Deck 21: Parenteral Nutrition Support

Question 1

Traditionally, central catheters enter the circulation at the ____ vein and are threaded into the superior vena cava with the tip of the catheter lying close to the heart.

A) brachial
B) right subclavian
C) basilic
D) cephalic

Answer 1

B

Question 2

Delivery of nutrient solutions directly into the vein is called ____.

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

Answer 2

C

Question 3

Redness, swelling, and tenderness at the infusion site of a vein is described as ____.

A) hematoma
B) phlebitis
C) infiltration
D) nerve damage

Answer 3

B

Question 4

A 21-year-old athlete who has a nonfunctional gastrointestinal tract is scheduled for major gastric surgery in 3 weeks. His energy and nutrient needs are higher than those of the average person his age, but his fluid intake is restricted. What would be the preferred method of feeding for this patient in order to keep him well nourished until surgery?

A) clear liquids
B) peripheral parenteral nutrition
C) total parenteral nutrition
D) mechanically soft diet

Question 5

The large-diameter central veins are located near the ____.

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

Question 6

Dextrose concentrations of ____ percent or lower can be used for peripheral parenteral nutrition solutions.

A) 10
B) 30
C) 50
D) 70

Question 7

What is an advantage of total parenteral nutrition?

A) Nutrient concentrations do not need to be limited.
B) It accesses only peripheral veins.
C) Patients who require only brief support (7 to 10 days) can use it.
D) It is less invasive.

Question 8

The small-diameter veins that are used for peripheral parenteral nutrition carry blood from the ___________.

A) heart
B) limbs
C) kidneys
D) brain

Question 9

Which statement regarding peripheral insertion of central catheters is false?

A) It is lower in cost
B) It is less invasive
C) It enters the circulation at the basilica vein
D) It enters the circulation at the right subclavian vein

Question 10

The protein in a total parenteral nutrition solution is primarily in the form of ____.

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

Question 11

Peripheral parenteral nutrition is most often used in patients who require nutrition support for less than ____.

A) 2 weeks
B) 6 weeks
C) 3 months
D) 6 months

Question 12

Osmolality refers to milliosmoles of ions and molecules per _____

A) liter of solution (mOsm/L)
B) kilogram of solvent (mOsm/kg)
C) kilogram of solution (mOsm/kg)
D) liter of solvent (mOsm/L)

Question 13

Osmolarity refers to milliosmoles of ions and molecules per ____.

A) liter of solution (mOsm/L)
B) kilogram of solvent (mOsm/kg)
C) kilogram of solution (mOsm/kg)
D) liter of solvent (mOsm/L)

Question 14

Parenteral nutrition would most likely be contraindicated in which condition?

A) paralytic ileus
B) GI bleeding
C) severe hyperglycemia
D) intractable vomiting

Question 15

The use of peripheral parenteral nutrition is not recommended in a patient with ____.

A) a partially functioning GI tract
B) low pain tolerance
C) weak peripheral veins
D) a swallowing disorder

Question 16

Which form of glucose is typically used in parenteral solutions?

A) dextrose
B) fructose
C) lactose
D) galactose

Question 17

To prevent phlebitis, the osmolarity of parenteral solutions used for peripheral parenteral nutrition is generally kept below ____ milliosmoles per liter.

A) 300
B) 600
C) 900
D) 1200

Question 18

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 19

The movement of water across biological membranes is known as ____.

A) osmosis
B) peripheral transport
C) diffusion
D) absorption

Question 20

Osmolality is usually derived by using ____.

A) equations that account for the nutrients and electrolytes
B) the weights of the nutrients and solution
C) an instrument called an osmometer
D) an instrument called a spectrometer

Question 21

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 22

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

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

Question 23

The approximate osmolarity of a 1-L solution that contains 35 g of amino acids, 200 g of dextrose, 20 g of lipids from a 20% fat emulsion, and 150 mEq and mmol of electrolytes would be __________ mOsm/L.

A) 1039.4
B) 1339.2
C) 1514.2
D) 1729.4

Question 24

How many grams of amino acids would be provided to a client receiving 2000 mL of a 5% amino acid solution?

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

Question 25

Why are few medications added to parenteral solutions?

A) to avoid potential drug-nutrient interactions
B) because too many can destabilize the dextrose
C) because they are unnecessary if the solution is properly balanced
D) because it is not possible to do so

Question 26

Approximately how many liters of fluids will be required by a stable adult patient weighing 81 kg?

A) 1.4 to 2.2 L
B) 2.4 to 3.2 L
C) 3.2 to 4.0 L
D) 4.0 to 4.4 L

Question 27

The administration of a second solution using a separate port is called a ____.

A) Y-connector
B) piggyback
C) double-lumen tube
D) distal port

Question 28

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

A) hypertriglyceridemia
B) hyperglycemia
C) diabetes
D) kidney failure

Question 29

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

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

Question 30

Which macronutrient is usually the main source of energy in parenteral nutrition?

A) carbohydrate
B) protein
C) fat
D) amino acids

Question 31

The energy content of 2 L of a parenteral solution that contains 22% dextrose and 15% amino acids supplemented with 300 mL of a 10% lipid emulsion is _________ kcalories

A) 1696
B) 2696
C) 3696
D) 4696

Question 32

Daily fluid needs range from ____ mL per kilogram of body weight in most stable patients.

A) 5 to 15
B) 15 to 25
C) 30 to 40
D) 35 to 45

Question 33

A physician writes an order for a patient to receive lipid emulsions via total parenteral nutrition twice a week. The purpose of this order to supply lipids is mainly to ____.

A) provide essential fatty acids
B) provide nonessential amino acids
C) provide essential minerals
D) suppress the immune response

Question 34

Although the administration of 3-in-1 solutions is simpler because only one infusion pump is required, what can occur when lipid emulsions have been added?

A) The solution is too dense to use in a central vein.
B) The solution causes platelet aggregation.
C) The solution often becomes contaminated.
D) The solution can form large lipid droplets.

Question 35

Cyclic parenteral nutrition is administered over ____ hours per day.

A) 3 to 6
B) 6 to 8
C) 8 to 14
D) 12 to 18

Question 36

Which trace mineral is typically 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 37

Which condition describes a metabolic complication of parenteral nutrition?

A) hypoglycemia
B) phlebitis
C) air embolism
D) sepsis

Question 38

A 3-in-1 solution that contains amino acids, lipids, and dextrose is also called a ____.

A) hydrolyzed solution
B) total nutrient admixture
C) elemental suspension
D) isotonic solution

Question 39

Which type of oil most commonly makes up the triglycerides in lipid emulsions?

A) corn oil
B) sunflower oil
C) soybean oil
D) coconut oil

Question 40

One major benefit of cyclic infusion of total parenteral nutrition is ____.

A) maintenance of high insulin levels
B) increase in fat stores
C) more freedom of movement during the day
D) achievement of a negative nitrogen balance

Question 41

Which type of parenteral nutrition provided at night allows patients to participate in routine activities during the day?

A) continuous
B) cyclic
C) peripheral
D) piggyback

Question 42

Before parenteral nutrition is discontinued, oral intake, tube feeding, or a combination of both should provide at least _____ percent of the estimated energy needs.

A) 40 to 50
B) 55 to 60
C) 60 to 75
D) 90 to 95

Question 43

Which statement is true of Terri's Law?

A) It allows hospitals to withdraw life-sustaining treatment against the wishes of the family.
B) It allowed the governor to order hospitals to withdraw life-sustaining treatment against the wishes of the family, but was found unconstitutional.
C) It allows hospitals to continue life-sustaining treatment against the wishes of the family.
D) It allowed the governor to intervene and act against a family's wishes in order to continue life-sustaining treatment, but was found unconstitutional.

Question 44

A patient should be fully informed of a treatment's benefits and risks in a fair and honest manner. If the patient agrees to the proposed treatment, it is referred to as ____.

A) autonomy
B) informed consent
C) beneficence
D) distributive justice

Question 45

When providers consider whether provision of health care for one patient would unfairly limit the care of other patients, ____ is being considered.

A) autonomy
B) informed consent
C) beneficence
D) distributive justice

Question 46

The enteral formula used for home nutrition is most often influenced by cost and ____.

A) taste
B) availability
C) efficiency of administration
D) appearance

Question 47

A 12-year-old patient is being weaned off of total parenteral nutrition. In addition to total parenteral nutrition, he is on a soft diet. The patient is 5 ft 2 in. tall and weighs 110 lb. His energy needs are estimated to be approximately 2100 kcal/day. His kcalorie count reveals he is consuming 1700 kcal/day. Which intervention is appropriate at this time?

A) Discontinue TPN.
B) Double his oral feedings.
C) Consider enteral feedings.
D) Increase TPN to provide an additional 1100 kcal.

Question 48

Shawna is on home total parenteral nutrition and is having trouble adjusting to the changes in her life. Which organization does the text recommend as a good source of support and information for her?

A) Oley Foundation
B) P-CAN
C) Livestrong
D) ACS

Question 49

One of the greatest concerns of patients who use home nutrition support is the ____.

A) inability to consume meals with friends
B) appearance of the tube
C) risks of the tube becoming clogged
D) inability to choose the type and amount of formula delivered

Question 50

Liver enzymes should be monitored ____ during parenteral support.

A) hourly
B) daily
C) weekly
D) every 2 weeks

Question 51

How often should the fluid intake and output of a patient on total parenteral nutrition be checked?

A) before starting
B) every 4 to 8 hours
C) daily
D) once a week

Question 52

Refeeding syndrome is characterized by fluid and electrolyte imbalances and ____.

A) systemic infection
B) hypothyroidism
C) severe weight loss
D) hyperglycemia

Question 53

Which condition describes a catheter-related complication of parenteral nutrition?

A) refeeding syndrome
B) gallbladder disease
C) air embolism
D) nutrient deficiencies

Question 54

What best describes the role of the nurse on the nutrition support team?

A) diagnosing nutrition problems
B) recommending the appropriate diet
C) performing direct patient care
D) recommending appropriate drug therapy

Question 55

The health care team has just ordered total parenteral nutrition for Mr. Calabria. He is a 58-year-old man who is suffering from intractable diarrhea. Before Mr. Calabria 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 56

A female patient who is on long-term parenteral nutrition is at risk for ____.

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

Question 57

In which situation would home total parenteral nutrition be an appropriate means for maintaining adequate nutrition status?

A) an individual with dysphagia
B) an individual with chronic intestinal obstruction
C) an individual with head and neck cancer
D) an individual with neurological impairment affecting the esophagus

Question 58

The potential good that can come from a proposed treatment is referred to as ____.

A) autonomy
B) informed consent
C) beneficence
D) distributive justice

Question 59

When refrigerated, ready-made parenteral solutions may be stable for ____.

A) 1 week
B) 10 days
C) 2 weeks
D) 3 weeks

Question 60

A patient on total parenteral nutrition for longer than a few ____ is at risk for "sludge" buildup in the gallbladder and gallstone formation.

A) hours
B) days
C) weeks
D) months

Question 62

Questions 65-68 Short Case Study
Elena Hayes is a 64-year-old realtor. She has been admitted to the local medical center six times in the past 3 months with severe pancreatitis. Elena has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a subacute nursing facility for therapy.
The registered dietitian completing Elena's initial assessment should expect which result?

A) high albumin
B) weight loss
C) high iron
D) low insulin

Question 63

Discuss possible metabolic complications associated with parenteral nutrition and suggest ways to correct such complications.

Question 64

The do-not-resuscitate (DNR) order is most often used in patients for whom ____.

A) death is expected and inevitable
B) treatment is excessively costly and not reimbursable
C) organ procurement is in progress
D) families have requested it

Question 65

Questions 65-68 Short Case Study
Elena Hayes is a 64-year-old realtor. She has been admitted to the local medical center six times in the past 3 months with severe pancreatitis. Elena has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a subacute nursing facility for therapy.
Upon admission, Elena tells her nurse that she has a lot of fear with regard to nutrition support because she experienced a "vein blowout" at a previous admission. What is the most likely cause of this incident?

A) high glucose in the TPN
B) low amino acids in the TPN
C) low vitamin K in the PPN
D) high osmolarity of the PPN

Question 66

Questions 62-64 Short Case-study  
 
Devon Young is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Devon to the medical-surgical unit for evaluation of reported symptoms of poor appetite, constipation, nausea, and vomiting for 3 days.
After surgery, Devon remains on ventilator support but his gut function is improving. The doctor should initiate ____.

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

Question 67

Define refeeding syndrome. Why does it occur and how can it be prevented?

Question 68

Discuss the quality-of-life issues that need to be addressed with patients receiving long-term nutrition support at home.

Question 69

Discuss the use of carbohydrates in parenteral nutrition.

Question 70

Questions 65-68 Short Case Study
Elena Hayes is a 64-year-old realtor. She has been admitted to the local medical center six times in the past 3 months with severe pancreatitis. Elena has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a subacute nursing facility for therapy.
Laboratory values indicate that Elena's blood glucose is extremely high. Which nutrient component of her total parenteral nutrition must be adjusted?

A) water
B) dextrose
C) amino acids
D) chromium

Question 71

Questions 65-68 Short Case Study
Elena Hayes is a 64-year-old realtor. She has been admitted to the local medical center six times in the past 3 months with severe pancreatitis. Elena has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a subacute nursing facility for therapy.
The nutrition support team decides to increase the kcal in Ms. Hayes's total parenteral nutrition slowly to prevent ____.

A) hypoglycemia
B) an elevated white blood cell count
C) refeeding syndrome
D) weight gain

Question 72

Compare and contrast peripheral parenteral nutrition and total parenteral nutrition.

Question 73

Questions 62-64 Short Case-study  
 
Devon Young is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Devon to the medical-surgical unit for evaluation of reported symptoms of poor appetite, constipation, nausea, and vomiting for 3 days.
Upon admission, what diet is most appropriate for Devon until he receives further testing?

A) nothing by mouth
B) low sodium
C) low fiber
D) high protein/high kcalorie

Question 74

Questions 62-64 Short Case-study  
 
Devon Young is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Devon to the medical-surgical unit for evaluation of reported symptoms of poor appetite, constipation, nausea, and vomiting for 3 days.
Devon will need intestinal surgery and will be receiving nothing by mouth for 15 to 20 days. How can his medical team meet his nutritional needs during this time?

A) regular diet
B) elemental formula
C) enteral nutrition
D) parenteral nutrition