Deck 15: Enteral and Parenteral Nutrition Support

Question 1

Highly concentrated nutrient solutions are not suitable for peripheral parenteral nutrition.

Answer 1

True

Question 2

Enteral nutrition is preferred over parenteral nutrition because enteral nutrition is associated with fewer complications.

Answer 2

True

Question 3

Any drug-nutrient interaction that occurs between conventional foods and drugs can occur between formulas and drugs as well.

Answer 3

True

Question 4

Types of formulas that contain intact proteins are called:

A) disease-specific formulas.
B) hydrolyzed formulas .
C) standard formulas.
D) modular formulas.
E) monomeric formulas.

Question 5

What type of enteral formulas are made from whole foods and derive their protein primarily from pureed meat?

A) s tandard
B) h ydrolyzed
C) b lenderized
D) m odular
E) p olymeric

Question 6

When a patient receives enteral nutrition through tube feedings, they cannot eat food.

Question 7

Once the need for intravenous nutrition has resolved, the client should be immediately taken off of the solution and put onto an oral diet.

Question 8

The economic impact of home nutrition support is a concern for people on these programs.

Question 9

Many tube feeding complications can be prevented by selecting the formula and feeding route wisely, preparing the formula correctly, and delivering it appropriately.

Question 10

Enteral nutrition provides nutrients by using the:

A) lymphatic system.
B) digestive tract.
C) central veins.
D) peripheral veins.
E) urinary system.

Question 11

A drawback to using specialized or disease-specific formulas is that:

A) they are expensive.
B) patients do not tolerate them well.
C) they cause high gastric residuals.
D) they are not available for common chronic conditions.
E) they contain too much dextrose or sucrose.

Question 12

If a client tolerates a formula after it is initiated, the rate of a continuous feeding should be increased by about 30 milliliters per hour every 8 to 10 hours.

Question 13

Insertion of central catheters is less invasive and more easily performed than direct insertion of peripherally inserted catheters.

Question 14

A patient who is suffering from weakness and lethargy is using an oral supplement to take in extra nutrients. A disadvantage of using oral nutrition supplements is that:

A) they are only available in the hospital.
B) patients must consume large volumes to gain any benefits.
C) they are too high in sugar and fat.
D) taste becomes an important consideration.
E) they must be delivered through a feeding tube.

Question 15

Low-profile gastrostomy tubes are often preferred by active individuals for long-term home enteral nutrition programs.

Question 16

Fiber-containing formulas would most likely be used for what condition?

A) d iarrhea
B) c hronic kidney disease
C) c eliac disease
D) v itamin K deficiency
E) h emophilia

Question 17

A formula that approximates the osmolality of normal blood serum:

A) is called a hypertonic formula.
B) is referred to as an isotonic formula.
C) has an osmolality of approximately 500 milliosmoles per liter.
D) is usually a hydrolyzed formula.
E) often causes constipation with use.

Question 18

What describes an advantage of using a nasogastric tube to provide enteral tube feedings?

A) It is not easily removed if a patient is disoriented.
B) It has a low risk of aspiration.
C) It may allow enteral feedings even if an obstruction is present.
D) It is more comfortable when being inserted.
E) It is easy to insert and maintain.

Question 19

The energy density of most enteral formulas is between:

A) 0.5 and 0.9 kcalories per mL.
B) 1.0 and 2.0 kcalorie per mL.
C) 1.5 and 3.0 kcalories per mL.
D) 2.0 and 4.0 kcalories per mL.
E) 3.0 and 4.5 kcalories per mL.

Question 20

Which patient would most likely be a candidate for enteral tube feedings?

A) a patient with severe dysphagia
B) a  person suffering from intractable diarrhea
C) a  patient with gastrointestinal bleeding
D) a  person suffering from a paralytic ileus
E) a  patient who has undergone a bone marrow transplant

Question 21

A parenteral solution containing 500 mL of a 20% lipid emulsion would provide _____ kcalories from lipids.

A) 550
B) 1000
C) 1500
D) 1800
E) 2000

Question 22

What describes an advantage of using a closed system for delivering enteral feedings?

A) l ess likelihood of contamination
B) i ncreased nurse contact with the patient
C) r easonable cost and less expense
D) i ncreased patient tolerance
E) e nhanced flavor for the patient

Question 23

Phlebitis may develop as a result of:

A) tube feeding intolerance.
B) refeeding syndrome.
C) peripheral parenteral nutrition.
D) the use of hypertonic formulas.
E) elevated blood glucose levels.

Question 24

Compared to enteral nutrition, parenteral nutrition:

A) carries a greater risk of complications.
B) is less expensive.
C) can be used for longer periods of time.
D) requires hospitalization.
E) provides more nutrients.

Question 25

What action would best prevent bacterial contamination when providing an enteral tube feeding?

A) u sing fresh formula every 48 hours
B) s toring open or mixed formula in the refrigerator
C) a dding fresh formula to formula that has been hanging
D) c hanging the feeding container and tubing every 72 hours
E) h anging no more than a 24-hour supply of formula

Question 26

A "12 French" feeding tube has a diameter of:

A) 2 mm.
B) 4 mm.
C) 6 mm.
D) 8 mm.
E) 12 mm.

Question 27

What tube placement site would be the most appropriate for a client who is expected to be on a tube feeding for less than 4 weeks?

A) gastrostomy
B) jejunostomy
C) nasogastric
D) enterostomy
E) duodenostomy

Question 28

A parenteral solution that contains dextrose and amino acids but which requires lipids to be administered separately is called a(n):

A) standard formula.
B) modular formula.
C) 2-in-1 solution.
D) total nutrient admixture.
E) all-in-one solution.

Question 29

Which candidate would most likely benefit from peripheral parenteral nutrition?

A) a  patient who needs nutrition support for 2 to 4 weeks
B) a  person who has fluid restrictions
C) a  patient who does not have high nutrient needs
D) a  patient with a central line
E) a  person who has swallowing difficulties

Question 30

Delivering 250 to 500 milliliters of formula over 5 to 15 minutes is referred to as:

A) a bolus feeding.
B) a continuous drip feeding.
C) an intermittent feeding.
D) a slow drip feeding.
E) a closed tube feeding.

Question 31

In infants, _____ tube placement may be preferred because it doesn't interfere with breathing.

A) nasogastric
B) nasoduodenal
C) orogastric
D) nasojejunal
E) jejunostomy

Question 32

Which type of enteral formula usually has the highest osmolality?

A) s tandard formulas
B) m odular formulas
C) s pecialized formulas
D) e lemental formulas
E) hypertonic formulas

Question 33

The main source of energy in parenteral solutions is:

A) amino acids.
B) glucose.
C) lipid emulsions.
D) fluids and electrolytes.
E) vitamins.

Question 34

Before discontinuing a tube feeding, the patient's oral intake should meet about _____ of estimated nutrient needs.

A) 1/4
B) 1/3
C) 1/2
D) 2/3
E) 3/4

Question 35

Enteral formulas may be used orally to supplement a patient's diet. When this occurs, _____ becomes an important consideration.

A) taste
B) kcalorie content
C) osmolality
D) cost
E) glucose content

Question 36

Dextrose overfeeding or rapid infusion of lipid emulsions may result in :

A) hypernatremia.
B) hypertriglyceridemia.
C) hyperglycemia.
D) hyperkalemia.
E) hypercalcemia.

Question 37

The dextrose monohydrate used in parenteral nutrition solutions provides _____ kcal/g.

A) 0.9
B) 1.8
C) 2.5
D) 3.4
E) 4.2

Question 38

The outer diameter of a feeding tube is measured in:

A) millimeters.
B) French units.
C) milliliters.
D) English units.
E) centimeters.

Question 39

Even though water needs vary, a patient requires  about _____ mL of water per kg of body weight per day .

A) 5 to 10
B) 10 to 15
C) 25 to 30
D) 30 to 40
E) 50 to 60

Question 40

Which condition would most likely require nutrition delivered through TPN?

A) a  severe swallowing disorder
B) m echanical ventilation
C) a  neurological disorder
D) p aralytic ileus
E) i mpaired esophageal motility

Question 41

What action would most likely prevent refeeding syndrome in a malnourished patient? 

A) Avoid adding dextrose to the TPN infusion.
B) Do not allow the patient to eat.
C) Provide extra vitamin supplements.
D) Include stomach acid-reducing medications in the TPN solution.
E) Start the patient's feedings at a slow rate.

Question 42

Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center and resuscitated after being found unconscious in his car in a parking lot. His history was obtained by contacting his daughter. The patient presents with:
End-stage adenocarcinoma of the gastroesophageal juncture.
Chronic malnutrition and significant weight loss × 1 year. Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
Acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery. Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8". Admission Wt: 107 lbs. Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr. Edward is not being actively treated for cancer at his request. A peripheral line for hydration and nutrition support has been inserted.
The nutrition support team determines how much carbohydrate, protein, fat, vitamins, minerals, and fluid they will administer to Mr. Edward. What component of Mr. Edward's peripheral nutrition infusion will provide the greatest number of kcalories in the smallest volume of fluid?

A) 250 mL of a 30% lipid emulsion
B) 250 mL of a 10% dextrose solution
C) 250 mL of a 10% amino acid solution
D) 250 mL of a 10% lipid emulsion
E) 250 mL of a 20% lipid emulsion

Question 43

Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center and resuscitated after being found unconscious in his car in a parking lot. His history was obtained by contacting his daughter. The patient presents with:
End-stage adenocarcinoma of the gastroesophageal juncture.
Chronic malnutrition and significant weight loss × 1 year. Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
Acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery. Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8". Admission Wt: 107 lbs. Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr. Edward is not being actively treated for cancer at his request. A peripheral line for hydration and nutrition support has been inserted.
Because Mr. Edward is starting parenteral nutrition, what actions should the team take that would best prevent liver damage?

A) Increase energy amounts in the nutrition formulation.
B) Provide a supplemental lipid infusion.
C) Decrease the amount of lipid infusion.
D) Administer infusions over a period of 4 to 6 weeks.
E) Provide continuous infusions instead of intermittent infusions.

Question 44

Lifelong adherence to dietary restrictions is recommended for individuals with PKU in order to protect their:

A) lung function.
B) cognitive function.
C) muscular function.
D) kidney function.
E) cardiac function.

Question 45

Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center and resuscitated after being found unconscious in his car in a parking lot. His history was obtained by contacting his daughter. The patient presents with:
End-stage adenocarcinoma of the gastroesophageal juncture.
Chronic malnutrition and significant weight loss × 1 year. Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
Acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery. Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8". Admission Wt: 107 lbs. Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr. Edward is not being actively treated for cancer at his request. A peripheral line for hydration and nutrition support has been inserted.
Which type of feeding would be least likely to cause Mr. Edward any complications?

A) a  cyclic parenteral infusion
B) a  continuous parenteral infusion
C) a n oral feeding
D) t otal parenteral nutrition
E) c ontinuous enteral feedings

Question 46

Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center and resuscitated after being found unconscious in his car in a parking lot. His history was obtained by contacting his daughter. The patient presents with:
End-stage adenocarcinoma of the gastroesophageal juncture.
Chronic malnutrition and significant weight loss × 1 year. Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
Acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery. Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8". Admission Wt: 107 lbs. Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr. Edward is not being actively treated for cancer at his request. A peripheral line for hydration and nutrition support has been inserted.
Which parenteral infusion complication is Mr. Edward at risk of developing?

A) h ypoglycemia
B) r efeeding syndrome
C) h ypernatremia
D) h ypovolemia
E) m etabolic bone disease

Question 47

Dietary treatment of galactosemia depends primarily on the elimination of:

A) chicken and fish.
B) milk and milk products.
C) fruits and vegetables.
D) cereals and pasta.
E) peanuts and tree nuts.

Question 48

The appropriate method for administering TPN to an acutely ill and malnourished patient is as a:

A) continuous infusion.
B) bolus infusion.
C) cyclic infusion.
D) prn infusion.
E) gravity infusion.

Question 49

Mr. Avery is a 77-year-old retired engineer. He is 5'10" tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.
Mr. Avery is receiving continuous enteral tube feedings and has an order for oral phenytoin. Which method is most appropriate for administering the medication?

A) Stop the formula infusion for an hour before and after administering the drug.
B) Crush the drug and administer it with the enteral formula.
C) Administer the medication through the tube and flush with 100 mL of water afterward.
D) Have Mr. Avery take the medication by mouth.
E) Crush the medication and dissolve it in water to administer through the feeding tube.

Question 50

Rapid changes in infusion rates of a parenteral solution can cause:

A) fluctuations in blood glucose levels.
B) diarrhea.
C) obstructions.
D) infection.
E) a clogged IV tube.

Question 51

Mr. Avery is a 77-year-old retired engineer. He is 5'10" tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.
Mr. Avery's swallowing ability and oral intake are improving. He is now consuming about 2/3 of his estimated nutrient needs from oral intake. It would be appropriate at this time to:

A) discontinue the tube feeding.
B) increase the rate of the tube feeding.
C) decrease the rate of the parenteral feeding.
D) discontinue the parenteral feeding.
E) include a vitamin-mineral supplement with the tube feeding.

Question 52

Mr. Avery is a 77-year-old retired engineer. He is 5'10" tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.
After two weeks, Mr. Avery is moved to a rehab facility. It would be appropriate at this time to change his feeding method to:

A) total parenteral nutrition.
B) an intermittent feeding.
C) an oral supplement.
D) peripheral parenteral nutrition.
E) a clear liquid diet.

Question 53

Mr. Avery is a 77-year-old retired engineer. He is 5'10" tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.
Which form of nutrition support is appropriate for Mr. Avery at this time? 

A) continuous parenteral nutrition
B) tube feedings
C) oral enteral supplements
D) peripheral parenteral nutrition
E) cyclic parenteral nutrition

Question 54

Parenteral nutrition can be discontinued when _____ of estimated energy needs are being met by oral intake, tube feeding, or a combination of the two.

A) 35-50%
B) 25-35%
C) 35-75%
D) 60-75%
E) 80-90%

Question 55

Mr. Avery is a 77-year-old retired engineer. He is 5'10" tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.
Mr. Avery's feeding is being delivered continuously by an infusion pump. What best describes an advantage of using a continuous feeding?

A) It provides an accurate and steady flow rate.
B) It is similar to usual patterns of eating for the patient.
C) It provides less freedom of movement for the patient.
D) There is less risk of diarrhea.
E) It is a less expensive method.

Question 56

Long-term TPN administration may result in complications such as:

A) gallbladder disease.
B) heart disease.
C) diabetes.
D) bone cancer.
E) hearing loss.

Question 57

Infants diagnosed with galactosemia are given formulas that do not contain:

A) iron.
B) lactose.
C) tyrosine.
D) soy.
E) dextrose.

Question 58

Mr. Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center and resuscitated after being found unconscious in his car in a parking lot. His history was obtained by contacting his daughter. The patient presents with:
End-stage adenocarcinoma of the gastroesophageal juncture.
Chronic malnutrition and significant weight loss × 1 year. Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
Acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery. Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8". Admission Wt: 107 lbs. Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr. Edward is not being actively treated for cancer at his request. A peripheral line for hydration and nutrition support has been inserted.
Mr. Edward's blood glucose level rises to 350 mg/dL. What response from the health care team is most appropriate?

A) Nothing; this is acceptable for a patient receiving TPN.
B) Taper off his lipid infusion.
C) Stop his TPN infusion entirely.
D) Infuse insulin with his TPN.
E) Change the dextrose concentration from 5% to 10%.

Question 59

Mr. Avery is a 77-year-old retired engineer. He is 5'10" tall and weighs 171 pounds. He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.
In the absence of any pre-existing medical problems or problems with digestion and absorption, the type of enteral formula that would be most appropriate for Mr. Avery is a(n):

A) standard formula.
B) elemental formula.
C) specialized formula.
D) 3-in-1 solution.
E) low-fiber formula.

Question 60

Currently, the primary treatment for many inborn errors that involve nutrient metabolism is:

A) nutrition therapy.
B) gene therapy.
C) the use of dietary supplements.
D) genetic counseling.
E) surgery.

Question 62

Name and discuss five metabolic complications that may result from parenteral feedings.

Question 63

Differentiate between the characteristics and uses of standard formulas and hydrolyzed formulas.

Question 64

Describe characteristics of clients who are candidates for peripheral parenteral nutrition.

Question 65

Nursing Exam Review Multiple Choice Infusing medications along with an enteral formula increases the osmolality of the tube feeding and may cause a patient to experience:

A) diarrhea.
B) hyperglycemia.
C) high blood pressure.
D) constipation.
E) hyperlipidemia.

Question 66

What is refeeding syndrome and how can it be prevented?

Question 67

Nursing Exam Review Multiple Choice When administering an enteral feeding to a patient, the nurse understands that a hydrolyzed enteral formula contains:

A) only one nutrient source.
B) lactose .
C) partially or fully broken down nutrients.
D) intact proteins.
E) a combination of dextrose and sucrose.

Question 68

Identify specific conditions that necessitate the use of total parenteral nutrition (TPN) by central vein.

Question 69

Nursing Exam Review Multiple Choice The nurse in the neonatal intensive care unit understands that the preferred feeding tube placement for an infant is orogastric because:

A) it allows the infant to learn the suck-swallow reflex.
B) it provides the infant with a more direct route for feeding.
C) it allows the infant to breathe more normally during feeding.
D) it decreases the chance of overfeeding the infant.
E) it prevents the infant from losing weight.

Question 70

Nursing Exam Review Multiple Choice Which person would be the most appropriate candidate when considering home nutrition support?

A) a  patient with a severe swallowing disorder
B) a  person with delayed cognitive functioning
C) a  patient who requires a mechanical ventilator
D) a  person with a severe head injury
E) a  patient who has hearing loss

Question 71

Nursing Exam Review Multiple Choice The nurse is working with a patient who requires a tube feeding but who would like to return to work and resume other activities. What is the best way to feed this patient?

A) u sing a nasojejunal tube
B) p roviding continuous feedings
C) u sing a nasogastric tube
D) low-profile gastrostomy
E) c hanging from tube feedings to parenteral feedings