Question 1

Which trace element needs to be initially given at higher levels when there is a risk of refeeding syndrome?

Accepted Answer

When refeeding syndrome occurs, serum levels of phosphorus, potassium, and magnesium fall below normal levels, resulting in the electrolyte imbalances associated with refeeding syndrome.As a patient's stores of these nutrients may be depressed after extended time without eating, infusion of glucose contributes to decreasing blood levels of these minerals further as they are shifted into cells with glucose.Potential cardiac and pulmonary complications can be avoided by supplementing the patient with phosphorus, potassium, and magnesium and by limiting the initial amounts of glucose administered when feeding resumes.

Question 2

Feeding tube diameter is measured in

Accepted Answer

Feeding tube internal diameter is measured in French size.

Question 3

What type of enteric tube enters the body at the nose and terminates at the stomach?

Accepted Answer

A nasogastric tube is inserted through the nares and run down the throat and esophagus to end in the stomach.A nasojejunal tube is inserted in the same manner, but its terminus is in the jejunum.A PEG tube is placed through the abdominal wall so it feeds directly into the stomach.A PEJ is similar except that it feeds into the jejunum.

Question 4

After assessment of a patient has determined that oral intake is inadequate, what is the next determination to be made?

Accepted Answer

The choice for use of enteral versus parenteral nutrition should be made based on whether the GI tract is functioning and capable of supporting the use of enteral nutrition.If the GI tract works, the preference is to meet the patient's nutritional needs through enteral nutrition.Tube type, formula type, and TPN composition are all decisions that need to be made later.

Question 5

A common complication of enteral tube feeding is

Accepted Answer

Although diarrhea is the most commonly reported complication associated with enteral feeding, often the enteral nutrition is not the cause.More likely reasons for the diarrhea to occur include bacterial overgrowth, antibiotic use, gastrointestinal motility disorders, and administration of hyperosmolar medications and electrolyte supplements.Adjusting the medications and their administration can correct the diarrhea.The use of prebiotics and probiotics, pectin, bulking agents, and antidiarrheal medications are other ways to treat the diarrhea.

Question 6

For the patient with delayed gastric emptying, nausea and vomiting, or other indications of risk of aspiration, the tube should be placed through the

Accepted Answer

Nasoduodenal or nasojejunal tubes bypass the stomach, thus reducing the likelihood of instigating nausea or vomiting, not relying on the stomach's motility, and because they are post-pyloric, reduces the risk of aspiration as formula would have to go past two sphincters to work its way back to the trachea.Tubes placed through the mouth are not commonly used because they can interfere with a patient's ability to talk.

Question 7

The most important technique for prevention of aspiration in an enterally fed patient is:

Accepted Answer

The role of enteral feeding in development of aspiration is controversial.Many experts believe that the primary source of aspiration into the airway is saliva and throat contents, not formula.Aspiration can usually be prevented by positioning the patient with the head and shoulders above the chest whenever feeding occurs.

Question 8

In general, a patient's parenteral feeding can be discontinued when enteral nutrition meets _____ of the patient's need.

Accepted Answer

When a patient is meeting 75% of nutrition needs through either enteral or parenteral nutrition, the parenteral nutrition may be discontinued.This process may take up to 2 to 3 days as the parenteral nutrition is weaned.Parenteral nutrition administration is not stopped at once because this could contribute to fluid and electrolyte imbalances or rebound hypoglycemia.

Question 9

Which one of these routes of parenteral access is considered long term?

Accepted Answer

PICC lines are inserted into a vein in the antecubital area of the arm and threaded into the subclavian vein, allowing greater mobility for the patient and decreased infection risk.Tunneled versions of single- or multiple-lumen catheters into the subclavian or the external jugular vein are also types of long-term access.Peripheral IV catheters and single-lumen, nontunneled catheters placed in the subclavian or internal or external jugular veins are also short-term catheters.

Question 10

For a fluid restricted patient, an appropriate formula to select for use would be _____ kcal/mL.

Accepted Answer

Patients with cardiopulmonary, renal, or hepatic failure may require fluid restriction.Most standard formulas of 1 to 1.2 kcal/mL concentration contain 80% to 85% water.A concentrated formula with 1.5 to 2 kcal/mL is about 70% water.All patients on enteral nutrition support require water flushes to maintain the integrity of the feeding tube and to ensure adequate fluid.

Question 11

Which condition would most likely require parenteral nutrition as the medical nutrition therapy?

Accepted Answer

Severe acute pancreatitis may result in inadequate digestive and absorptive capacity in the gastrointestinal tract.In this situation, providing enteral feeding may not be able to provide adequate nutrition.Pancreatitis may be associated with severe abdominal pain associated with feeding or with ileus.Enteral nutrition can be provided to patients with HIV/AIDS, patients who have failure to thrive, and patients with oral or esophageal trauma because the gastrointestinal tract is still accessible in these conditions

Question 12

The osmolarity of a 1-L bottle of 5% dextrose solution is _____ mOsm/L.

Accepted Answer

The grams of dextrose in 1 L or 1000 mL of 5% dextrose are equal to 1000 mL ´ 5% = 50 g.For the osmolarity of a dextrose solution, multiply the grams of dextrose per liter by 5 (50 g ´ 5 = 250 mOsm/L).

Question 13

In home care, what is the recommended administration method for enteral nutrition?

Accepted Answer

Because the provision of the enteral nutrition will generally be by the family or caregivers in the home, the best method for administering enteral nutrition is the easiest, bolus feeding.This method does not require special equipment, such as a hanging pole, or equipment that may require maintenance, such as pumps.The family can be trained to start with half of one can of formula fed four to six times a day and can work their way up to the patient's total needs as tolerated.

Question 14

The maximum osmolality of parenteral solution that the cephalic or brachial vein may tolerate for infusion is _____ mOsm/kg.

Accepted Answer

Because the cephalic and brachial veins are common sites used for peripheral parenteral nutrition, highly concentrated parenteral solutions with more than 800 to 900 mOsm/kg are not tolerated.The provision of fat is possible because it is isotonic, but protein and carbohydrate may have to be limited.Also, the addition of electrolytes, multivitamins, and trace elements increase osmolality, making it difficult to provide complete nutrition in a limited volume.

Question 15

The calorie concentration provided by most general-purpose formulas is _____ kcal/mL.

Accepted Answer

Most standard enteral formulas for use with the general patient population provide 1 to 1.2 kcal/mL.When a fluid restriction is required, formulas that are concentrated to 1.5 to 2 kcal/mL are appropriate.

Question 16

The functions of the _____ system are better maintained with enteral feedings than with parenteral feedings.

Accepted Answer

Enteral nutrition stimulates the gastrointestinal system and its immunity to maintain the integrity of the mucosal lining.This has been substantiated in numerous animal models but not always in animal models.Indirect evidence has suggested that enteral nutrition preserves mucosal integrity during critical illness in humans.However, in regard to possible bacterial translocation and the development of sepsis, these outcomes have been seen in patients receiving parenteral nutrition, but in those with a very short small bowel.

Question 17

The patient most likely to experience refeeding syndrome is a patient who has

Accepted Answer

Although all patients who have received no nutrition for an extended period of time are at risk of developing refeeding syndrome, those who have been replenished by parenteral nutrition are at particular risk because of the direct infusion of carbohydrate, electrolytes, and fluids into the blood system.Digestion and absorption mediate the development of refeeding syndrome.With parenteral nutrition, electrolyte and fluid balances should be monitored to prevent potential imbalances and complications.

Question 18

A patient is receiving an intravenous solution that provides 120 g of dextrose monohydrate.How many calories does this provide the patient?

Accepted Answer

As dextrose monohydrate is a molecule of glucose and water, it has a lower calorie concentration than other carbohydrates (3.4 kcal/g vs.4 kcal/g).120 g ´ 3.4 kcal/g = 408 kcal.Ten percent lipid emulsions provide 1.1 kcal/mL solution.Twenty percent lipid emulsions provide 2 kcal/g solution.

Question 19

The following is NOT a potential complication of nasoenteric feeding tubes.

Accepted Answer

Thrombophlebitis is a complication of peripheral PN.Sinusitis, vocal cord paralysis, and pulmonary injury can all be complications of nasoenteric feeding tubes.

Question 20

A major drawback of safflower and soybean based lipid emulsions is:

Accepted Answer

Linoleic acid alters prostaglandin metabolism, thereby producing both proinflammatory and immunosuppressive effects.Three-in-one PN mixtures combine the lipid with the dextrose and amino acids, but it can also be given separately through a peripheral line.

Quiz 14: Food-Nutrient Delivery: Nutrition Support Methods