Deck 15: Enteral and Parenteral Nutrition Support

Question 1

One method of making the transition from an intravenous feeding to an oral diet is to place the client on a tube feeding.

Answer 1

True

Question 2

Patients undergoing severe metabolic stress may develop hyperglycemia, which is a common complication associated with TPN.

Answer 2

True

Question 3

Low-profile gastrostomy tubes are often preferred by children and active adults for long-term home enteral nutrition programs.

Answer 3

True

Question 4

The economic impact of home nutrition support programs is a concern for people on these programs.

Question 5

If a client tolerates a formula after it is initiated, the rate of a continuous feeding should be increased by about 30 milliliters per hour every 8 to 10 hours.

Question 6

Enteral nutrition includes:

A)TPN.
B)PPN.
C)tube feedings.
D)simple IVs.

Question 7

Most duodenal and jejunal feedings are delivered by continuous drip.

Question 8

Enteral nutrition is more costly than parenteral nutrition.

Question 9

In PPN the osmolarity of a feeding solution is usually limited to 500 milliosmoles per liter.

Question 10

Enteral nutrition is preferred over parenteral nutrition because enteral nutrition is associated with fewer complications.

Question 11

Any drug-nutrient interaction that occurs between conventional foods and drugs can occur between formulas and drugs as well.

Question 12

Standard IV amino acid solutions contain essential amino acids but no nonessential amino acids.

Question 13

Insertion of peripherally inserted catheters is less invasive and more easily performed than direct insertion of catheters into central veins.

Question 14

Only when people cannot meet their nutrient needs using the enteral route should they receive total parenteral or intravenous (IV) nutrition support.

Question 15

When a patient is being tube fed, they cannot eat food.

Question 16

Once the need for intravenous nutrition has resolved, the client should be immediately taken off of the solution and put onto an oral diet.

Question 17

A patient's appetite may remain suppressed for several weeks after parenteral nutrition is terminated.

Question 18

Enteral nutrition provides nutrients using:

A)the lymphatic system.
B)the digestive tract.
C)central veins.
D)peripheral veins

Question 19

Highly concentrated nutrient solutions are not suitable for peripheral parenteral nutrition.

Question 20

Many tube feeding complications can be prevented by selecting the formula and feeding route wisely, preparing the formula correctly, and delivering it appropriately.

Question 21

All of the following statements describe modular formulas except they:

A)are prepared for patients who require specific nutrient combinations.
B)are created from individual macronutrients.
C)are complete formulas.
D)may be added to other enteral formulas to adjust the nutrient composition.

Question 22

Types of formulas that contain complete proteins are called:

A)disease-specific formulas.
B)hydrolyzed formulas.
C)standard formulas.
D)modular formulas.

Question 23

A formula that approximates the osmolality of normal blood serum:

A)is called a hypertonic formula.
B)is referred to as an isotonic formula.
C)has an osmolality of approximately 500 milliosmoles per liter.
D)is usually a hydrolyzed formula.

Question 24

You are working with a client whose ability to digest and absorb food is impaired, but whose nutrient needs are not elevated.Which of the following formulas would you select?

A)a standard formula
B)an elemental formula
C)a combination of modular formulas
D)a disease-specific formula

Question 25

Fiber in an enteral formula provides all of the following benefits except:

A)it normalizes intestinal function.
B)it helps to treat diarrhea and constipation.
C)it increases the caloric content of the formula.
D)it helps with blood glucose control.

Question 26

Aspiration risk is high for all of the following except:

A)patients with esophageal disorders.
B)patients with neuromuscular diseases.
C)patients who are unconscious.
D)patients with renal disease.

Question 27

The outer diameter of a feeding tube is measured in:

A)millimeters.
B)French units.
C)milliliters.
D)English units.

Question 28

An ideal formula for a client is one that:

A)meets medical and nutrient needs.
B)is the most expensive.
C)provides fiber.
D)contains lactose.

Question 29

Which of the following feeding tube placement sites would be the most appropriate for a client who is expected to be on a tube feeding for less than 4 weeks?

A)gastrostomy
B)jejunostomy
C)nasogastric
D)duodenostomy

Question 30

Parenteral nutrition refers to the delivery of nutrient solutions into:

A)the mouth.
B)a vein.
C)the intestines.
D)the stomach.

Question 31

Enteral formulas may be used orally to supplement a patient's diet.When this occurs, _____ becomes an important consideration.

A)taste
B)cost
C)osmolality
D)kcalorie content

Question 32

A "12 French" feeding tube has a diameter of:

A)2 mm.
B)4 mm.
C)6 mm.
D)8 mm.

Question 33

Which type of enteral formula usually has the highest osmolality?

A)standard formulas
B)modular formulas
C)specialized formulas
D)elemental formulas

Question 34

All of the following are characteristics of elemental formulas except:

A)they contain broken-down molecules of protein.
B)they require only minimal digestion.
C)they are used for clients who have a smaller than normal area for absorbing nutrients.
D)they are given to clients who are able to digest and absorb nutrients without difficulty.

Question 35

In infants, _____ tube placement may be preferred because it aids breathing.

A)nasogastric
B)nasoduodenal
C)orogastric
D)nasojejunal

Question 36

Feeding tubes:

A)may have one or two lumens.
B)are selected based on the largest diameter that will fit the patient.
C)are rigid and inflexible.
D)cannot be used when gastric decompression is necessary.

Question 37

A drawback to using specialized or disease-specific formulas is:

A)they are expensive.
B)patients do not tolerate them well.
C)they cause high gastric residuals.
D)they are not available for common chronic conditions.

Question 38

Most enteral formulas provide between:

A)0.5 and 0.9 kcalories per mL.
B)1.0 and 2.0 kcalorie per mL.
C)1.5 and 3.0 kcalories per mL.
D)2.0 and 8.0 kcalories per mL.

Question 39

Tube feedings are commonly used for individuals with:

A)malabsorption disorders.
B)high-output fistulas.
C)severe swallowing difficulties.
D)nonfunctional GI tracts.

Question 40

_____ formulas are made from whole foods and derive their protein primarily from pureed meat or poultry.

A)Standard
B)Hydrolyzed
C)Blenderized
D)Modular

Question 41

Phelebitis may develop as a result of:

A)tube feeding intolerance.
B)refeeding syndrome.
C)peripheral parenteral nutrition.
D)the use of hypertonic formulas.

Question 42

Which of the following medical conditions or treatments indicates the need for TPN?

A)severe swallowing disorders
B)mechanical ventilation
C)extremely high nutrient needs
D)paralytic ileus

Question 43

An adult's requirement for water is about:

A)1000 mL/day.
B)1500 mL/day.
C)2000 mL/day.
D)2500 mL/day.

Question 44

The main source of energy in parenteral solutions is:

A)amino acids.
B)glucose.
C)lipid emulsions.
D)fluids and electrolytes.

Question 45

To minimize the possibility of aspiration of formula in tube-fed clients, the head of the client's bed should be elevated:

A)after administering the feeding.
B)during administration of the feeding.
C)during and for 30-60 minutes after administration of the feeding.
D)during and for 2-3 hours after administration of the feeding.

Question 46

A procedure in which the stomach contents of a patient can be removed by suction is called:

A)gastric decompression.
B)enterostomy.
C)gastric residuals.
D)aspiration.

Question 47

A 5% dextrose solution contains:

A)2.5 grams of dextrose monohydrate per 100 mL.
B)5 grams of dextrose monohydrate per 100 mL.
C)2.5 grams of dextrose monohydrate per liter.
D)5 grams of dextrose monohydrate per liter.

Question 48

The advantages of a closed feeding system include:

A)less likelihood of contamination.
B)less expense.
C)increased nurse contact with the patient.
D)increased patient tolerance.

Question 49

Candidates for peripheral parenteral nutrition include clients who:

A)require a 1000-mOsm/L solution.
B)have fluid restrictions.
C)have high nutrient needs.
D)require short-term nutrition support.

Question 50

Compared to enteral nutrition, parenteral nutrition:

A)carries a greater risk of complications.
B)is less expensive.
C)can be used for longer periods of time.
D)requires hospitalization.

Question 51

All of the following are ways to prevent bacterial contamination of open system tube feedings except:

A)using fresh formula every 48 hours.
B)storing open or mixed formula in the refrigerator.
C)never adding fresh formula to formula that has been hanging.
D)changing the feeding container and tubing every 24 hours.

Question 52

Which of the following statements regarding transitioning from tube feeding to an oral diet is correct?

A)The patient must begin the transition by consuming the formula she has been receiving as an oral supplement.
B)The transition should be made all at once.
C)The patient shifts to an oral diet as the formula's volume is gradually decreased.
D)Oral intake should be about ¹/₃ of estimated nutrient needs when the tube feeding is discontinued.

Question 53

Which of the following statements is true regarding the administration of medications to patients who are tube fed?

A)Medications should be given by mouth when possible.
B)All medications should be crushed before placing them in the feeding tube.
C)Place the patient in a prone position before administering medications.
D)Give all medications before flushing the feeding tube.

Question 54

All of the following conditions raise water requirements except:

A)heart disease.
B)severe vomiting.
C)fever.
D)blood loss.

Question 55

Dextrose monohydrate provides _____ kcal/g.

A)0.9
B)1.8
C)2.5
D)3.4

Question 56

Delivering 250 to 500 milliliters of formula over 5 to 15 minutes is referred to as:

A)a bolus feeding.
B)a continuous drip feeding.
C)an intermittent feeding.
D)a slow drip feeding.

Question 57

Central TPN is indicated for each of the following except:

A)clients who cannot be fed through the GI tract.
B)situations in which long-term parenteral nutrition will be required.
C)situations in which fluids need to be restricted.
D)clients who are moderately malnourished.

Question 58

Before discontinuing a tube feeding, the patient's oral intake should meet about _____ of estimated nutrient needs.

A)¹/₃
B)¹/₂
C)³/₄
D)²/₃

Question 59

The amino acids in a parenteral solution provide _____ kcal per gram.

A)2
B)3.4
C)4
D)4.4

Question 60

Estimate the fluid needs of a 70-year-old female who weighs 110 pounds.

A)1000 mL
B)1500 mL
C)3000 mL
D)1050 mL

Question 61

Mr.Avery's swallowing ability and oral intake are improving.He is now consuming about ²/₃ of his estimated nutrient needs from oral intake.It would be appropriate at this time to:

A)discontinue the tube feeding.
B)increase the rate of the tube feeding.
C)decrease the rate of the parenteral feeding.
D)discontinue the parenteral feeding.
Use the following case study to answer questions 63-68.
Mr)Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center upon being found unconscious in his car in a parking lot and resuscitated.His history was obtained by contacting his daughter.The patient presents with:
$\bullet$ end-stage adenocarcinoma of the gastroestophageal juncture.
$\bullet$ chronic malnutrition and significant weight loss × 1 year.Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
$\bullet$ acute pancreatitis with intractable vomiting.
Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery.Meds: antilipemic medication, antihypertensive medication.
Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
Ht: 5'8".Admission Wt: 107 lbs.Usual Wt, 1 year ago: 170 lbs.
Social Hx: Lives alone; cooks and shops for himself despite illness.
Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
Mr)Edward is not being actively treated for cancer at his request.Plan is to keep Mr.Edward NPO and place a peripheral line for hydration and nutrition support.

Question 62

After two weeks, Mr.Avery is moved to a rehab facility.It would be appropriate at this time to change his feeding method to:

A)total parenteral nutrition.
B)an intermittent feeding.
C)an oral supplement.
D)peripheral parenteral nutrition.

Question 63

A parenteral solution containing 500 mL of a 20% lipid emulsion would provide _____ kcalories from lipids.

A)550
B)1000
C)1500
D)1800

Question 64

Which of the following trace minerals is not included in a parenteral solution?

A)zinc
B)copper
C)iron
D)selenium

Question 65

Parenteral nutrition can be discontinued when _____ of estimated energy needs are being met by oral intake, tube feeding, or a combination of the two.

A)35-50%
B)25-35%
C)35-75%
D)65-75%

Question 66

How many kcalories would a client receive from an IV solution containing 1000 mL of 50% dextrose and 1200 mL of 7% amino acid solution?

A)1785
B)1942
C)2036
D)2124

Question 67

To prevent refeeding syndrome in a severely stressed individual you would:

A)start feedings at a slow rate.
B)introduce nutrients by vein.
C)provide vitamin supplements.
D)delay enteral feedings.

Question 68

Long-term TPN may result in complications such as:

A)gallbladder disease.
B)heart disease.
C)diabetes.
D)cancer.

Question 69

The appropriate method for administering TPN to a critically ill and malnourished patient is:

A)as a bolus infusion.
B)via continuous infusion.
C)via cyclic infusion.
D)as needed.

Question 70

All of the following are criteria for the selection of candidates for home parenteral and enteral nutrition except:

A)the cleanliness of the home environment.
B)the client's financial resources.
C)the ability of the patient or caregiver to learn the necessary procedures.
D)the client's expected lifespan.
Use the following case study to answer questions 57-62.
Mr)Avery is a 77-year-old retired engineer.He is 5'10" tall and weighs 171 pounds.He suffered a stroke, which left him with left-sided paralysis, and he is having difficulty swallowing so he is unable to meet his nutritional needs via oral intake at this time.

Question 71

In the absence of any pre-existing medical problems or problems with digestion and absorption, the type of enteral formula that would be most appropriate for Mr.Avery is a(n):

A)standard formula.
B)elemental formula.
C)specialized formula.
D)3-in-1 solution.

Question 72

Lipid emulsions that contain excessive linoleic acid may:

A)hamper immune responses.
B)minimize negative nitrogen balance.
C)spare vital protein.
D)contribute to hyperglycemia.

Question 73

Mr.Avery's feeding is being delivered continuously by an infusion pump.The advantage of a continuous feeding is:

A)an accurate and steady flow rate.
B)less expense.
C)more freedom of movement for the patient.
D)less risk of diarrhea.

Question 74

Rapid changes in infusion rates of a parenteral solution can cause:

A)fluctuations in blood glucose levels.
B)diarrhea.
C)obstructions.
D)infection.

Question 75

All of the following are true statements concerning IV lipid emulsions except that:

A)they provide essential fatty acids.
B)they are hypertonic.
C)they are a concentrated source of energy.
D)they are often infused daily.

Question 76

Lipid infusions must be restricted in patients with:

A)diseases that require fluid restriction.
B)hypertriglyceridemia.
C)hyperglycemia.
D)hyperkalemia.

Question 77

Mr.Avery's physician is hopeful that his swallowing ability will improve in the coming weeks.Which feeding route would be most appropriate for Mr.Avery at this time?

A)orogastric
B)nasojejunal
C)nasogastric
D)parenteral

Question 78

A parenteral solution that contains dextrose, amino acids, and lipids is called a:

A)standard formula.
B)modular formula.
C)2-in-1 solution.
D)total nutrient admixture.

Question 79

Which form of nutrition support is appropriate for Mr.Avery at this time?

A)total parenteral nutrition
B)tube feeding
C)oral enteral supplement
D)peripheral parenteral nutrition

Question 80

A condition that may develop when a severely malnourished person is aggressively fed is called:

A)shock.
B)refeeding syndrome.
C)translocation.
D)systemic inflammatory response syndrome.