Question 1

Which condition is an indication for parenteral nutrition?&#10;A) Oropharyngeal dysphagia&#10;B) Necrotizing enterocolitis&#10;C) Traumatic brain injury&#10;D) Cystic fibrosis

Accepted Answer

Necrotizing enterocolitis is a condition where the intestines are inflamed and can become necrotic, often necessitating bowel rest and parenteral nutrition to allow healing.

Question 2

Which of the following PN solutions would be most appropriate for infusion into a PIV?&#10;A) Fluid restricted PN for a child with complex congenital heart defects&#10;B) PN solution containing final dextrose concentration of 10% and osmolality of 1000mOsm/L&#10;C) PN for a child with severe malnutrition and short bowel syndrome who is anticipated to receive home PN support&#10;D) PN solution containing final dextrose concentration of 12% and osmolality of 850mOsm/L

Accepted Answer

Peripheral intravenous (PIV) lines can typically handle solutions with an osmolality of up to 900 mOsm/L. The solution in option D has an osmolality of 850 mOsm/L, making it suitable for PIV infusion.

Question 3

LP is a 2-month-old male with a weight of 5.5kg, who is receiving 500ml of continuous 24 hour 2:1 PN. The PN solution contains 2g/kg/day of amino acid and 85 grams of dextrose, with a separate 20% Intralipid solution providing 55ml of lipid. What is the Glucose infusion rate (GIR) of the PN?

A) 10.7mg/kg/min
B) 6.9mg/kg/min
C) 8.2mg/kg/min
D) 12.1mg/kg/min

A

Accepted Answer

The correct answer is A.GIR = (85g/24hr x 1000mg/g) / (5.5kg x 60min/hr) = 10.7mg/kg/min

Question 4

Which of the following would be appropriate to reduce the risk of PNALD in a patient on long-term PN?&#10;A) Increase the amino acid concentration of the solution&#10;B) Reduce soybean-oil predominant lipid emulsion&#10;C) Cycle the PN infusion time to 18 hours&#10;D) Both Reduce soybean-oil predominant lipid emulsion and Cycle the PN infusion time to 18 hours

Accepted Answer

Reducing soybean-oil predominant lipid emulsion can decrease omega-6 fatty acids, which are associated with liver inflammation. Cycling PN infusion allows the liver to rest, reducing the risk of liver disease.

Question 5

What is the caloric provision of the following PN solution, as provided to a 15kg child? 450ml 2:1 PN, 175g dextrose, 2g/kg amino acids with 150ml SMOF lipid providing 2g/kg/day&#10;A) 75kcal/kg/day&#10;B) 63kcal/kg/day&#10;C) 67kcal/kg/day&#10;D) 85kcal/kg/day

Accepted Answer

The total calories are calculated by adding the calories from dextrose, amino acids, and lipids. Dextrose provides 3.4 kcal/g, amino acids provide 4 kcal/g, and lipids provide 9 kcal/g. For a 15kg child, the total calories are approximately 67 kcal/kg/day.

Question 6

Which would be an appropriate consideration for a PN solution in a patient who in PN dependent with a direct bilirubin of 2.4mg/dL?&#10;A) Reduce calcium and phosphorus&#10;B) Increase manganese and decrease copper&#10;C) Decrease both manganese and copper&#10;D) Reduce carnitine

Accepted Answer

In patients with cholestasis or liver dysfunction, such as indicated by elevated direct bilirubin, it is appropriate to decrease manganese and copper in the PN solution to prevent accumulation and potential toxicity, as these trace elements are primarily excreted via the biliary route.

Question 7

Which access is most appropriate for a home PN dependent 3-year-old patient?&#10;A) PICC&#10;B) Midline catheter&#10;C) PIV&#10;D) Tunneled Broviac

Accepted Answer

A Tunneled Broviac catheter is most appropriate for long-term parenteral nutrition in a young child, as it is designed for long-term use and reduces the risk of infection compared to other options.

Question 8

In the event of a trace element national shortage, which of the following would be acceptable?&#10;A) Discontinue trace elements from all pediatric PN solutions&#10;B) Check daily for biochemical and physical signs of deficiency and provide trace elements once patient exhibiting deficiency&#10;C) Provide enteral trace elements when medically able, and reduce parenteral trace element provision to twice weekly&#10;D) Continue to provide trace elements daily in all pediatric PN solutions until trace element supply exhausted

Accepted Answer

Providing enteral trace elements when possible and reducing parenteral provision to twice weekly helps conserve resources while still addressing nutritional needs.

Question 9

Calcium and phosphorus solubility in a PN solution is affected by which of the following factors:&#10;A) Amino acid content, pH, L-cysteine hydrochloride&#10;B) Potassium, temperature, pH&#10;C) Central access, temperature, carnitine&#10;D) Amino acid content, potassium, presence of lipid

Accepted Answer

The solubility of calcium and phosphorus in parenteral nutrition (PN) solutions is influenced by amino acid content, pH, and the presence of L-cysteine hydrochloride, which can help to increase solubility and reduce the risk of precipitation.

Question 10

Which of the following factors support successful home PN provision?&#10;A) Trained primary and backup caregivers&#10;B) Coordination with home care company for orders and necessary supplies&#10;C) Safe home environment, with adequate refrigeration and telephone service&#10;D) All of these

Accepted Answer

All of these factors are essential for successful home parenteral nutrition (PN) provision, ensuring safety, proper management, and effective communication.

Deck 11: Parenteral Nutrition