Deck 5: Enteral and Parental Nutrition Support

Question 1

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

A) ​consider electrolyte needs.
B) ​establish a dosing weight.
C) ​determine fluid needs.
D) ​determine a kcal goal.
E) ​consider vitamin and mineral needs.

Answer 1

B

Question 2

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

A) ​diffuse peritonitis
B) ​intestinal obstruction
C) ​GI bleeding
D) ​impaired swallowing
E) ​intractable vomiting

Answer 2

D

Question 3

Which describes a true statement about continuous enteral feedings?

A) ​They are administered several times a day -- every 30 minutes.
B) ​They may be administered by gravity from a container suspended above the patient.
C) ​They consist of the administration of approximately 250 mL of formula at a time.
D) ​They are usually more time consuming for staff to administer.
E) ​They require a pump and other equipment to administer.

Answer 3

E

Question 4

For the critically ill patient in the hospital, enteral feedings should be advanced to meet the nutrition prescription within:

A) ​12 hours.
B) ​48 hours.
C) ​72 hours.
D) ​1 week.
E) ​2 weeks.

Question 5

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

A) ​Instill heparin into the tubing
B) ​Slow the feeding to run at ½ the normal rate for one hour a day
C) ​Use a small volume syringe and add air into the tube
D) ​Flush with 25 mL of tap water several times a day
E) ​Reinsert the stylet that was used during tube placement

Question 6

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

A) ​every day.
B) ​3 times per week.
C) ​every week.
D) ​every 1-2 weeks.
E) ​prn.

Question 7

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

A) ​The tube can be inserted at the bedside
B) ​The tube is used for short-term feedings
C) ​It allows for bolus feedings
D) ​There is little risk of infection
E) ​The tube can be used for IV fluids

Question 8

A surgeon places a feeding tube that provides nutrients directly into the patient's stomach. This type of tube is called a:

A) ​nasogastric tube.
B) ​jejunostomy
C) ​surgical gastrostomy.
D) ​percutaneous endoscopic gastrostomy.
E) ​surgical gastrectomy.

Question 9

The thickness of a liquid is known as its:

A) ​osmolality.
B) ​viscosity.
C) ​nutrient density.
D) ​osmolarity.
E) ​coagulation.

Question 10

Which is an example of a research-supported reason to use enteral nutrition support?

A) ​Decreased risk of respiratory infections
B) ​Improved wound healing
C) ​Increased tolerance of formulas
D) ​Complete nutritional coverage
E) ​Ease of administration

Question 11

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

A) ​parenteral nutrition.
B) ​bolus feedings.
C) ​refeeding.
D) ​intermittent feeding.
E) ​trophic nutrition.

Question 12

Which best describes a disadvantage of using a nasogastric tube in a patient?

A) ​Discomfort for the patient
B) ​Formula must be delivered by pump only
C) ​It requires a surgical procedure
D) ​There is a risk of infection at the site
E) ​There is a greater risk of tube clogging

Question 13

Which is an example of a true statement regarding peripheral parenteral nutrition (PPN)?

A) ​PPN instills small volumes of concentrated fluids.
B) ​PPN requires only small amounts to be nutritionally adequate
C) ​PPN is typically most acceptable for a fluid-restricted patient.
D) ​The high osmolality of PPN may cause small veins to collapse.
E) ​Peripheral access for PPN is easier to maintain than a central line.

Question 14

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

A) ​A patient with Crohn's disease
B) ​A pregnant patient
C) ​A patient with an endotracheal tube
D) ​A patient with celiac disease
E) ​A patient with a concurrent diagnosis of cancer

Question 15

Which patient is most likely at risk of refeeding syndrome?

A) ​A patient recovering from outpatient surgery
B) ​A patient with gastroesophageal reflux
C) ​A patient with hypermagnesemia
D) ​A patient with osteoporosis
E) ​A patient with a history of long-term inadequate oral intake

Question 16

In which condition would parenteral nutrition most likely be indicated?

A) ​Short bowel syndrome
B) ​Increased oral fluid intake
C) ​Hyperkalemia
D) ​Severe dysphagia
E) ​Cardiovascular disease

Question 17

A registered dietitian is assisting with 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?

A) ​Insert the tube in the patient's nose and advance the tube
B) ​Obtain an abdominal radiograph
C) ​Remove the stylet from the tube
D) ​Measure for gastric placement
E) ​Tape the tube to the patient's nose

Question 18

The usual nutrient density of enteral formulas ranges between:

A) ​0.5 and 1.0 kcal/mL
B) ​1.0 and 2.0 kcal/mL
C) ​2.0 and 2.5 kcal/mL
D) ​3.0 and 3.5 kcal/mL
E) ​4.0 and 5.5 kcal/mL

Question 19

The protein component of most enteral formulas comes from:

A) ​lactose.
B) ​monosaccharides.
C) ​dextrin and fatty acids.
D) ​albumin and whey.
E) ​soy or casein.

Question 20

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

A) ​Instill blue dye into the feeding
B) ​Check a level of lung aspirate daily
C) ​Elevate the head of the bed at least 30 degrees
D) ​Instill the feeding at a faster rate
E) ​Increase fiber to 8 g in each supplement

Question 21

Which is the correct amount of kcalories needed daily for this patient to maintain normal body weight?

A) ​1110 - 1750 kcal
B) ​1840 - 2210 kcal 
C) ​2350 - 2380 kcal
D) ​2900 - 3020 kcal
E) ​3150 - 3200 kcal

Question 22

A lipid-based drug that is often administered to the critically ill patient is called:

A) ​Hydrosol.
B) ​Hepatosol.
C) ​Propofol.
D) ​Aminess.
E) ​Clinisol.

Question 23

A three-in-one solution of parenteral nutrition prepared by an automated compounder contains:

A) ​fatty acids, iron, and monosaccharides.
B) ​dextrose, amino acids, and lipids.
C) ​omega-3 fatty acids, triglycerides, and commercial amino acids.
D) ​oligosaccharides, leucine, and valine.
E) ​nonessential amino acids, dextrose, and vitamins.

Question 24

Which type of complication is most often associated with parenteral nutrition administration?

A) ​rash
B) ​lung damage
C) ​Osteoporosis
D) ​kidney stones
E) ​Infection

Question 25

How much folic acid is typically required in an adult preparation of parenteral nutrition?
2 mg

A) ​250 mcg
B) ​500 mcg
C) ​600 mcg
D) ​1 mg
E) ​2 mg

Question 26

Which statement regarding an implantable port would be considered true?

A) ​An implantable port may be placed by a surgeon or a specially trained registered nurse.
B) ​An implantable port is usually inserted into the arm and threaded to the vena cava.
C) ​An implantable port must have the catheter changed every few days to reduce the risk of infection.
D) ​An implantable port may be difficult to access by the patient.
E) ​An implantable port is only suitable for short-term access.

Question 27

Which situation must be considered when making a decision to start parenteral nutrition?

A) ​The length of time nutrition support is needed
B) ​The patient's BMI
C) ​The patient's need for amino acids in solution
D) ​The physician's ability to obtain an order
E) ​The need for an automated compounder

Question 28

The Hickman® catheter is an example of which type of catheter used for parenteral nutrition?

A) ​peripherally inserted central catheter
B) ​non-tunneled catheter
C) ​implantable port
D) ​tunneled catheter
E) ​Swan-Ganz catheter

Question 29

The minimum amount of carbohydrate found in parenteral nutrition as specified by the DRI is:

A) ​60 g/day.
B) ​130 g/day.
C) ​200 g/day.
D) ​240 g/day.
E) ​300 g/day.

Question 30

Which element is not added routinely to standard parenteral nutrition formulas?​

A) ​selenium
B) ​zinc
C) ​iron
D) ​chromium
E) ​copper

Question 31

Which situation would require that the patient change from enteral nutrition to parenteral nutrition?

A) ​The patient loses 5 pounds
B) ​The patient develops a paralytic ileus
C) ​The patient can no longer afford enteral nutrition 
D) ​The patient develops sleeping problems
E) ​The protein content of the enteral nutrition needs to be changed

Question 32

The primary source of carbohydrate in parenteral nutrition comes from:

A) ​modified food starch.
B) ​maltose oligosaccharides.
C) ​dextrose monohydrate.
D) ​arginine polyesterols.
E) ​high fructose corn syrup.

Question 33

Calculate the daily fluid requirements for this patient.

A) ​1000 mL
B) ​1800 mL
C) ​2200 mL
D) ​3100 mL
E) ​3400 mL

Question 34

Which type of medication would most likely be added to parenteral nutrition solution for patient care?

A) ​acetaminophen
B) ​keterolac
C) ​fentanyl
D) ​cimetidine
E) ​demerol 

Question 35

Which condition is an example of a gastrointestinal complication that may develop with parenteral feedings?

A) ​irritable bowel syndrome
B) ​cholestasis
C) ​dumping syndrome
D) ​nausea
E) ​gastroesophageal reflux

Question 36

Which best describes a common consequence of malnutrition?

A) ​increased gastric emptying
B) ​delayed wound healing
C) ​Cirrhosis
D) ​atrophic gastritis
E) ​hearing loss

Question 37

Which describes an advantage of compounding parenteral solutions in the hospital pharmacy?

A) ​Cost effectiveness
B) ​Increased patient satisfaction
C) ​Decreased risk of infection
D) ​The ability to combine blood products with the solution, if necessary
E) ​Reduction in nursing requirements

Question 38

Which method of providing enteral nutrition would be most appropriate for this patient?

A) ​orogastric tube
B) ​nasointestinal feeding tube
C) ​Jejunostomy
D) ​surgical gastrostomy
E) ​nasogastric tube

Question 39

Which describes recommended criteria for use of enteral feedings in a pediatric patient?

A) ​Weight loss of 5 pounds in 6 months
B) ​Unable to obtain 20% of caloric needs by mouth
C) ​Requiring over 4 hours a day to eat
D) ​Inadequate oral intake for over 48 hours
E) ​Persistent TSF below the 50th percentile

Question 40

How many grams of protein per kilogram of body weight does this patient need?

A) ​0.8
B) ​1.0
C) ​1.2
D) ​1.5
E) ​2.0

Question 41

_______________ is added to formulas and is generally thought to improve stool consistency and reduce diarrhea.

Question 42

Among infants, _______________ or _______________ are typically used for enteral feedings.

Question 43

Peripheral parenteral nutrition requires large volumes to meet nutritional needs, which makes this route unacceptable for any fluid-restricted patient.

Question 44

The first decision to make when designing the nutrition prescription is how to establish access to the gastrointestinal tract.

Question 45

_______________ feeding tubes enter the gastrointestinal tract through the nose and reside in the duodenum or jejunum.

Question 46

A substance that is water loving or that attracts water is said to be _______________.

Question 47

Benefits attributed to fiber, particularly improved bowel function, have more often been associated with insoluble fiber.

Question 48

Up to 40% of nursing home patients exhibit some signs of malnutrition.

Question 49

In the geriatric population, nutrition support may not be initiated until oral intake has declined precipitously due to advanced progression of diseases.

Question 50

Enteral nutrition refers to delivery of nutrients distal to the oral cavity of the gastrointestinal tract via a tube, catheter, or _______________.

Question 51

The outer lumen diameter of a feeding tube is described using a measurement called _______________ size.

Question 52

Enteral formulas are often the sole source of water for patients receiving them.

Question 53

Recent research has reexamined the use of blenderized feedings and has demonstrated improved tolerance in some children with feeding disorders.

Question 54

Short-chain fatty acids are used by the intestinal cells, called _______________, as fuel and play a role in maintaining gastrointestinal integrity.

Question 55

Feeding access is achieved when a feeding tube is placed into the stomach or _______________.

Question 56

One of the most common disadvantages of surgical gastrostomy tubes is that they become dislodged easily.

Question 57

The osmolality of body fluids is _______________ mOsm/kg.

Question 58

Parenteral solutions may contain as many as 5 different items when they are initially compounded.

Question 59

_______________ feedings consist of the administration of 250-500 mL of formula several times daily.

Question 60

Post-pyloric access is most often used when the patient is at high risk of aspiration.

Question 61

Increased permeability to _______________ has been noted when atrophic intestinal cells result from lack of enteral stimulation.

Question 62

Explain indications for using parenteral nutrition and list several conditions that would require parenteral nutrition instead of enteral nutrition.

Question 63

If parenteral nutrition is administered continuously for several weeks, transient elevations in _______________ enzymes may be noted.

Question 64

_______________ is a term used to describe several common metabolic alterations that may occur during nutritional repletion of patients who are malnourished or in a state of starvation.

Question 65

Describe the procedure for inserting a nasogastric feeding tube.

Question 66

The wire guide within the enteral tube that assists with insertion is called the _______________.

Question 67

Describe the use of a pharmacy compounder with the nutrition prescription and list advantages as well as disadvantages.

Question 68

List five examples of nutrition diagnoses that would indicate a need for enteral nutrition.

Question 69

List and describe the three different types of enteral feeding methods.

Question 70

The primary difference between enteral and parenteral feedings is that nutrients are provided via the _______________ rather than the gastrointestinal tract in PN.

Question 71

Providing adequate free _______________ as well as using a fiber-supplemented formula are steps that may be performed to relieve constipation associated with enteral feedings.

Question 72

List the steps of determining the nutrition prescription.

Question 73

Describe indications, advantages, and disadvantages of the following types of enteral feeding tubes: nasogastric tubes, orogastric tubes, gastrostomy tubes, PEG tubes.

Question 74

Excessive _______________ in parenteral nutrition may contribute to hyperglycemia, hepatic steatosis, and excessive carbon dioxide production.

Question 75

Parenteral solutions are compounded under the supervision of a licensed _______________.

Question 76

The lipid in most parenteral solutions available in the United States is an emulsion of _______________.

Question 77

The most common type of parenteral access is a(n) _______________.

Question 78

List four examples of potential complications associated with parenteral nutrition.

Question 79

Give two examples of each of the following: short-term venous access, long-term venous access.

Question 80

List and describe four examples of complications associated with enteral feedings.