Deck 21: Parenteral Nutrition Support

Question 1

Candidates for TPN are patients who ____.

A)are unable to use their GI tracts for long periods (> 10 days)
B)are malnourished and exhibit anorexia
C)have high nutrient needs that they may otherwise meet orally
D)have severe swallowing disorders

Answer 1

A

Question 2

Redness, swelling, and tenderness at the insertion site is described as ____.

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

Answer 2

B

Question 3

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 3

B

Question 4

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

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

Question 5

Parenteral nutrition would most likely be contraindicated in which condition?

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

Question 6

What describes a benefit of peripheral insertion of a central catheter?

A)decreased risk of infection
B)less pain for the patient
C)lower cost
D)decreased risk of electrolyte imbalance

Question 7

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

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

Question 8

The protein in a TPN solution is primarily in the form of ____.

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

Question 9

Which form of glucose is available in parenteral solutions?

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

Question 10

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

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

Question 11

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 12

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 13

The use of PPN is not possible in a patient with ____.

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

Question 14

Dextrose concentrations of ____ percent or lower can be used for PPN solutions.

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

Question 15

What is an advantage of TPN?

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 16

PPN 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 17

A client receiving greater than 2000 kcalories per day via parenteral nutrition should ____.

A)have it administered via peripheral vein
B)receive dextrose and amino acids only
C)have it administered in bolus form
D)be given nutrition by the central venous route

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

Joan Sussman is in her second trimester of pregnancy and has experienced hyperemesis gravidarum (excessive vomiting, possible fluid and electrolyte imbalances)for 14 days. At this point, she is a candidate for ____.

A)a clear liquid diet
B)a tube feeding
C)peripheral parenteral nutrition
D)total parenteral nutrition

Question 20

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

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

Question 21

The benefits of cyclic infusion of TPN include ____.

A)maintenance of high insulin levels
B)increase in fat stores
C)flexibility in the daily scheduling of activities
D)achievement of a negative nitrogen balance

Question 22

Daily fluid needs range from ____ milliliters per kilogram of body weight in most adults.

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

Question 23

What best describes the insertion of a central line for parenteral nutrition?

A)The procedure requires local anesthesia.
B)The patient is typically asleep during the procedure.
C)The insertion can only be done by a nurse or qualified technician.
D)The patient who is anxious usually receives sedatives.

Question 24

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 25

What is usually the main source of energy provided by parenteral nutrition?

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

Question 26

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

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

Question 27

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 28

Why are few medications added to parenteral solutions?

A)to avoid potential drug-nutrient interactions
B)to avoid clogging the tubing
C)because they are unnecessary if the solution is properly balanced
D)because it is not possible to do so

Question 29

How many grams of amino acids would be provided to a client receiving 2,000 mL of a 5 percent amino acid solution?

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

Question 30

A physician writes an order for Mrs. Wilson to receive parenteral lipids twice a week. The purpose of this order is to ____.

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

Question 31

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 32

Which trace mineral is 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 33

PPN solutions are limited in their osmolarity and TPN solutions ____.

A)can be as nutrient dense as necessary
B)may be deficient in other components
C)are required to be of a certain osmolarity
D)are also limited in their osmolarity

Question 34

The health care team has just ordered Mr. Carter to begin TPN. He is a 58-year-old man who is suffering from intractable diarrhea. Before Mr. Carter 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 35

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

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

Question 36

How many kcalories are provided by 3 liters of a 5 percent dextrose solution?

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

Question 37

Which type of parenteral nutrition is provided at night so patients can participate in routine activities during the day?

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

Question 38

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 39

A person on cyclic parenteral nutrition receives an infusion at a constant rate for ____ hours per day.

A)3  to  6
B)6  to  8
C)8  to  16
D)12  to  18

Question 40

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 41

Liver enzymes should be monitored ____ during parenteral support.

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

Question 42

A patient on TPN for longer than a few ____ is at risk for "sludge" buildup in the gallbladder and gall stone formation.

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

Question 43

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

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

Question 44

Among social issues, 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 45

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 46

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 47

Karly is on home TPN 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 48

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

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

Question 49

How often should the fluid intake and output of a patient on TPN be checked?

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

Question 50

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 51

Maria is a home health dietitian. She is evaluating a new TPN patient. She expects that the patient will want to change his regimen to ____.

A)continuous infusion
B)cyclic infusion
C)NPO
D)bolus infusion

Question 52

When providers consider whether treatment for one patient may cause harm to another patient, ____ is being considered.

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

Question 53

Greg Thomas is a 12-year-old who is being weaned off of TPN. In addition to TPN, Greg is on a soft diet. Greg is 5'2" and weighs 110 pounds. His energy needs are estimated to be approximately 2100 kcal/day. His calorie 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 54

Kristin Sullivan is on long-term parenteral nutrition. This places her at risk for ____.

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

Question 55

Before parenteral nutrition is discontinued, oral intake, tube feeding, or a combination should provide at least what proportion of the estimated energy needs?

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

Question 56

The 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 57

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

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

Question 58

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

A)one week
B)ten days
C)two weeks
D)three weeks

Question 59

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 60

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

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

Question 61

Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a sub-acute nursing facility for therapy. The registered dietitian completing Julia's initial assessment should expect which result?

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

Question 62

Discuss possible metabolic complications associated with intravenous nutrition and possible corrections of these complications.

Question 63

Compare and contrast peripheral parenteral nutrition and total parenteral nutrition.

Question 64

Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor's appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days. Marc will need intestinal surgery and will be NPO for 10 to 14 days. How can his medical team meet his nutritional needs?

A)regular diet
B)elemental formula
C)PPN
D)TPN

Question 66

Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor's appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days. What should the nutritional support team do to ensure that Marc can consume enough food orally to meet his energy needs?

A)Send double portions.
B)Discontinue the tube feeding.
C)Discontinue the TPN.
D)Switch to nocturnal, cyclic feedings.

Question 67

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

Question 68

Discuss the use of carbohydrates in parenteral nutrition.

Question 69

Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a sub-acute nursing facility for therapy. The nutrition support team decides to increase the kcal in Ms. Reynolds's TPN slowly to prevent ____.

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

Question 73

Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a sub-acute nursing facility for therapy. After six weeks of intense nutrition support, her liver enzymes are elevated. The dietitian recommends ____.

A)a low-fat diet
B)elemental tube feedings
C)cyclic TPN
D)continuous TPN

Question 75

Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor's appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days. After surgery, Marc remains on ventilator support but his gut function is improving. The doctor should initiate ____.

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

Question 76

Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor's appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days. Upon admission, what diet is most appropriate for Marc until he receives further testing?

A)NPO
B)low sodium
C)low fiber
D)high protein/high kcalorie

Question 77

Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a sub-acute nursing facility for therapy. Upon admission, Julia tells her nurse that she has a lot of fear in regards to nutrition support due to 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 78

Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a sub-acute nursing facility for therapy. Laboratory values indicate that Julia's  blood glucose is extremely high. Which nutrient component of her TPN must be adjusted?

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

Question 79

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

Question 80

Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor's appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days. Marc's  nausea and vomiting continued after he was admitted. Nasogastric decompression has been started. Which diet should be recommended to completely meet his nutritional needs?

A)clear liquid
B)elemental formula
C)low fiber
D)TPN