Deck 19: Nutrition Support: Enteral and Parenteral Nutrition

Question 1

If a patient's dietary intake is inadequate, the first step in nutrition support should be to:

A) prescribe vitamin supplements.
B) begin parenteral nutrition.
C) begin enteral tube feeding.
D) provide small, frequent meals and liberalize modified diets.

Answer 1

D

Question 2

Energy needs may be 50% to 100% above basal energy expenditure in patients with:

A) sepsis.
B) severe burns.
C) bone fractures.
D) cancer cachexia.

Answer 2

B

Question 3

A client would be a candidate for total parenteral nutrition (TPN) if he or she had:

A) a poor appetite after major surgery.
B) severe depression and unwillingness to eat.
C) radiation enteritis causing minimal food intake for over 2 weeks.
D) lost more than 10% of usual body weight in the past 9 months.

Answer 3

C

Question 4

During critical illness, plasma levels of the hepatic proteins (albumin, transferrin, and prealbumin) generally indicate:

A) overall nutritional status.
B) hydration status.
C) risk of morbidity and mortality.
D) nitrogen balance.

Question 5

The person who is most likely to have a high risk of malnutrition is one with:

A) a superficial first-degree burn.
B) chronic disease.
C) cataracts.
D) a heart attack.

Question 6

The types of carbohydrate most commonly used in enteral nutrition formulas are:

A) polysaccharides and oligosaccharides.
B) glucose polymers.
C) dextrose.
D) monosaccharides.

Question 7

Measurement of nitrogen balance requires:

A) an accurate 24-hour urine collection.
B) a 24-hour feces collection.
C) measurement of serum albumin.
D) high protein intake.

Question 8

The most important factor in decisions concerning use of parenteral nutrition is:

A) age.
B) gender.
C) competence of the clinical nutritionist.
D) status of the gastrointestinal tract.

Question 9

A problem associated with use of blenderized formulas is:

A) lack of flavor.
B) lack of viscosity.
C) bacterial contamination.
D) nutrient density.

Question 10

Prebiotics or probiotics may be added to enteral formulas to improve:

A) the viscosity of the formula.
B) the osmolality of the formula.
C) the intestinal flora in the gastrointestinal tract.
D) motility in the gastrointestinal tract.

Question 11

In most critically ill patients, energy needs do not exceed basal energy needs by more than:

A) 10%.
B) 20%.
C) 30%.
D) 50%.

Question 12

Subjective global assessment relies on information from:

A) history and physical examination.
B) biochemical and anthropometric data.
C) the patient's own assessment of his or her condition.
D) the health care team's collective opinions.

Question 13

Essential fuel sources for critically ill patients are:

A) dextrose and lipid emulsions.
B) protein and vitamins.
C) glucose and electrolytes.
D) glucose and protein.

Question 14

If a patient weighed 150 lb 6 months ago and now weighs 130 lb, the weight loss would be considered:

A) mild.
B) moderate.
C) significant.
D) severe.

Question 15

The timing of beginning nutrition support depends on the patient's:

A) age.
B) weight.
C) nutritional status.
D) personal preferences.

Question 16

Lactose is not usually used in commercial enteral nutrition formulas because:

A) it is too sweet.
B) it exerts too much osmotic pressure.
C) lactose intolerance is common in critically ill patients.
D) it interferes with drug absorption.

Question 17

Complications associated with parenteral nutrition include:

A) low blood glucose levels.
B) electrolyte abnormalities.
C) loss of appetite.
D) depression.

Question 18

When an open delivery system is used for tube feeding, the maximum hang time for the formula is:

A) 2 hours.
B) 8 hours.
C) 24 hours.
D) 48 hours.

Question 19

The nutrient density of most commercial enteral formulas is:

A) 1 to 2 kcal/mL.
B) 2 to 5 kcal/mL.
C) 4 to 5 kcal/mL.
D) 4 to 10 kcal/mL.

Question 20

The Mifflin-St. Jeor equations for calculating basal energy expenditure are based on:

A) sex and weight.
B) lean body mass and age.
C) sex, height, weight, and age.
D) sex, height, and ideal body weight.

Question 21

A rich source of the essential fatty acids linoleic and linolenic acids is:

A) vegetable oil.
B) butterfat.
C) monoglycerides.
D) diglycerides.

Question 22

Nasoenteric tubes can be inserted into the stomach, duodenum, and:

A) rectum.
B) jejunum.
C) ileum.
D) gallbladder.

Question 23

If a client requires parenteral nutrition for the next 4 months, the route of choice for feeding will probably be via a:

A) nasogastric tube.
B) central vein.
C) nasoenteric tube.
D) peripheral vein.

Question 24

The most appropriate route of feeding for a client with gastric cancer is via a(n):

A) esophagostomy.
B) gastrostomy.
C) jejunostomy.
D) ileostomy.

Question 25

In critically ill patients, tolerance of enteral tube feedings is generally best when feedings are:

A) continuous.
B) intermittent.
C) boluses.
D) cyclic.

Question 26

Formula intolerance may be indicated by:

A) bloating and constipation or diarrhea.
B) consistent daily weight and fluid balance.
C) patient fatigue and weakness.
D) low serum albumin and transferrin levels.

Question 27

One form of protein that is often used in standard enteral nutrition formulas is:

A) denatured.
B) intact.
C) essential.
D) incomplete.

Question 28

Regular monitoring of a client who is receiving tube feeding includes:

A) serum sodium and potassium.
B) serum albumin, prealbumin, and transferrin.
C) 24-hour urine and clean-catch urine.
D) serum iron.

Question 29

A common definition of diarrhea is:

A) more than three stools per day or greater than 500 mL of stool per day for 2 consecutive days.
B) more than five stools per day for 3 consecutive days.
C) more than three watery stools in 4 hours accompanied by signs of dehydration.
D) at least 200 g of unformed stool for 3 consecutive days.

Question 30

Weight should be measured daily in patients receiving nutrition support to help determine their:

A) nutritional status.
B) hydration status.
C) energy balance.
D) nitrogen balance.

Question 31

Peripheral parenteral nutrition is appropriate when the patient requires parenteral nutrition for less than:

A) 5 days.
B) 7 days.
C) 14 days.
D) 20 days.

Question 32

If a tube-fed patient has blood glucose values higher than 200 mg/dL, he or she should be given:

A) insulin.
B) a prokinetic agent.
C) formula with added fiber.
D) a low-carbohydrate formula.

Question 33

The American Medical Association recommends that trace elements added to parenteral nutrition solutions should include:

A) iron, zinc, calcium, and phosphorus.
B) sodium, potassium, copper, and chloride.
C) zinc, copper, manganese, and chromium.
D) manganese, selenium, fluoride, and iron.

Question 34

Patients who are receiving enteral feedings should:

A) sit upright in a chair.
B) have the head of the bed elevated 30 to 45 degrees.
C) have their head and feet elevated 30 to 45 degrees.
D) lie flat.

Question 35

Osmotic pressure (osmolality) of an enteral nutrition formula is determined by the:

A) amount of fat in the solution.
B) size of particles in the solution.
C) viscosity of the solution.
D) number of particles in the solution.

Question 36

Individual intolerance of a formula is most likely to be caused by:

A) drug interactions.
B) temperature.
C) osmolarity.
D) the form of fat used.

Question 37

In enteral nutrition formulas that contain amino acids, the form of the amino acids is:

A) simple.
B) complex.
C) hydrolyzed.
D) crystalline.

Question 38

Signs of overhydration include:

A) elevated blood urea nitrogen level.
B) weight loss.
C) decreased blood pressure.
D) edema.

Question 39

The preferred route for long-term enteral feeding is:

A) nasogastric.
B) enterostomal.
C) nasoenteric.
D) peripheral vein.

Question 40

Clients who are on ventilators, are restrained, are comatose, or have a depressed gag reflex and are receiving tube feedings should have feeding tubes placed into the:

A) jejunum.
B) stomach.
C) ileum.
D) duodenum.

Question 41

The percentage of energy provided by protein in parenteral nutrition is normally:

A) 10% to 15%.
B) 10% to 20%.
C) 15% to 20%.
D) 20% to 30%.

Question 42

Intravenous iron should be given to patients receiving parenteral nutrition:

A) daily.
B) weekly.
C) as a separate injection.
D) only if they have anemia.

Question 43

Placement of enteral feeding tubes should be confirmed using:

A) x-ray examination.
B) magnetic resonance imaging.
C) manual verification.
D) aspirates of gastrointestinal fluids.

Question 44

The amount of energy provided by dextrose in parenteral nutrition solutions is:

A) 2.4 kcal/g.
B) 3.4 kcal/g.
C) 4.0 kcal/g.
D) 4.3 kcal/g.

Question 45

To prevent essential fatty acid deficiency, the percentage of energy provided by lipid in parenteral nutrition solutions should be at least:

A) 1% to 2%.
B) 2% to 4%.
C) 4% to 10%.
D) 10% to 15%.

Question 46

The form of protein used in standard parenteral nutrition solutions is:

A) hydrolyzed protein.
B) essential amino acids.
C) crystalline amino acids.
D) branched-chain amino acids.

Question 47

During the first 24 hours of TPN formula administration, the amount of carbohydrate infused should not exceed:

A) 50g.
B) 100g.
C) 200g.
D) 250g.