia.

Back 360

1: poor wound healing.

Front 361

In the body, glycogen is mainly found in

1: brain and liver.
2: skeletal muscle and kidneys.
3: small intestine and brain.
4: liver and skeletal muscle.

Back 361

4: liver and skeletal muscle.

Front 362

Glucose and galactose gain access to enterocytes via

1: glucose-dependent insulinotropic polypeptide (GIP).
2: glucokinase.
3: enterokinase.
4: sodium-glucose transporter 1 (SGLT-1)

Back 362

4: sodium-glucose transporter 1 (SGLT-1)

Front 363

Which of the following is a practical biochemical test for assessing Vitamin A status?

1: Plasma carotenoid level
2: Serum retinol concentration
3: Plasma transthyretin-retinol binding protein (TTR-RBP) concentration
4: Serum retinol binding protein level

Back 363

2: Serum retinol concentration

Front 364

Potential metabolic causes for a respiratory quotient (RQ) greater than 1 include all of the following EXCEPT

1: overfeeding.
2: hypoventilation.
3: excess CO2 production.
4: provision of excess buffering agents (e.g., sodium bicarbonate).

Back 364

2: hypoventilation.

Front 365

Albumin has a half-life of approximately

1: 3 days.
2: 8 days.
3: 12 days.
4: 20 days.

Back 365

4: 20 days.

Front 366

Triglycerides that require bile acids to facilitate enzymatic digestion and absorption are typically

1: 3 carbons in length.
2: 6 carbons in length.
3: 9 carbons in length.
4: 12 carbons in length.

Back 366

4: 12 carbons in length.

Front 367

When determining nitrogen balance, urea accounts for what percentage of total urine nitrogen losses?

1: 50%
2: 60%
3: 70%
4: 80%

Back 367

4: 80%

Front 368

Measurement of which of the following reflects the functional status of the trace element selenium?

1: Plasma selenium level
2: Erythrocyte concentration
3: Plasma glutathione peroxidase
4: Methionine

Back 368

3: Plasma glutathione peroxidase

Front 369

A 50-year-old male weighs 80 kg. Calculate the estimated volume of his intravascular space.

1: 4 L
2: 8 L
3: 12 L
4: 16 L

Back 369

1: 4 L

Front 370

Underfeeding is associated with

1: poor wound healing.
2: hepatic steatosis.
3: azotemia.
4: hypertriglyceridemia.

Back 370

1: poor wound healing.

Front 371

In the body, glycogen is mainly found in

1: brain and liver.
2: skeletal muscle and kidneys.
3: small intestine and brain.
4: liver and skeletal muscle.

Back 371

4: liver and skeletal muscle.

Front 372

Sorbitol-induced hypokalemia is caused by

1: inadequate dietary intake.
2: increased renal potassium loss.
3: excess potassium loss in the stool.
4: transcellular shift of potassium from the extracellular fluid into cells.

Back 372

3: excess potassium loss in the stool.

Front 373

Dietary fiber helps to regulate normal defecation by

1: increasing stool weight and bulk.
2: inhibiting the growth of colonic bacteria.
3: reducing incidence of constipation.
4: removing water from the colon.

Back 373

1: increasing stool weight and bulk.

Front 374

The majority of protein absorption takes place in the

1: small intestine.
2: stomach.
3: large intestine.
4: mouth.

Back 374

1: small intestine.

Front 375

A patient awaiting liver transplant has been taking a diuretic to control ascites and peripheral edema. Which of the following acid-base disorders is expected?

1: Metabolic acidosis
2: Metabolic alkalosis
3: Respiratory acidosis
4: Respiratory alkalosis

Back 375

2: Metabolic alkalosis

Front 376

Which of the following is a common effect of enteral fiber on the intestinal tract?

1: Faster transit throughout
2: Increased fecal bacteria concentrations
3: Improvement in constipation
4: Improvement in diarrhea

Back 376

4: Improvement in diarrhea

Front 377

All of the following methods to determine energy expenditure account for age EXCEPT

1: Harris-Benedict Equation.
2: Owen Equation.
3: Mifflin-St. Jeor Equation.
4: Swinamer Equation.

Back 377

2: Owen Equation.

Front 378

Which of the following vitamins requires formation of micelles for intestinal absorption?

1: A
2: B1
3: B12
4: C

Back 378

1: A

Front 379

Which of the following is an example of a short chain fatty acid?

1: Lauric acid
2: Stearic acid
3: Oleic acid
4: Butyric acid

Back 379

4: Butyric acid

Front 380

Glycogen stores can sustain normal activities in a healthy 70 kg man for approximately

1: 1 day.
2: 3 days.
3: 7 days.
4: 14 days.

Back 380

1: 1 day.

Front 381

In which part of the body are essential amino acids oxidized?

1: Muscle
2: Kidney
3: Small intestine
4: Liver

Back 381

4: Liver

Front 382

Presence of dietary fiber in the distal ileum contributes to

1: increased intestinal transit time.
2: delayed gastric emptying.
3: bacterial fermentation.
4: creation of short-chain fatty acids.

Back 382

2: delayed gastric emptying.

Front 383

The best method to administer psyllium soluble fiber via feeding tube is to

1: mix with formula in a gravity drip feeding bag.
2: avoid administering via feeding tube due to clogging risk.
3: mix with water and other medications and give by syringe followed by 10 mL water flush.
4: dilute in water and give by syringe followed by 10 mL water flush.

Back 383

4: dilute in water and give by syringe followed by 10 mL water flush.

Front 384

Which of the following is a common sign seen in a patient with Vitamin D toxicity?

1: Hypocalcemia
2: Metabolic bone disease
3: Soft tissue calcification
4: Hypohosphatemia

Back 384

3: Soft tissue calcification

Front 385

Which statement is true regarding effects of fiber-supplemented diets on altered bowel elimination?

1: Soluble fiber intake corrects constipation
2: Fiber-containing formulas will reduce diarrhea in tube fed patients
3: Wheat bran increases irritable bowel syndrome (IBS) symptoms of abdominal pain and bloating
4: High fiber diet increases incidence of involuntary stool leakage

Back 385

3: Wheat bran increases irritable bowel syndrome (IBS) symptoms of abdominal pain and bloating

Front 386

Oxidation of fatty acids for adenosine triphosphate (ATP) production occurs in

1: all cells that contain mitochondria.
2: the mitochondria of the adipocyte only.
3: the red blood cells only.
4: the blood stream.

Back 386

1: all cells that contain mitochondria.

Front 387

Indirect calorimetry (IC) calculates

1: total energy expenditure.
2: nitrogen balance.
3: heat released from the subject.
4: resting energy expenditure (REE) and respiratory quotient (RQ).

Back 387

4: resting energy expenditure (REE) and respiratory quotient (RQ).

Front 388

Mild hypercalcemia, defined as a total serum calcium of 10.3-12.9 mg/dL, should initially be treated with

1: sodium phosphate.
2: hydration.
3: hemodialysis.
4: bisphosphonates.

Back 388

2: hydration.

Front 389

Transformation of free long-chain fatty acids into acylcarnitines requires

1: carnitine.
2: choline.
3: arginine.
4: glutamine.

Back 389

1: carnitine.

Front 390

Phosphofructokinase, a rate-limiting enzyme of glycolysis, is inhibited when ATP is abundant. Why is this inhibition important?

1: Facilitates gluconeogenesis to maintain euglycemia
2: Allows the cell to divert glucose to be stored as glycogen
3: Promotes catabolism
4: Enhances the TCA cycle

Back 390

2: Allows the cell to divert glucose to be stored as glycogen

Front 391

The presence of which of the following facilitates the absorption of sodium in the lumen of the small intestine?

1: Glucose
2: Potassium
3: 1,25-dihydroxycholecalciferol
4: Protein

Back 391

1: Glucose

Front 392

Linoleic acid and α-linolenic acid are referred to as essential fatty acids in humans because

1: they are the only fatty acids that can be used for adenosine triphosphate (ATP) production.
2: they cannot be synthesized by humans and must be obtained through diet.
3: they are the only fatty acids absolutely required to sustain life.
4: they require L-carnitine to enter the mitochondria.

Back 392

2: they cannot be synthesized by humans and must be obtained through diet.

Front 393

Which of the following is a sign observed in PN patients with inadequate chromium replacement?

1: Weight gain
2: Hypoglycemia
3: Hyperglycemia
4: Rhabdomyolysis

Back 393

3: Hyperglycemia

Front 394

In response to illness and trauma, there is an increase in which of the following hormones?

1: Cortisol, epinephrine, growth hormone, and glucagon
2: Insulin, epinephrine, estrogen, and somatostatin
3: Glucagon, gastrin, insulin-like growth factor, and renin
4: Leptin, cortisol, growth hormone, and cholecystokinin

Back 394

1: Cortisol, epinephrine, growth hormone, and glucagon

Front 395

Consumption of soluble fiber contributes to

1: lower levels of high density lipoprotein cholesterol.
2: lower levels of total and low density lipoprotein cholesterol.
3: lower risk of developing colon cancer.
4: increase in blood glucose concentrations.

Back 395

2: lower levels of total and low density lipoprotein cholesterol

Front 396

The catabolic phase of the metabolic response to critical illness usually lasts

1: 1 day.
2: 3 days.
3: 5 days.
4: 7 days.

Back 396

4: 7 days.

Front 397

The accuracy of indirect calorimetry may be decreased by

1: mechanical ventilation with FiO2 ≥ 60.
2: holding routine nursing care or activities during the study.
3: measurements made in a quiet, thermoneutral environment.
4: keeping the rate and composition of nutrients being infused stable for 12 hours.

Back 397

1: mechanical ventilation with FiO2 ≥ 60.

Front 398

The acute phase response has what effect on serum iron and ferritin levels?

1: Increases serum iron levels and increases serum ferritin levels
2: Increases serum iron levels and decreases serum ferritin levels
3: Decreases serum iron levels and decreases serum ferritin levels
4: Decreases serum iron levels and increases serum ferritin levels

Back 398

4: Decreases serum iron levels and increases serum ferritin levels

Front 399

Intestinal bezoar is a rare but adverse effect of fiber administration via tube feeding formulas. A strategy to prevent this is to

1: administer fiber separately from formula.
2: use insoluble bulk-forming fiber.
3: provide adequate water flushes to maintain hydration.
4: infuse tube feeds continuously via enteral pump.

Back 399

3: provide adequate water flushes to maintain hydration.

Front 400

Loss of parietal cells, secondary to a gastectomy, may lead to a deficiency of

1: vitamin C.
2: vitamin B12.
3: vitamin E.
4: choline.

Back 400

2: vitamin B12.

Front 401

What effect does fiber have on gastro-intestinal transit time?

1: Dietary fiber in a solid or liquid meal results in delayed gastric emptying
2: The effects of fiber in the upper GI tract do not differ from the effects of fiber in the colon
3: Fiber in the distal ileum increases gastric emptying
4: Consumption of insoluble fiber increases gastric emptying

Back 401

1: Dietary fiber in a solid or liquid meal results in delayed gastric emptying

Front 402

The basic structure of a lipid consists of

1: a phospholipid backbone with 3 fatty acid molecules attached via ester linkage.
2: a fatty acid backbone with 3 glycerol molecules attached via ester linkage.
3: a cholesterol backbone with 3 fatty acid molecules attached via ester linkage.
4: a glycerol backbone with 3 fatty acid molecules attached via ester linkage.

Back 402

4: a glycerol backbone with 3 fatty acid molecules attached via ester linkage.

Front 403

Wilson's disease is characterized by the accumulation of which of the following in the liver?

1: Copper
2: Manganese
3: Selenium
4: Iron

Back 403

1: Copper

Front 404

Choline supplementation has been investigated as a treatment for which of the following disease states?

1: Myocardial infarction
2: Pancreatic insufficiency
3: Hepatic steatosis
4: Alcoholic encephalopathy

Back 404

3: Hepatic steatosis

Front 405

Which of the following is a possible complication of dietary fiber-containing enteral formulas?

1: Altered absorption of minerals
2: Bloating and flatulence
3: Increased effectiveness of some medications
4: Fluid retention

Back 405

2: Bloating and flatulence

Front 406

When administered in high amounts, arginine is considered therapeutic for

1: immune function and wound healing.
2: fuel for rapidly dividing cells.
3: increasing lean body mass.
4: improving hepatic steatosis.

Back 406

1: immune function and wound healing.

Front 407

During extended periods of fasting (starvation), the main source of energy is from

1: protein catabolism.
2: gluconeogenesis.
3: glycolysis.
4: ketogenesis.

Back 407

4: ketogenesis.

Front 408

Which of the following best describes enteral glutamine supplementation in the critically ill?

1: Enteral glutamine is preferred over parenteral glutamine
2: Supplementation of enteral glutamine to glutamine containing immune-modulating formulations improves morbidity and mortality statistics
3: Approximately 20-40 g glutamine/day should be administered to all critically ill patients
4: The addition of enteral glutamine to a non-glutamine enteral nutrition regimen has shown to reduce the length of stay in some ICU patients

Back 408

4: The addition of enteral glutamine to a non-glutamine enteral nutrition regimen has shown to reduce the length of stay in some ICU patients

Front 409

Which of the following metabolic complications is most likely to occur in patients with short bowel syndrome with small bowel bacterial overgrowth?

1: D-lactic acidosis
2: D-lactic alkalosis
3: Metabolic alkalosis
4: Respiratory acidosis

Back 409

1: D-lactic acidosis

Front 410

Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in which type of liver disease?

1: Hepatic steatosis
2: Well-compensated cirrhosis
3: Decompensated cirrhosis
4: Fulminant hepatic failure

Back 410

4: Fulminant hepatic failure

Front 411

Which of the following are counter-regulatory hormones responsible for the hypercatabolism observed in critically ill trauma patients?

1: Glycogen, insulin, norepinephrine
2: Glucagon, epinephrine, cortisol
3: Glycerol, serotonin, thymoglobulin
4: Glycerin, leptin, adenosine

Back 411

2: Glucagon, epinephrine, cortisol

Front 412

For a patient requiring nutrition support therapy, which of the following may be necessary for a patient with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT)?

1: Low potassium
2: Increased phosphorus
3: Low protein
4: Increased fluid

Back 412

4: Increased fluid

Front 413

Nutrition support for solid-organ transplant patients receiving cyclosporine may need to be modified due to the presence of

1: hyperkalemia.
2: hypoglycemia.
3: hypermagnesemia.
4: hypocholesterolemia.

Back 413

1: hyperkalemia.

Front 414

Zinc supplementation should be provided to patients with wounds

1: of any and all types.
2: who are suspected to have a zinc deficiency.
3: who are elderly.
4: who have below normal zinc levels.

Back 414

2: who are suspected to have a zinc deficiency.

Front 415

In patients with severe acute pancreatitis, the use of enteral nutrition via nasojejunal feeding tube rather than parenteral nutrition is associated with

1: an increased incidence of hyperglycemia.
2: a lower risk of developing septic complications.
3: a greater incidence of negative nitrogen balance.
4: a decreased frequency of pancreatic stimulation.

Back 415

2: a lower risk of developing septic complications.

Front 416

The nutritional needs of a patient with a bone marrow transplant without acute graft versus host disease are best met with

1: 20-25 kcal/kg daily with >= 1.5 g protein per kg body weight.
2: 20-25 kcal/kg daily with 80% of total calories from carbohydrate.
3: 30-35 kcal/kg daily with >= 1.5 g protein per kg body weight.
4: 30-35 kcal/kg daily with 80% of total calories from carbohydrate.

Back 416

3: 30-35 kcal/kg daily with >= 1.5 g protein per kg body weight

Front 417

In patients with cirrhosis, which of the following should be implemented to avoid starvation during the night?

1: Late evening snack
2: Tube feeding at night
3: Branched-chain amino acids
4: Parenteral nutrition at night

Back 417

1: Late evening snack

Front 418

Which of the following best describes the use of megestrol acetate in patients receiving radiation therapy?

1: Should only be used in cachectic patients
2: Promotes weight loss in patients receiving radiation therapy
3: Should not be used in patients receiving radiation therapy
4: Is used prophylactically for appetite stimulation and to promote weight gain

Back 418

4: Is used prophylactically for appetite stimulation and to promote weight gain

Front 419

Which of the following is a major contributing factor in the development of metabolic bone disease in patients with inflammatory bowel disease?

1: Corticosteroids
2: Aluminum toxicity
3: Blood transfusions
4: Oxalic acid deficiency

Back 419

1: Corticosteroids

Front 420

Patients with short bowel syndrome would benefit most from octreotide injections in the presence of

1: an intact colon.
2: short bowel secondary to mesenteric ischemia.
3: short bowel secondary to inflammatory bowel disease.
4: refractory diarrhea not controlled with standard antidiarrheal agents.

Back 420

4: refractory diarrhea not controlled with standard antidiarrheal agents.

Front 421

Increased mortality in maintenance hemodialysis (MHD) patients has been associated with

1: low baseline body fat percentage and fat loss.
2: elevated albumin and decreased C-reactive protein values.
3: increased body mass index.
4: decreased serum cholesterol.

Back 421

1: low baseline body fat percentage and fat loss.

Front 422

What are the protein requirements for a patient receiving peritoneal dialysis (PD)?

1: 0.6-0.8 grams per kilogram per day
2: 1.2-1.3 grams per kilogram per day
3: 1.5-1.8 grams per kilogram per day
4: 2.0-2.2 grams per kilogram per day

Back 422

2: 1.2-1.3 grams per kilogram per day

Front 423

Which of the following best describes the treatment of diarrhea in inflammatory bowel disease?

1: Cholestyramine is effective treatment for steatorrhea
2: Patients with diarrhea should be treated with prebiotics
3: Antidiarrheal agents can contribute to toxic megacolon
4: Pharmacological therapy is withheld until diarrhea exceeds 1 L/day

Back 423

3: Antidiarrheal agents can contribute to toxic megacolon

Front 424

In patients with liver disease a low protein restriction may be recommended for patients with which of the following conditions?

1: Acute hepatic encephalopathy until cause is diagnosed and eliminated
2: Chronic alcoholic liver disease with cirrhosis
3: Hepatocellular carcinoma preparing for hepatectomy
4: Primary sclerosing cholangitis awaiting transplantation

Back 424

1: Acute hepatic encephalopathy until cause is diagnosed and eliminated

Front 425

A 14-year-old girl with a 4-month history of intentional weight loss of 10% of her usual weight and a BMI less than the 5th percentile is diagnosed with anorexia nervosa. She is admitted to an eating disorder clinic and states she wants to gain weight but cannot consume the quantities of food she knows she needs. A 24-hour calorie count reveals the patient is consuming 850 kcal of mostly starchy foods and soft drinks. Which of the following is the most appropriate nutrition intervention at this time?

1: Peripheral parenteral nutrition
2: High calorie diet with a calorie count
3: Ad lib diet and nighttime tube feedings
4: Ad lib diet with 72 hour calorie count

Back 425

3: Ad lib diet and nighttime tube feedings

Front 426

Malnourished women with hyperemesis gravidarum who require specialized nutrition support are likely to require supplementation of

1: chloride.
2: thiamin.
3: vitamin E.
4: manganese.

Back 426

2: thiamin.

Front 427

Which of the following acute changes in serum chemistries would be expected in a patient who is experiencing tumor lysis syndrome?

1: Hypercalcemia and hypomagnesemia
2: Hyperkalemia and hyperphosphatemia
3: Hypernatremia and hypermagnesemia
4: Hypoalbuminemia and hyperphosphatemia

Back 427

2: Hyperkalemia and hyperphosphatemia

Front 428

Which of the following immunomodulating nutrients may be harmful in patients with severe sepsis?

1: Arginine
2: Glutamine
3: Nucleic acids
4: Omega-3 fatty acids

Back 428

1: Arginine

Front 429

Which of the following diets should be recommended to patients with a short bowel and part of their colon remaining?

1: High fat
2: High oxalate
3: High simple carbohydrate
4: High complex carbohydrate

Back 429

4: High complex carbohydrate

Front 430

A patient with acute renal failure who requires specialized nutrition support would most likely benefit from a solution containing which of the following?

1: Essential amino acids only
2: Essential amino acids with arginine only
3: Essential amino acids and nonessential amino acids
4: Essential amino acids and branched-chain amino acids

Back 430

3: Essential amino acids and nonessential amino acids

Front 431

Gastric hypersecretions following significant small bowel resection (especially the jejunum) can become problematic. Which of the following medications have shown to be the most successful in suppressing gastric hypersecretions?

1: Cholestyramine
2: Loperamide
3: Histamine2 receptor antagonists (H2-blockers)
4: Proton pump inhibitors (PPIs)

Back 431

4: Proton pump inhibitors (PPIs)

Front 432

Nephrolithiasis, caused by calcium oxalate stones, can occur in patients with short bowel syndrome (SBS) who

1: have no remaining colon.
2: do not maintain adequate hydration.
3: have no remaining ileum.
4: take < 500 mg calcium 2-3 times per day.

Back 432

2: do not maintain adequate hydration.

Front 433

What is the most appropriate feeding strategy for a morbidly obese trauma patient receiving mechanical ventilation?

1: High protein, hypocaloric feeding
2: High protein, hypercaloric feeding
3: Low protein, hypocaloric feeding
4: Low protein, hypercaloric feeding

Back 433

1: High protein, hypocaloric feeding

Front 434

Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for

1: hyperkalemia.
2: azotemia.
3: hypermagnesium.
4: hypoglycemia.

Back 434

2: azotemia.

Front 435

What is the recommended dietary protein intake in acutely ill patients receiving continuous renal replacement therapy (CRRT)?

1: 0.5-0.8 g/kg per day
2: 1.2-1.5 g/kg per day
3: 1.5-2 g/kg per day
4: 2.5-3 g/kg per day

Back 435

3: 1.5-2 g/kg per day

Front 436

Which of the following is the inpatient glycemic target for critically ill patients?

1: 80-110 mg/dL
2: 140-180 mg/dL
3: 180-210 mg/dL
4: 210-240 mg/dL

Back 436

2: 140-180 mg/dL

Front 437

Which of the following has NOT been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving enteral nutrition?

1: Refeeding syndrome
2: Tube feeding syndrome
3: Underfeeding
4: Overfeeding

Back 437

2: Tube feeding syndrome

Front 438

Which of the following best describes the use of enteral nutrition support in hyperemesis gravidarum (HEG)?

1: Postpyloric placement of feeding tubes requires radiation exposure, which is an unacceptable risk during pregnancy
2: Concentrated, hypertonic enteral formulas are indicated to maximize delivery of nutrients needed during pregnancy in a smaller volume
3: Successful use has been reported and a trial of enteral nutrition prior to initiation of parenteral nutrition is appropriate
4: Prospective, randomized clinical trials have demonstrated the superiority of enteral nutrition over parenteral nutrition in regard to infectious complications and successful delivery of goal protein and calories

Back 438

3: Successful use has been reported and a trial of enteral nutrition prior to initiation of parenteral nutrition is appropriate

Front 439

Which of the following types of fistulas will result in the greatest degree of nutritional loss?

1: Distal low output
2: Distal high output
3: Proximal low output
4: Proximal high output

Back 439

4: Proximal high output

Front 440

What is the glomerular filtration rate (GFR) of a patient with end-stage renal disease?

1: >90 mL/min/1.73 m2
2: 30-59 mL/min/1.73 m2
3: 15-29 mL/min/1.73 m2
4: <15 mL/min/1.73 m2

Back 440

4: <15 mL/min/1.73 m2

Front 441

A 51-year-old female who is 10 years post gastric bypass surgery for obesity presented with numbness and tingling in her distal lower extremities that had progressively worsened. She was on an oral multivitamin supplement. She was significantly anemic and neutropenic. Her vitamin B12 level was normal as were her serum iron, ferritin, and transferrin levels. What nutritional deficiency is the most likely cause of all of these symptoms?

1: Thiamin
2: Zinc
3: Folate
4: Copper

Back 441

4: Copper

Front 442

Supplementation with which of the following nutrients is routinely restricted during the early stages following hematopoietic stem cell transplantation?

1: Sodium
2: Folate
3: Iron
4: Vitamin B12

Back 442

3: Iron

Front 443

Under conditions of sepsis and stress, which of the following metabolic alterations are most likely to occur?

1: Increased glucose production and increased glucose uptake
2: Increased glucose production and decreased glucose uptake
3: Decreased glucose production and decreased glucose uptake
4: Decreased glucose production and increased glucose uptake

Back 443

2: Increased glucose production and decreased glucose uptake

Front 444

Human immunodeficiency virus (HIV) associated lipodystrophy syndrome is

1: visceral fat loss.
2: not observed in patients on highly active antiretroviral therapy (HAART).
3: observed in patients with a greater than 7 year history of HIV.
4: seen mostly in patients younger than 40 years old.

Back 444

3: observed in patients with a greater than 7 year history of HIV.

Front 445

The highest prevalence and severity of weight loss is found in patients with which of the following types of cancer?

1: Lung and colon
2: Breast and ovarian
3: Prostate and testicular
4: Pancreatic and gastric

Back 445

4: Pancreatic and gastric

Front 446

In patients with burns, providing caloric support above energy expenditure has been found to

1: decrease mortality.
2: improve wound healing.
3: decrease fat mass accumulation.
4: have no effect on lean body mass preservation.

Back 446

4: have no effect on lean body mass preservation.

Front 447

In pulmonary insufficiency, excessive calorie administration may cause increased blood pCO2 resulting in

1: metabolic acidosis.
2: metabolic alkalosis.
3: respiratory acidosis.
4: respiratory alkalosis.

Back 447

3: respiratory acidosis.

Front 448

Which of the following is an important indicator of protein-calorie malnutrition in chronic liver disease?

1: Jaundice
2: Muscle wasting
3: Elevated liver function tests
4: Hepatic encephalopathy

Back 448

2: Muscle wasting

Front 449

Which of the following best describes the use of semi-elemental formula without enzyme replacement or the use of standard formula with enzyme replacement in regards to optimal absorption of fat and nitrogen in a pancreatic insufficient patient with cystic fibrosis?

1: Both allow for similar absorption
2: Neither provides optimal absorption
3: Standard formula with enzyme replacement provides optimal absorption
4: Semi-elemental formula without enzyme replacement provides optimal absorption

Back 449

1: Both allow for similar absorption

Front 450

Protein-calorie malnutrition is most common in which of the following types of liver disease?

1: Viral hepatitis
2: Cirrhosis
3: Hepatic steatosis
4: Nonalcoholic steatohepatitis (NASH)

Back 450

2: Cirrhosis

Front 451

Which of the following is NOT a cause of malnutrition in a patient with liver disease?

1: Malabsorption
2: Decreased caloric intake
3: Abnormal fuel metabolism
4: Reduced energy expenditure

Back 451

4: Reduced energy expenditure

Front 452

A patient with Crohn's disease that involves the distal ileum should be closely monitored for malabsorption of

1: iron.
2: calcium.
3: vitamin B12.
4: folic acid.

Back 452

3: vitamin B12.

Front 453

Persistent hyperglycemia in patients with type 2 diabetes can result in the development of

1: cholestasis.
2: lipotoxicity.
3: hepatic steatosis.
4: macorcytic anemia.

Back 453

2: lipotoxicity.

Front 454

A patient with chronic heart failure on high-dose furosemide is started on enteral nutrition for an inability to consume adequate oral nutrition. Despite a slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected in the cause of his symptoms?

1: Thiamin
2: Vitamin B12
3: Folate
4: Riboflavin

Back 454

1: Thiamin

Front 455

Which of the following is NOT true of essential fatty acid deficiency (EFAD) in patients with cystic fibrosis?

1: Biochemical EFAD may be seen in both pancreatic sufficient and insufficient patients
2: Patients with cystic fibrosis should be routinely supplemented with docosahexaenoic acid (DHA) to prevent development of EFAD
3: Canola oil is a good source of linoleic and linolenic acids used to enterally treat EFAD
4: Those patients with moderate to severe lung disease are at high risk for EFAD

Back 455

2: Patients with cystic fibrosis should be routinely supplemented with docosahexaenoic acid (DHA) to prevent development of EFAD

Front 456

A patient with a percutaneous endoscopic gastrostomy (PEG) tube on home enteral nutrition (HEN) for 8 weeks calls a member of the home nutrition support team at 8 a.m. because the tube became dislodged at 6 a.m. Which of the following interventions is MOST appropriate?

1: Make arrangements to return patient to hospital that day for a tube replacement with radiologic confirmation
2: Make arrangements to return patient to hospital that day to have tube converted to an open surgical gastrostomy
3: Send a nurse to patient's home to replace the tube using dilators to open the tract so the replacement tube can easily be inserted
4: Send a nurse to patient's home to place a large bore nasogastric feeding tube

Back 456

1: Make arrangements to return patient to hospital that day for a tube replacement with radiologic confirmation

Front 457

Which of the following vascular access devices (VADs) should not be used for home parenteral nutrition (HPN)?

1: Hickman catheter
2: Peripherally-inserted central catheter (PICC)
3: Midline catheter
4: Implanted port

Back 457

3: Midline catheter

Front 458

Third-party payors (insurance companies) are LEAST likely to reimburse which of the following home enteral nutrition expenses?

1: Feeding bags and tubing
2: Enteral feeding pumps
3: Enteral formula
4: IV pole and/or syringes

Back 458

3: Enteral formula

Front 459

Which of the following is NOT a frequently reported concern of caregivers of patients receiving enteral tube feedings?

1: Guilt
2: Causing harm
3: Social embarrassment
4: Fatigue

Back 459

2: Causing harm

Front 460

Which of the following is the MOST practical approach for managing micronutrients in long-term parenteral nutrition (PN) patients?

1: Obtain serum values for all vitamins and trace elements yearly
2: Perform a micronutrient assessment every 6 months
3: Provide micronutrients only when laboratory values indicate abnormal levels
4: Do not use commercial preparations; provide each micronutrient individually

Back 460

2: Perform a micronutrient assessment every 6 months

Front 461

Which of the following is a non-profit organization identified as a resource for home nutrition patients and their caregivers?

1: American Dietetic Association
2: American Society for Parenteral and Enteral Nutrition
3: Oley Foundation
4: American Society for Clinical Nutrition

Back 461

3: Oley Foundation

Front 462

Initially, how often should electrolytes be monitored in a patient on home parenteral nutrition support?

1: Daily
2: Weekly
3: Monthly
4: Bi-monthly

Back 462

2: Weekly

Front 463

Prior to initiation of home parenteral nutrition (HPN), laboratory data should be obtained within

1: 24 hours.
2: 48 hours.
3: 72 hours.
4: 96 hours.

Back 463

2: 48 hours.

Front 464

Skin care around a feeding ostomy site should be accomplished by cleaning with

1: alcohol.
2: mild soap and water.
3: iodine-povidone.
4: hydrogen peroxide.

Back 464

2: mild soap and water.

Front 465

Patients receiving home parenteral nutrition (HPN) who belong to a support group are shown to experience which of the following?

1: Higher reactive depression
2: Lower quality of life (QOL)
3: Fewer hospital readmissions
4: Increased incidence of catheter-related sepsis

Back 465

3: Fewer hospital readmissions

Front 466

The use of 70% ethanol is most effective for clearing catheter occlusions due to

1: calcium-phosphate precipitation.
2: lipid residue.
3: tobramycin.
4: phenytoin.

Back 466

2: lipid residue.

Front 467

Which of the following enteral feeding schedules should be recommended to patients and their families when preparing for home enteral nutrition?

1: Schedule feedings outside of normal meal times
2: Schedule feedings during meal times
3: A schedule that allows for integration of feeding into the patient’s and family’s lifestyle
4: Feeding schedule that separated the patient during meal times to minimize the family’s discomfort with the process

Back 467

3: A schedule that allows for integration of feeding into the patient’s and family’s lifestyle

Front 468

When evaluating the home environment for a patient receiving parenteral nutrition, which of the following is required?

1: Access to telephone
2: Isolated infusion area
3: Back-up electrical generator
4: Dedicated refrigerator

Back 468

1: Access to telephone

Front 469

Which of the following data should be collected in the home care provider's performance improvement plan?

1: First-dose precautions
2: Discharge instructions
3: Hospital readmission
4: Consent for care

Back 469

3: Hospital readmission

Front 470

The clinical manifestations of copper deficiency can be similar to what other micronutrient deficiency?

1: Vitamin B12
2: Manganese
3: Vitamin E
4: Zinc

Back 470

1: Vitamin B12

Front 471

Which trace element deficiency is most likely to occur in long-term parenteral nutrition (PN)-dependent patients after 3 to 6 months of therapy?

1: Iron
2: Copper
3: Chromium
4: Manganese

Back 471

1: Iron

Front 472

The referral process to a home infusion company for parenteral and enteral therapy includes scheduling all of the following EXCEPT

1: formula delivery.
2: equipment delivery.
3: infusion nursing care.
4: physical therapy.

Back 472

4: physical therapy.

Front 473

Home-prepared or blenderized enteral nutrition (EN) formulations should be discarded after

1: 6 hours.
2: 12 hours.
3: 24 hours.
4: 48 hours.

Back 473

4: 48 hours.

Front 474

The lowest risk candidates for initiation of parenteral nutrition (PN) in the home setting would be

1: infants.
2: teenagers.
3: intravenous drug abusers.
4: diabetic patients.

Back 474

2: teenagers.

Front 475

Which of the following is true concerning aluminum contamination in long-term parenteral nutrition (PN)?

1: The amount on the manufacturer’s label is greater than measured amounts
2: Each PN bag must provide the amount of aluminum per liter
3: The clinical manifestations of aluminum toxicity are specific and sensitive
4: Aluminum toxicity is the primary etiology of parenteral nutrition-associated bone disease

Back 475

1: The amount on the manufacturer’s label is greater than measured amounts

Front 476

A patient on long-term home enteral nutrition suddenly develops nausea and vomiting. The most likely cause is

1: frequent use of sorbitol-containing medications.
2: gastric outlet obstruction.
3: low osmolarity formula.
4: sudden decrease in enteral feeding rate.

Back 476

2: gastric outlet obstruction.

Front 477

According to current Medicare guidelines, coverage for an enteral feeding pump can be justified under which of these circumstances?

1: The patient is being fed using a jejunal feeding tube
2: The patient states that bolus tube feedings interrupt his daily schedule; his preference is to infuse feedings during the night using a pump
3: The patient’s caregiver has difficulty preparing several bolus feedings each day
4: The patient has severe dysphagia and is at risk for aspiration

Back 477

1: The patient is being fed using a jejunal feeding tube

Front 478

Medicare reimbursement for home and community-based professional nutrition educational services provided by a registered dietitian is restricted to patients who

1: live alone.
2: have cancer.
3: are over the age of 65.
4: have diabetes or renal disease.

Back 478

4: have diabetes or renal disease.

Front 479

Which of the following is true regarding parenteral nutrition (PN)-associated metabolic bone disease?

1: Cyclic PN reduces the risk of developing metabolic bone disease
2: Excessive dietary protein may lead to a positive calcium balance
3: All patients on PN for longer than 1 year should be evaluated for metabolic bone disease
4: Adequate supplementation of calcium and phosphorus is achieved with PN

Back 479

3: All patients on PN for longer than 1 year should be evaluated for metabolic bone disease

Front 480

Medicare approved indications for home parenteral nutrition (HPN) include which of the following?

1: Supplement to enteral nutrition
2: End-stage renal disease (ESRD)
3: Long-term loss of gastrointestinal function
4: Lactose intolerance

Back 480

3: Long-term loss of gastrointestinal function

Front 481

Home infusion providers should have policies that address

1: reimbursement criteria for phone consultations.
2: availability of social workers to address psychosocial issues.
3: equipment repair services.
4: education, training, and evaluation of patient/caregiver competency.

Back 481

4: education, training, and evaluation of patient/caregiver competency.

Front 482

Which of the following is true concerning manganese and patients on long-term parenteral nutrition (PN)?

1: Manganese deficiency occurs in patients on PN for greater than 1 year
2: Hypermanganesemia has been reported only in patients with cholestasis
3: Manganese in commercial trace element preparations may result in hypermanganesemia
4: The best indicator of manganese status is serum manganese

Back 482

3: Manganese in commercial trace element preparations may result in hypermanganesemia

Front 483

Which of the following diagnoses would meet Medicare Part B coverage criteria to qualify a beneficiary for home enteral nutrition?

1: Dysphagia
2: Aspiration pneumonia
3: Anorexia
4: Malnutrition

Back 483

1: Dysphagia

Front 484

Managed care and private insurance companies often use which established criteria/guidelines when approving coverage for home parenteral nutrition?

1: Medicare criteria
2: State-funded Medicaid program criteria
3: Oley Foundation criteria
4: A.S.P.E.N. Standards for Specialized Nutrition Support: Home Care Patients

Back 484

1: Medicare criteria

Front 485

Patients/caregivers should receive discharge instructions regarding home enteral nutrition by qualified members of the healthcare team. The education should include which of the following?

1: The name of the formula, total daily volume to infuse, administration schedule, water flushes and calories the formula will provide
2: Standard precaution instruction, the name of the formula, total daily volume to infuse, administration schedule, water flushes, the discharging hospital's healthcare team member's phone number
3: Standard precaution instruction, the name of the formula, total daily volume to infuse, administration schedule, water flushes and calories and protein the formula will provide
4: The name of the formula, total daily volume to infuse, administration schedule, water flushes and proper storage of unused formula

Back 485

4: The name of the formula, total daily volume to infuse, administration schedule, water flushes and proper storage of unused formula

Front 486

According to Medicare (and Medicaid) guidelines, under the prosthetic device act, home enteral nutrition (HEN) is covered for a patient who

1: cannot meet his/her nutrition requirements by oral intake.
2: has documented weight loss of 10% in 3 months and refuses to eat.
3: has a permanent disease of the structures that normally permit food to reach the small bowel.
4: has a temporary (estimated as less than 3 months) impairment or disease of the mouth, esophagus or stomach that prevents food from reaching the small bowel.

Back 486

3: has a permanent disease of the structures that normally permit food to reach the small bowel.

Front 487

Patient education materials for home enteral and parenteral nutrition patients should be written at what grade level?

1: 6th
2: 9th
3: 10th
4: 12th

Back 487

1: 6th

Front 488

Following placement of a percutaneous endoscopic gastrostomy (PEG) tube, the patient should be taught how to observe for signs and symptoms of buried bumper syndrome including

1: redness or pain at tube site.
2: constipation.
3: leakage of enteral formula from tube site.
4: high gastric residuals.

Back 488

1: redness or pain at tube site.

Front 489

Upon acceptance by a home care provider for home nutrition support services, all patients shall undergo nutrition screening within

1: 24 hours.
2: 48 hours.
3: 72 hours.
4: 96 hours.

Back 489

3: 72 hours.

Front 490

Which of the following is the best way to determine chromium deficiency?

1: Serum chromium levels
2: Empiric treatment when deficiency is suspected
3: Urinary chromium levels
4: Serum glucose to insulin ratio

Back 490

2: Empiric treatment when deficiency is suspected

Front 491

Which of the following is true regarding the concept of qualilty of life in HPN patients?

1: Most patients believe that the HPN access catheter has little effect on their self-image or self-esteem
2: Patients with chronic bowel disease seem to cope less effectively than patients with acute gastrointestinal trauma
3: Social isolation is not an issue since most infusions are cycled over night
4: Adjusting to HPN is easier for patients who have stability in their employment

Back 491

4: Adjusting to HPN is easier for patients who have stability in their employment

Front 492

When transitioning a patient from hospital to home parenteral nutrition (HPN) support, screening criteria should include which of the following?

1: Adequate closet space for parenteral nutrition supplies
2: Presence of electricity and sanitary water supply in the home
3: Cellular telephone access
4: A caregiver

Back 492

2: Presence of electricity and sanitary water supply in the home

Front 493

Failure to monitor which micronutrient in long-term parenteral nutrition (PN) patients is most likely to result in toxicity?

1: Manganese
2: Zinc
3: Folate
4: Molybdenum

Back 493

1: Manganese

Front 494

Justification is unnessary, according to Medicare (and Medicaid) guidelines, for patients to receive coverage for home parenteral nutrition (HPN) who

1: have less than 10 feet of small bowel beyond the ligament of Treitz.
2: are unable to receive greater than 25% of nutrition requirements via enteral nutrition.
3: require between 25-35 calories per kilogram per day.
4: have gastrointestinal losses that exceed 25% of oral intake of 2-2.5 liters per day and urine output is less than 1 liter per day.

Back 494

3: require between 25-35 calories per kilogram per day.

Front 495

Following initial certification of parenteral nutrition by Medicare, after what length of time is recertification required?

1: 6 months
2: 1 year
3: 1 month
4: Never

Back 495

1: 6 months

Front 496

Which of the following is a key concept that should be included in the post-discharge teaching regimen for a home parenteral nutrition (HPN) patient?

1: Reimbursement requirements
2: Normal values for electrolytes
3: Signs and symptoms of hypo/hyperglycemia
4: Components of the parenteral nutrition (PN) formula

Back 496

3: Signs and symptoms of hypo/hyperglycemia

Front 497

Serum aminotransferase levels have steadily increased in the past 3 months in an adult patient with short bowel syndrome.The patient has been receiving a 12 hour cycle of 3-in-1 -home parenteral nutrition (HPN) solution. The clinician’s initial plan may include

1: removal of all trace elements from HPN.
2: increasing lipid calories to prevent essential fatty acid deficiency.
3: evaluation for possible overfeeding of dextrose and/or lipid.
4: addition of carnitine and choline to the HPN.

Back 497

3: evaluation for possible overfeeding of dextrose and/or lipid.

Front 498

Which of the following is the BEST way for a home nutrition support provider to know if a patient and/or caregiver understands enteral tube feeding delivery?

1: Verbal description of proper techniques
2: Written explanation of proper techniques
3: Appropriate responses to questions asked
4: Return demonstration of procedure techniques

Back 498

4: Return demonstration of procedure techniques

Front 499

The maximum time an open system enteral feeding formulation container should be used is

1: 6 hours.
2: 8 hours.
3: 10 hours.
4: 12 hours.

Back 499

4: 12 hours.

Front 500

A malnourished patient has been diagnosed with metastatic ovarian cancer and has been on parenteral nutrition in the hospital. She has been diagnosed with partial mechanical small bowel obstruction that is inoperable. She is taking small amounts of a full liquid diet by mouth, but is unable to take enough nutrition to maintain her weight. She has lost 12% of her body weight in the past 2 months. According to current Medicare guidelines, this patient’s home parenteral nutrition (HPN) will be covered under which of the following circumstances?

1: The physician must write an order for the patient to be nil per os or \"nothing by mouth\"
2: Medical record must include a radiology report documenting the presence of partial small bowel obstruction
3: Medical record must document failure of an enteral tube feeding trial, or explain why an enteral feeding tube is not an option
4: No further documentation is necessary to confirm coverage

Back 500

3: Medical record must document failure of an enteral tube feeding trial, or explain why an enteral feeding tube is not an option

Front 501

Which of the following is true concerning zinc status in long-term parenteral nutrition (PN) patients?

1: Serum zinc is a reliable indicator of zinc status
2: Parenteral doses of 50 mg/d have been proven safe
3: Parenteral zinc interferes with copper bioavailability
4: Zinc deficiency is the most commonly suspected trace element abnormality

Back 501

4: Zinc deficiency is the most commonly suspected trace element abnormality

Front 502

To meet the Medicare payor criteria for home parenteral nutrition, the attending physician must provide his/her best estimate that the patient's condition requires home parenteral nutrition for at least

1: 30 days.
2: 60 days.
3: 90 days.
4: 120 days.

Back 502

3: 90 days.