Deck 5: Enteral and Parenteral Nutrition Support

Question 1

Which patient is most likely at the risk of refeeding syndrome?

A) a patient recovering from outpatient surgery
B) a patient with gastroesophageal reflux
C) a patient with hypermagnesemia
D) a patient with osteoporosis
E) a patient with a history of long-term inadequate oral intake

Answer 1

E

Question 2

The protein component of most enteral formulas comes from:

A) lactose
B) monosaccharides
C) dextrin and fatty acids
D) albumin and whey
E) soy or casein

Answer 2

E

Question 3

The thickness of a liquid is known as its:

A) osmolality
B) viscosity
C) nutrient density
D) osmolarity
E) coagulation

Answer 3

B

Question 4

A nutritionally unstable patient who is receiving enteral feedings should have fluid status assessed at least:

A) every day
B) three times per week
C) every week
D) every 1-2 weeks
E) PRN

Question 5

To which of the following blood vessels are the central catheters inserted?

A) cephalic vein
B) subclavian vein
C) lumbar vein
D) gonadal vein
E) iliac vein

Question 6

Which example is not considered to be a contraindication to enteral feeding?

A) diffuse peritonitis
B) intestinal obstruction
C) GI bleeding
D) impaired swallowing
E) intractable vomiting

Question 7

The means of prescribing a very small rate of enteral nutrition with the goal to minimize villous atrophy is known as:

A) parenteral nutrition
B) bolus feedings
C) refeeding
D) intermittent feeding
E) trophic nutrition

Question 8

The first step in determining the enteral nutrition prescription is to:

A) consider electrolyte needs
B) establish a dosing weight
C) determine fluid needs
D) determine a kcal goal
E) consider vitamin and mineral needs

Question 9

Which of the following actions is appropriate to prevent a clogged feeding tube?

A) instill heparin into the tubing
B) slow the feeding to run at ½ the normal rate for one hour a day
C) use a small volume syringe and add air into the tube
D) flush the tube with 25 mL of tap water several times a day
E) reinsert the stylet that was used during tube placement

Question 10

Which best describes an advantage of a percutaneous endoscopic gastrostomy (PEG) tube?

A) The tube can be inserted at the bedside.
B) The tube is used for short-term feedings.
C) It allows for bolus feedings.
D) There is little risk of infection.
E) The tube can be used for IV fluids.

Question 11

Which is a true statement about continuous enteral feedings?

A) They are administered daily for 30 minutes.
B) They may be administered by gravity from a container suspended above the patient.
C) They consist of the administration of approximately 250 mL of formula at a time
D) They are usually more time consuming for staff to administer.
E) They require a pump and other equipment to administer.

Question 12

A registered dietitian is assisting with the placement of a nasogastric tube in a patient. The patient has just received a dose of metoclopramide (Reglan). What is the next appropriate step in the process?

A) insert the tube in the patient's nose and advance the tube
B) obtain an abdominal radiograph
C) remove the stylet from the tube
D) measure for gastric placement
E) tape the tube to the patient's nose

Question 13

The usual nutrient density of enteral formulas ranges between:

A) 0.5 and 1.0 kcal/mL
B) 1.0 and 2.0 kcal/mL
C) 2.0 and 2.5 kcal/mL
D) 3.0 and 3.5 kcal/mL
E) 4.0 and 5.5 kcal/mL

Question 14

Which of the following medical conditions will require a lower range of protein intake?

A) trauma
B) burns
C) sepsis
D) bone marrow transplant
E) acute kidney injury

Question 15

Which patient is at the highest risk of aspiration when receiving an enteral feeding?

A) a patient with Crohn's disease
B) a pregnant patient
C) a patient with an endotracheal tube
D) a patient with celiac disease
E) a patient with a concurrent diagnosis of cancer

Question 16

In which clinical condition would parenteral nutrition most likely be indicated?

A) short bowel syndrome
B) increased oral fluid intake
C) hyperkalemia
D) severe dysphagia
E) cardiovascular disease

Question 17

Which of the following nursing interventions is appropriate to reduce the risk of aspiration during enteral feedings?

A) instill a blue dye into the feeding
B) check the level of lung aspirate daily
C) elevate the head of the patient at an angle ≥30 degrees
D) continue the feeding at a faster rate
E) increase fiber to 8 g in each supplement

Question 18

Which is an advantage of a research-supported use of enteral nutrition support?

A) decreased risk of respiratory infections
B) improved wound healing
C) increased tolerance of formulas
D) complete nutritional coverage
E) ease of administration

Question 19

Identify a true statement regarding peripheral parenteral nutrition (PPN).

A) PPN involves the administration of concentrated fluids.
B) PPN involves the administration of small volumes of nutrients.
C) PPN is typically most acceptable for a fluid-restricted patient.
D) The high osmolality of PPN may cause small veins to collapse.
E) Peripheral access for PPN is easier to maintain than a central line.

Question 20

The number of water-attracting particles per kilogram of water is called:

A) osmolality
B) viscosity
C) osmolarity
D) nutrient density
E) coagulation

Question 21

An 80-year-old male patient has end-stage Alzheimer's and has recently been diagnosed with severe dysphagia. This patient is getting discharged from hospital. His height is 5' 9" and he weighs 162 pounds with no recent changes in weight.
Calculate the approximate daily fluid requirements of this patient.

A) 1000 mL
B) 1800 mL
C) 2200 mL
D) 3100 mL
E) 3400 mL

Question 22

An 80-year-old male patient has end-stage Alzheimer's and has recently been diagnosed with severe dysphagia. This patient is getting discharged from hospital. His height is 5' 9" and he weighs 162 pounds with no recent changes in weight.
Which method of providing enteral nutrition would be most appropriate for this patient?

A) orogastric tube
B) nasointestinal feeding tube
C) jejunostomy
D) surgical gastrostomy
E) nasogastric tube

Question 23

Which medical condition is an example of a gastrointestinal complication that may develop with parenteral feedings?

A) irritable bowel syndrome
B) cholestasis
C) dumping syndrome
D) nausea
E) gastroesophageal reflux

Question 24

A three-in-one solution of parenteral nutrition prepared by an automated compounder contains:

A) fatty acids, iron, and monosaccharides
B) dextrose, amino acids, and lipids
C) omega-3 fatty acids, triglycerides, and commercial amino acids
D) oligosaccharides, leucine, and valine
E) nonessential amino acids, dextrose, and vitamins

Question 25

The minimum amount of carbohydrate intake parenteral nutrition as specified by the DRI is:

A) 60 g/day
B) 130 g/day
C) 200 g/day
D) 240 g/day
E) 300 g/day

Question 26

Which element is not added routinely to standard parenteral nutrition formulas?

A) selenium
B) zinc
C) iron
D) chromium
E) copper

Question 27

A lipid-based drug that is often administered to a critically ill patient is:

A) hydrosol
B) hepatosol
C) propofol
D) amines
E) clinisol

Question 28

Which situation must be considered when deciding to start parenteral nutrition?

A) the length of time the patient will require nutrition support
B) the patient's social involvement
C) the patient's sleep routine
D) the physician's ability to obtain an order
E) the need for an automated compounder

Question 29

In the United States, the primary source of carbohydrate in parenteral nutrition is:

A) modified food starch
B) maltose oligosaccharides
C) dextrose monohydrate
D) arginine polyesters
E) high fructose corn syrup

Question 30

Which type of medication would most likely be added to parenteral nutrition solution for patient care?

A) acetaminophen
B) keterolac
C) fentanyl
D) cimetidine
E) demerol

Question 31

An 80-year-old male patient has end-stage Alzheimer's and has recently been diagnosed with severe dysphagia. This patient is getting discharged from hospital. His height is 5' 9" and he weighs 162 pounds with no recent changes in weight.
Which situation would require that the patient change from enteral nutrition to parenteral nutrition?

A) the patient loses 5 pounds
B) the patient develops a paralytic ileus
C) the patient can no longer afford enteral nutrition
D) the patient develops sleeping problems
E) the protein content of the enteral nutrition needs to be changed

Question 32

Which is a common consequence of malnutrition?

A) increased gastric emptying
B) delayed wound healing
C) cirrhosis
D) atrophic gastritis
E) hearing loss

Question 33

Which is an advantage of compounding parenteral solutions in the hospital pharmacy?

A) cost-effectiveness
B) multiple administration sets
C) decreased risk of infection
D) increased infusion of particulate into the patient
E) increased nursing time

Question 34

Which of the following components of SMOF lipid emulsion is the chief source of omega-6 fatty acids? olive oil

A) sunflower oil
B) mustard oil
C) soybean oil
D) fish oil
E) olive oil

Question 35

What is the recommended criteria for use of enteral feedings in a pediatric patient?

A) weight loss of 5 pounds in 6 months
B) unable to obtain 20% of caloric needs by mouth
C) requiring over 4 hours a day to eat
D) inadequate oral intake for over 48 hours
E) persistent TSF below the 50th percentile

Question 36

An 80-year-old male patient has end-stage Alzheimer's and has recently been diagnosed with severe dysphagia. This patient is getting discharged from hospital. His height is 5' 9" and he weighs 162 pounds with no recent changes in weight.
What is the correct amount of kcals needed to maintain the normal body weight of this patient?

A) 1110-1750 kcal
B) 1840-2210 kcal
C) 2350-2380 kcal
D) 2900-3020 kcal
E) 3150-3200 kcal

Question 37

The Hickman^®catheter is an example of which type of catheter that is used for parenteral nutrition?

A) peripherally inserted central catheter
B) non-tunneled catheter
C) implantable port
D) tunneled catheter
E) Swan-Ganz catheter

Question 38

Which of the following medical conditions occurs because of excessive carbohydrate intake through parenteral nutrition formulas?

A) hypoglycemia
B) hepatitis
C) hepatic steatosis
D) jaundice
E) hypolipidemia

Question 39

Which statement regarding an implantable port is true?

A) An implantable port can be self-placed by the patient.
B) An implantable port is usually inserted into the arm and threaded to the vena cava.
C) An implantable port must have the catheter changed every few hours to reduce the risk of infection.
D) An implantable port may be difficult for the patient to access.
E) An implantable port is only suitable for short-term access.

Question 40

An 80-year-old male patient has end-stage Alzheimer's and has recently been diagnosed with severe dysphagia. This patient is getting discharged from hospital. His height is 5' 9" and he weighs 162 pounds with no recent changes in weight.
How many grams of protein per kilogram of body weight does this patient need?

A) 0.8
B) 1.0
C) 1.2
D) 1.5
E) 2.0

Question 41

The first decision to make when designing an enteral nutrition prescription is how to establish access to the gastrointestinal tract.

Question 42

Enteral nutrition refers to delivery of nutrients distal to the oral cavity of the gastrointestinal tract via a tube, catheter, or _______________.

Question 43

The disadvantages of peptide and crystalline amino acid products include increased _______________ and _______________.

Question 44

Feeding access is achieved when a feeding tube is placed into the stomach or _______________.

Question 45

The osmolality of body fluids in a healthy individual is _______________ mOsm/kg.

Question 46

Peripheral parenteral nutrition requires large fluid volumes to meet nutritional needs, which makes this route unacceptable for any fluid-restricted patient.

Question 47

Enteral formulas are often the primary source of water for patients receiving them.

Question 48

Recent research has reexamined the use of blenderized feedings and has demonstrated an improved tolerance in children with feeding disorders.

Question 49

Benefits attributed to fiber, particularly improved bowel function, are often associated with insoluble fiber.

Question 50

A substance that is water loving or that attracts water is said to be _______________.

Question 51

_______________ consist of the administration of 250-500 mL of formula several times daily.

Question 52

The rapid administration of 1,000 to 1,500 mL of formula several times a day is called bolus feeding.

Question 53

Parenteral solutions can contain as many as five different items when they are initially compounded.

Question 54

The outer lumen diameter of a feeding tube is described using a measurement called _______________ size.

Question 55

_______________ is added to formulas and is generally thought to improve stool consistency and reduce diarrhea.

Question 56

_______________ feeding tubes enter the gastrointestinal tract through the nose and reside in the duodenum or jejunum.

Question 57

Short-chain fatty acids are used by the intestinal cells called _______________ as fuel and play a role in maintaining gastrointestinal integrity.

Question 58

Postpyloric access is most often used when the patient is at high risk of diarrhea.

Question 59

One of the most common disadvantages of surgical gastrostomy tubes is that they get dislodged easily.

Question 60

In the geriatric population, nutrition support may not be initiated until oral intake has declined precipitously due to advanced progression of diseases.

Question 61

The primary difference between enteral and parenteral feedings is that nutrients are provided via the _______________ rather than the gastrointestinal tract in PN.

Question 62

List and describe three different types of enteral feeding delivery methods.

Question 63

_______________ is a term used to describe several common metabolic alterations that may occur during nutritional repletion of patients who are malnourished or in a state of starvation.

Question 64

Excessive _______________ in parenteral nutrition may contribute to hyperglycemia, hepatic steatosis, and excessive carbon dioxide production.

Question 65

Describe indications, advantages, and disadvantages of the following types of enteral feeding tubes: nasogastric tubes, orogastric tubes, gastrostomy tubes, PEG tubes.

Question 66

List five examples of nutrition diagnoses that may necessitate alternate routes for nutrition interventions.

Question 67

Increased permeability to _______________ has been noted when atrophic intestinal cells result from lack of enteral stimulation.

Question 68

Give two examples of each of the following: short-term venous access device, long-term venous access device.

Question 69

If parenteral nutrition is administered continuously for several weeks, transient elevations in the _______________ enzymes may be noted.

Question 70

The wire guide within the enteral tube that assists with insertion is called the _______________.

Question 71

The intravenous lipid emulsion in most parenteral solutions available in the United States since 1972 is an emulsion of _______________.

Question 72

The most common type of vascular access device is a(n) _______________.

Question 73

List four examples of potential complications associated with parenteral nutrition.

Question 74

List the steps of determining the nutrition prescription.

Question 75

The _______________ is an intravenous access device that is placed in the vein on the upper chest walls and exits the body near the xyphoid process, axilla, or abdominal wall.

Question 76

Describe the use of an automated compounder in managing a nutrition prescription. Also, list advantages and disadvantages of pharmacy compounding.

Question 77

Describe the procedure for inserting a nasogastric feeding tube.

Question 78

Parenteral solutions are compounded from as many as 40 different items under the supervision of a licensed _______________.

Question 79

List the indications for using parenteral nutrition, and list several conditions that would require parenteral nutrition instead of enteral nutrition.

Question 80

List and describe examples of complications associated with enteral feedings.