Question 1

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

Accepted Answer

Refeeding syndrome is a condition that can occur when a malnourished individual, who has been on a low-calorie diet for an extended period of time or has had inadequate oral intake, starts receiving nutrition rapidly. It can lead to electrolyte imbalances, fluid shifts in the body, and even organ failure. Patients with a history of long-term inadequate oral intake are at the highest risk of developing refeeding syndrome.

Question 2

The protein component of most enteral formulas comes from:

Accepted Answer

The protein component of most enteral formulas comes from soy or casein, which are both sources of high-quality protein. Lactose, monosaccharides, dextrin, and fatty acids are not sources of protein, and albumin and whey may not be appropriate for individuals with certain allergies or intolerances.

Question 3

The thickness of a liquid is known as its:

Accepted Answer

Viscosity refers to the thickness of a liquid, while osmolality, osmolarity, and nutrient density refer to different characteristics. Coagulation refers to the clotting of a liquid or blood.

Question 4

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

Accepted Answer

Enteral feedings can affect a patient's fluid status, and therefore it is important to assess fluid status frequently to avoid complications such as dehydration or fluid overload. Checking fluid status at least every day ensures that any changes can be quickly detected and addressed.

Question 5

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

Accepted Answer

Central catheters are commonly inserted into the subclavian vein, which is located beneath the collarbone and provides a direct route to the veins near the heart.

Question 6

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

Accepted Answer

Diffuse peritonitis, intestinal obstruction, GI bleeding, and intractable vomiting are all potential contraindications to enteral feeding. However, impaired swallowing may be managed with techniques such as a modified diet or thickened liquids, allowing for safe and effective enteral feeding.

Question 7

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

Accepted Answer

The means of prescribing a very small rate of enteral nutrition to minimize villous atrophy is known as trophic nutrition. This approach provides a low level of nutrients to ensure that the gut is stimulated to stay functional and prevent mucosal atrophy without putting the patient at risk of refeeding syndrome. Parenteral nutrition refers to nutrition provided intravenously, bolus feedings refer to a method of administering enteral nutrition in large volumes at a time, refeeding refers to the process of reintroducing nutrition to a malnourished patient, and intermittent feeding refers to a method of administering enteral nutrition at intervals rather than continuously.

Question 8

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

Accepted Answer

Establishing a dosing weight is the first step because it provides a baseline for calculating nutritional needs, including calories, protein, fluids, and other nutrients.

Question 9

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

Accepted Answer

Flushing the tube with tap water several times a day helps prevent clogging by clearing out any residual formula or medication. Instilling heparin into the tubing may be appropriate in certain situations, but it is not a general preventive measure for clogging. Slowing the feeding rate or using a small volume syringe and adding air into the tube are not effective in preventing clogged feeding tubes. Reinserting the stylet is not appropriate as it may cause damage to the tube.

Question 10

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

Accepted Answer

The answer of Which best describes an advantage of a...

Question 11

Which is a true statement about continuous enteral feedings?

Accepted Answer

Continuous enteral feedings require a pump and other equipment to administer. They are typically given over a longer period of time than bolus feedings, and are usually administered through a feeding tube.

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?

Accepted Answer

The next appropriate step would be to measure for gastric placement. Metoclopramide is a prokinetic medication used to increase gastric motility and aid in the passage of the nasogastric tube, so it is important to confirm proper placement before advancing the tube further. Obtaining an abdominal radiograph is typically done after initial placement to confirm proper positioning. Removing the stylet from the tube and taping the tube to the patient's nose are also steps in the process but would come after measuring for gastric placement.

Question 13

The usual nutrient density of enteral formulas ranges between:

Accepted Answer

The usual nutrient density of enteral formulas ranges between 1.0 and 2.0 kcal/mL. This allows for proper nutrition, caloric intake, and hydration for individuals who are unable to consume adequate nutrition orally. Options A, C, D, and E are not correct ranges for the usual nutrient density of enteral formulas.

Question 14

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

Accepted Answer

Acute kidney injury requires a lower range of protein intake because the kidneys are responsible for filtering and excreting waste products from protein metabolism. Therefore, in case of kidney injury, a lower protein intake is recommended to reduce stress on the kidneys. Trauma, burns, sepsis, and bone marrow transplant typically require higher ranges of protein intake to support tissue repair, immune function, and bone marrow production.

Question 15

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

Accepted Answer

A patient with an endotracheal tube is at the highest risk of aspiration during enteral feeding because the tube bypasses the natural barrier created by the epiglottis during swallowing, increasing the risk of food or liquid entering the airway and causing aspiration pneumonia.

Question 16

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

Accepted Answer

Parenteral nutrition is indicated in patients with short bowel syndrome where the small intestine is unable to absorb adequate nutrients causing malnutrition. It involves giving nutrients directly into the veins to provide the necessary calories, protein, vitamins, and minerals. Increased oral fluid intake and cardiovascular disease may be managed with dietary and lifestyle modifications along with medical treatment. Hyperkalemia may require medication management and severe dysphagia may require alternate feeding methods such as tube feeding, but not necessarily parenteral nutrition.

Question 17

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

Accepted Answer

Elevating the head of the patient at an angle ≥30 degrees is the appropriate nursing intervention to reduce the risk of aspiration during enteral feedings. This position helps to prevent reflux and pooling of feeding in the oropharynx, reducing the risk of aspiration. Instilling a blue dye into the feeding or checking the level of lung aspirate daily are not appropriate interventions for reducing the risk of aspiration. Continuing the feeding at a faster rate may increase the risk of aspiration, and increasing fiber to 8 g in each supplement may be appropriate for other indications but will not necessarily reduce the risk of aspiration.

Question 18

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

Accepted Answer

Enteral nutrition support is known to improve wound healing by providing essential nutrients directly to the gastrointestinal tract, which can enhance the body's ability to repair tissues.

Question 19

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

Accepted Answer

The high osmolality of PPN may cause small veins to collapse.

Question 20

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

Accepted Answer

Osmolality is the measure of the number of water-attracting particles per kilogram of water.

Quiz 5: Enteral and Parenteral Nutrition Support