Deck 21: Parenteral Nutrition Support

Question 1

Veins that are small in diameter and carry blood from the arms and legs are the

A)central veins.
B)hepatic veins.
C)peripheral veins.
D)portal veins.

Answer 1

C

Question 2

What is usually the main source of energy provided by parenteral nutrition?

A)Carbohydrate
B)Protein
C)Fat
D)Amino acids

Answer 2

A

Question 3

Daily fluid needs in young adults are approximately _____ per kg body weight versus approximately _____ per kg body weight in older adults.

A)25-30 mL, 30-40 mL
B)30-40 mL, 40-50 mL
C)30-40 mL, 25-30 mL
D)40-50 mL, 30-40 mL

Answer 3

C

Question 4

A 20% IV fat emulsion provides how many kcalories per mL?

A)1.0
B)1.1
C)2.0
D)2.1

Question 5

A client receiving greater than 2000 kcalories per day via parenteral nutrition should

A)have it administered via peripheral vein.
B)receive dextrose and amino acids only.
C)have it administered in bolus form.
D)be given nutrition by the central venous route.

Question 6

Which of the following forms of glucose is available in parenteral solutions?

A)Dextrose
B)Fructose
C)Lactose
D)Glucose

Question 7

Caution should be taken when administering parenteral lipids to people with which condition?

A)Hypertriglyceridemia
B)Hyperglycemia
C)Diabetes
D)Kidney failure

Question 8

The protein in a TPN solution is primarily in the form of

A)amino acids.
B)protein hydrolysate.
C)short-chain fatty acids.
D)intact protein.

Question 9

How much energy does glucose provide?

A)3 kcal/g
B)4 kcal/g
C)5 kcal/g
D)6 kcal/g

Question 10

For which of the following conditions are disease-specific amino acid solutions commercially available?

A)Hyperglycemia
B)Congestive heart failure
C)Kidney failure
D)Crohn's disease

Question 11

Which of the following trace minerals is not usually added to parenteral solutions?

A)Zinc
B)Nickel
C)Chromium
D)Selenium

Question 12

How much energy does dextrose provide?

A)3.4 kcal/g
B)4.0 kcal/g
C)4.4 kcal/g
D)5.0 kcal/g

Question 13

A physician writes an order for Mrs.Wilson to receive parenteral lipids twice a week.The purpose of this order is to

A)provide essential fatty acids.
B)provide nonessential amino acids.
C)provide excessive energy.
D)suppress the immune response.

Question 14

Judy Smith is a 36 year old who just had a bowel resection.She is expected to be NPO for approximately seven days.Which of the following would be appropriate nutrition support?

A)Peripheral parenteral nutrition
B)Total parenteral nutrition
C)Simple IV solutions with amino acids
D)Enteral feeding via nasogastric tube

Question 15

Which of these conditions is least likely to require TPN by central vein?

A)GI tract obstructions
B)Severe pancreatitis with intractable vomiting
C)Bone marrow transplants
D)Chronic kidney disease

Question 16

Delivery of nutrient solutions directly into the vein is called

A)standard nutrition.
B)enteral nutrition.
C)parenteral nutrition.
D)tube feeding.

Question 17

Which of the following nutrients is not found in parenteral solutions?

A)Vitamins and minerals
B)Amino acids
C)Fat
D)Fiber

Question 18

When lipids are administered parenterally on a daily basis, what is the main objective?

A)Increase the use of dextrose for energy
B)Promote the immune response
C)Provide a concentrated energy source
D)Avoid hypoglycemia

Question 19

Which trace mineral is excluded from parenteral solutions because it alters the stability of the other ingredients in the solution?

A)Zinc
B)Copper
C)Iron
D)Selenium

Question 20

The large-diameter central veins are located near the

A)extremities.
B)heart.
C)liver.
D)lungs.

Question 21

To ensure a patient who is receiving TPN is adapting to the solution, health care professionals monitor

A)electrolyte balance.
B)blood glucose concentration.
C)arterial blood gases.
D)a and b
E)a, b, and c

Question 22

Which of the following does not need to be monitored daily for a client receiving TPN?

A)Weight changes
B)Fluid intake and output records
C)Liver enzymes
D)Serum glucose

Question 23

Which statement is false?

A)To "piggyback" means to administer a second solution through a second catheter.
B)Few medications are added to parenteral solutions so that potential drug-nutrient interactions can be avoided.
C)Two separate ports may be attached to a single catheter using a Y-connector.
D)Heparin may be added to TPN by piggyback to prevent clotting at the catheter tip.

Question 24

Suppose a person is receiving 2000 milliliters of a 10% amino acid solution.What is the amount of amino acids provided?

A)100 grams
B)150 grams
C)200 grams
D)250 grams

Question 25

How many kcalories are provided by 3 liters of a 5% dextrose solution?.

A)150.
B)510
C)600
D)660

Question 26

Which of the following measurements should be taken daily for a client receiving TPN?

A)Weight
B)Serum calcium
C)Serum ammonia
D)CBC

Question 27

A person on cyclic parenteral nutrition receives an infusion at a constant rate for

A)3 to 6 hours per day.
B)6 to 8 hours per day.
C)8 to 16 hours per day.
D)12 to 18 hours per day.

Question 28

Which type of parenteral nutrition is provided at night so patients can participate in routine activities during the day?

A)Continuous parenteral nutrition
B)Cyclic parenteral nutrition
C)Peripheral parenteral nutrition
D)Piggyback parenteral nutrition

Question 29

To prevent bacterial contamination and maintain stability, parenteral solutions are:

A)warmed to room temperature prior to infusion.
B)exposed to light.
C)pasteurized.
D)compounded in the pharmacy under aseptic conditions.

Question 30

The health care team has just ordered Mr.Carter to begin TPN.He is a 58-year-old man who is suffering from intractable diarrhea.Before Mr.Carter starts TPN, what procedure should be performed?

A)X-ray to confirm catheter placement
B)Body mass index assessment
C)Calcium balance
D)Hand grip strength

Question 31

Which of the following is a possible catheter-related complication in parenteral nutrition?

A)Phlebitis
B)Hypertriglyceridemia
C)Air embolism
D)a and c

Question 32

A(n) _____ is made up of physicians, nurses, dietitians, and pharmacists.

A)food service department
B)nutrition support team
C)eating disorder treatment team
D)physical rehabilitation team

Question 33

The benefits of cyclic infusion of TPN include

A)maintenance of high insulin levels.
B)increase in fat stores.
C)flexibility in the daily scheduling of activities.
D)achievement of a negative nitrogen balance.

Question 34

How much dextrose would a person receive from 2000 milliliters of 50% dextrose?

A)750 grams
B)1000 grams
C)1250 grams
D)None of the above

Question 35

If a TPN solution contains 80 grams of amino acids per 1 L solution, what is the contribution of these amino acids to the osmolarity of the TPN?

A)100 mOsm/L
B)200 mOsm/L
C)400 mOsm/L
D)800 mOsm/L

Question 36

How many grams of amino acids would be provided to a client receiving 2,000 mL of a 5% amino acid solution?

A)50 grams
B)100 grams
C)200 grams
D)400 grams

Question 37

The health care team has just ordered Mr.Carter to begin TPN.He is a 58-year-old man who is suffering from intractable diarrhea.On a weekly basis, the health care team should perform what part of the nutrition care process?

A)Diagnose nutrition problems
B)Develop a health care plan
C)Assess nutrition status
D)Implement the nutrition care plan

Question 38

Which of the following would be the best method of delivery of long-term TPN to a 14 year old?

A)Cyclic infusion
B)PPN
C)Continuous TPN with lipids daily
D)Continuous TPN with lipids five times a week

Question 39

Which vitamin is omitted from parenteral solutions designed for patients on warfarin therapy?

A)Vitamin C
B)Vitamin D
C)Vitamin E
D)Vitamin K

Question 40

The health care team has just ordered Mr.Carter to begin TPN.He is a 58-year-old man who is suffering from intractable diarrhea.Which of the following should be monitored daily while Mr.Carter is on TPN?

A)Nutrition status
B)Fluid intake/output
C)Serum albumin
D)All of the above

Question 41

Maria is a home health dietitian.She is evaluating a new TPN patient.She expects that the patient will want to change his regimen to:

A)continuous infusion.
B)cyclic infusion.
C)NPO.
D)bolus infusion.

Question 42

Which of the following is checked daily until the patient is stabilized in order to determine tolerance to parenteral feedings?

A)Blood glucose
B)Electrolyte levels
C)Vitamin levels
D)a and b
E)b and c

Question 43

Mrs.Jackson is admitted to the hospital with a diagnosis of severe pancreatitis due to hypertriglyceridemia.Which macronutrient(s) in her TPN may need to be restricted?

A)Lipids
B)Carbohydrates
C)Amino acids
D)a and b

Question 44

Which of the following factors should be considered when planning home parenteral nutrition?

A)Refrigeration space
B)Back-up batteries
C)Catheter care
D)All of the above

Question 45

When a person is brought into the emergency room from a nursing home where she was found unresponsive in her room, and CPR is not administered, this is because the physicians are following the _____ in the patient's medical record.

A)do-not-resuscitate order
B)advance directive
C)durable power of attorney
D)living will

Question 46

What is the specific term for a written statement that specifies the medical procedures desired or not desired in the event that a person is unable to communicate or is incapacitated?

A)Do-not-resuscitate order
B)Advance directive
C)Durable power of attorney
D)Living will

Question 47

Greg Thomas is a 12 year old who is being weaned off of TPN.In addition to TPN, Greg is on a soft diet.Greg is 5'2" and weighs 110 lbs.His energy needs are estimated to be approximately 2100 kcal/day.His calorie count reveals he is consuming 1700 kcal/day.Which intervention is appropriate at this time?

A)Discontinue TPN.
B)Oral feeding should be doubled.
C)Enteral feeding should be considered.
D)TPN should be increased to provide an additional 1100 kcal.

Question 48

Which of the following clients would not be a candidate for a home cyclic TPN program?

A)An 86 year old with congestive heart failure
B)A 36 year old with Crohn's disease
C)A 52 year old with intestinal cancer
D)An 18 year old with radiation enteritis

Question 49

All of the following may occur when long-term TPN is discontinued and oral feedings are gradually reintroduced except

A)diarrhea.
B)suppression of appetite for several weeks.
C)bloating.
D)a reduction in albumin levels.

Question 50

What is the maximum blood glucose level that is considered acceptable for most patients receiving parenteral nutrition?

A)100 mg/dL
B)150 mg/dL
C)200 mg/dL
D)250 mg/dL

Question 51

Kristin Sullivan is on long-term parenteral nutrition.This place her at risk for:

A)type 1 diabetes.
B)osteoporosis.
C)liver cancer.
D)heart disease.

Question 52

What is the general term for a written or oral instruction regarding one's preferences for medical treatment to be used in the event that one becomes incapacitated?

A)Do-not-resuscitate order
B)Advance directive
C)Durable power of attorney
D)Living will

Question 53

If a person's or family's religious beliefs are not in accord with medical recommendations, health care providers are expected to:

A)consult the facility administrator.
B)lecture the family on what the best medical decision would be.
C)consider the family's viewpoint and try to resolve the issue in some way.
D)seek legal advice.

Question 54

Mr.Ming has been on home nutrition support for two months.He has become more withdrawn and depressed due to:

A)his inability to enjoy meals.
B)lack of sleep.
C)an increase in bathroom visits.
D)all of the above

Question 55

Mrs.Harper has been tolerating her tube feeding and is being discharged to her home this afternoon.The insurance company requests the dietitian to:

A)change the tube feeding method to continuous.
B)change the tube feeding product.
C)change the tube feeding method to bolus.
D)a and b
E)b and c

Question 56

For which of the following would home TPN be an appropriate means for maintaining adequate nutrition status?

A)Individuals with dysphagia
B)Individuals with intestinal obstructions.
C)Individuals with head and neck cancers
D)Individuals with neurological impairments affecting the esophagus

Question 57

Before parenteral nutrition is discontinued, oral intake, tube feeding, or a combination should provide at least what proportion of the estimated energy needs?

A)55%
B)60%
C)67%
D)82%

Question 58

Max, a 67-year-old homeless man with a history of alcoholism, is admitted with frostbite and severe malnutrition.What lab values should be monitored when his TPN is started to avoid the development of refeeding syndrome?

A)Folate, vitamin B₆, and vitamin B₁₂
B)Sodium, iron, and zinc
C)Calcium, vitamin D, and vitamin K
D)Phosphate, potassium, and magnesium

Question 59

In order to prevent the development of hyperglycemia, what is the recommended maximum amount of carbohydrate in a TPN solution that should be provided daily?

A)4 mg/kg body weight/minute
B)5 mg/kg body weight/minute
C)6 mg/kg body weight/minute
D)7 mg/kg body weight/minute

Question 60

A patient on TPN for longer than _____ is at risk for "sludge" buildup in the gallbladder and gall stone formation.

A)2 weeks
B)3 weeks
C)4 weeks
D)5 weeks

Question 61

Marc will need intestinal surgery and will be NPO for 10-14 days.How can his medical team meet his nutritional needs?

A)Regular diet
B)Elemental formula
C)PPN
D)PICC

Question 62

Which statement is true?

A)If a person has signed an organ donor card, his physician can remove his organs for donation even if his family members refuse to give their consent.
B)To avoid a conflict of interest, the care of organ donors and organ recipients is always performed by separate physicians.
C)If an individual is near death and has agreed to be an organ donor, her physician can initiate treatments that may cause harm to her in order to preserve the organs.
D)Physicians cannot alert the organ procurement team about available organs until the donor has shown no vital signs for at least 10 minutes.

Question 63

What should the nutritional support team do to ensure that Marc can consume enough food orally to meet his energy needs?

A)Send double portions
B)Discontinue the tube feeding
C)Discontinue the TPN
D)Switch to nocturnal feedings
Julia Reynolds is a 64-year-old realtor.She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis.Julia has been experiencing intractable vomiting and intense pain after eating.Her insurance will not cover home nutritional support.She is being transferred to a sub-acute nursing facility for therapy.

Question 64

The nutrition support team decides to increase the kcal in Ms.Reynolds's TPN _____ to prevent _____.

A)slowly, hypoglycemia
B)quickly, hypoglycemia
C)slowly, refeeding syndrome
D)quickly, refeeding syndrome

Question 65

Marc's nausea and vomiting continued after he was admitted.Nasogastric decompression has been started.Which diet should be recommended to completely meet his nutritional needs?

A)Clear liquid
B)Elemental formula
C)Low fiber
D)TPN

Question 66

Case Studies
Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet.His physician admits Marc to the medical-surgical unit for evaluation.At his doctor's appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.
Upon admission, what diet should the doctor prescribe for Marc?

A)NPO
B)Clear liquid
C)Low fiber
D)High protein/high kcalorie

Question 67

Laboratory values indicate that Julia's blood glucose is extremely high.Which nutrient component of her TPN must be adjusted?

A)Water
B)Dextrose
C)Amino acids
D)Chromium

Question 68

After surgery, Marc remains on ventilator support but his gut function is improving.The doctor should initiate:

A)a soft diet.
B)a clear liquid diet.
C)an elemental tube feeding.
D)PPN.

Question 69

After 6 weeks of intense nutrition support, her liver enzymes are elevated.The dietitian recommends:

A)a low-fat diet.
B)elemental tube feedings.
C)cyclic TPN.
D)continuous TPN.