Question 1

What are the benefits of enteral formulas with fiber?

Accepted Answer

Fiber helps maintain normal bowel function by promoting regularity and preventing constipation.

Question 2

Which of the following feedings is isotonic?

Accepted Answer

Isocal has an osmolality of 300 mOsm/kg which is within the range of isotonic solutions (250-350 mOsm/kg). Isotonic fluids have an osmolality similar to that of normal human plasma, which ranges from 275-295 mOsm/kg. Isocal has an osmolality of 300 mOsm/kg, which falls within this range and is therefore an isotonic feeding. The other choices have osmolalities higher than 300 mOsm/kg and are either hypertonic (Boost, Vivonex) or borderline hypertonic (Traumacal).

Question 3

Which of the following is a contraindication for tube feeding?

Accepted Answer

Hypomotility of the small intestine is a contraindication for tube feeding because it can lead to poor absorption and complications like bacterial overgrowth.

Question 4

In cases of gastroparesis, which methods of support would yield the best results?

Accepted Answer

The nasoduodenal method is the best choice in cases of gastroparesis because it bypasses the stomach and delivers nutrition directly into the small intestine where it can be absorbed more easily. Other methods, such as nasogastric and orogastric, may not be effective because the stomach is not functioning properly and may not be able to digest and absorb nutrients. Oral intake may also be difficult or inadequate in cases of gastroparesis. Nasoduodenal feeding would be the best choice for gastroparesis because it bypasses the stomach and delivers nutrients directly to the small intestine, which can improve symptoms such as nausea and vomiting. Nasogastric and orogastric feeding methods would still require the stomach to process the food, which may exacerbate symptoms. Oral feeding may not be feasible if a patient has severe gastroparesis and cannot tolerate oral intake.

Question 5

Your patient has had a portion of his stomach resected The physician predicts that he will likely be on nutrition support for a long time He has a functional GI tract What is the best way to feed this patient?

Accepted Answer

A jejunostomy, also known as a J-tube, would be the best option for this patient because they have a functional GI tract but a portion of their stomach has been surgically removed. This means that they may not be able to tolerate oral feedings initially and may require tube feedings. Jejunostomy allows for direct administration of the feeding formula into the small intestine, bypassing the stomach. This can reduce the risk of nausea, vomiting, and dumping syndrome. TPN and PPN are not the best choices because the patient has a functional GI tract, and tube feeding through PEG may not be viable as a portion of the stomach has been surgically removed.

Question 6

Which type of feeding tube is the most common, least expensive, and easiest to achieve and maintain?

Accepted Answer

Nasogastric tubes are the most common type of feeding tube due to their ease of placement and maintenance, as well as being relatively inexpensive compared to other types of tubes. Oragastric tubes, although also easy to place, are less commonly used due to increased risk of aspiration. Nasojejunal and nasoduodenal tubes are less common and typically used for specific medical conditions or situations. Nasogastric tubes are the most commonly used feeding tubes due to their ease of placement and lower cost compared to other types of feeding tubes. They are also easier to maintain than other tubes, as they can easily be replaced or repositioned if necessary.

Question 7

Formulas containing di- and tripeptides are termed:

Accepted Answer

Di- and tripeptides are formed by the hydrolysis of proteins. Therefore, formulas containing these peptides are termed hydrolyzed. Formulas containing di- and tripeptides are formed by the hydrolysis of larger protein molecules, and are therefore considered to be hydrolyzed.

Question 8

A disadvantage of using the gastrostomy route for a tube feeding is:

Accepted Answer

While all of the options listed are potential disadvantages, option B is the most specific to the gastrostomy route. Regurgitation, or the backward flow of stomach contents, can be more common with this method of feeding due to the opening in the stomach. The disadvantage of using the gastrostomy route for a tube feeding is that the feedings are sometimes regurgitated. The other options listed are not disadvantages of using the gastrostomy route for tube feeding. In fact, bypassing the stomach can be an advantage in some cases, such as when a patient has gastroparesis or other conditions affecting stomach emptying. The intestine is also capable of absorbing nutrients, so there is not necessarily a disadvantage to bypassing the stomach in this way.

Question 9

Which tube feeding administration is most useful for people who have poor tolerance to larger volumes of formula?

Accepted Answer

Continuous drip feeding is most useful for people who have poor tolerance to larger volumes of formula because it delivers nutrition at a slow, steady rate, reducing the risk of gastrointestinal discomfort.

Question 10

Which of the following tube feedings would leave the least residue in the gut?

Accepted Answer

A hydrolyzed formula is broken down into its smallest components, making it easier for the body to absorb and leaving less residue in the gut. Blenderized and polymeric formulas contain larger molecules and may leave more residue. Fiber-added formulas can also leave more residue and may cause discomfort or bowel obstruction in some patients. A hydrolyzed formula has already undergone partial or complete breakdown of its protein into smaller components. As a result, it leaves the least amount of residue in the gut, making it the best choice for patients who are intolerant of a high residue diet or have compromised gut function. Blenderized formulas contain whole foods, which may contribute to higher residue in the gut. Polymeric formulas contain intact protein and fiber, while fiber-added formulas contain added fiber, both of which may contribute to higher residue in the gut.

Question 11

Which of the following is true about enteral formulas?

Accepted Answer

Enteral formulas are often lactose free to accommodate individuals who are lactose intolerant or have malabsorption issues. Choice A is incorrect because enteral formulas may contain some short chain fatty acids (SCFA), but not always. Choice C is incorrect because enteral formulas typically contain amino acids or peptides, but not dipeptides. Choice D is incorrect because the source of fat in enteral formulas can vary and may include soybean oil, medium chain triglycerides (MCT), or a combination of different oils. Enteral formulas are designed to be lactose-free as lactose intolerance and malabsorption is common in individuals requiring enteral formula feedings. The composition of enteral formulas includes proteins, carbohydrates (sugars and fibers), and fats, but not necessarily dipeptides. The source of fat may vary depending on the specific formula and can include canola oil, soy oil, or medium-chain triglycerides (MCTs). SCFA (short-chain fatty acids) are typically produced in the colon through fermentation of dietary fibers and are not typically included in enteral formulas.

Question 12

You have a patient who weighs 215# and is on dialysis This patient often presents with edema Which of the following formulas would be best for this patient?

Accepted Answer

A nutrient-dense formula would be best for this patient as it provides a higher amount of nutrients per calorie, which can help manage the patient's fluid overload due to edema without causing malnutrition. Nutrient dense formula would be the best choice for this patient as it is designed to provide adequate nutrition while limiting fluid accumulation. This will be beneficial for the patient as they often present with edema.

Question 13

What is the consequence of a hyperosmolar formula?

Accepted Answer

A hyperosmolar formula can draw water into the intestines, leading to diarrhea.

Question 14

Which of the following is not a contraindication to enteral feeding?

Accepted Answer

Paralytic ileus, nonresponsive intractable vomiting and diarrhea, and intestinal obstruction distal to tube are all contraindications to enteral feeding. However, severe dysphagia may require modifications to the feeding method or tube placement, but it is not an absolute contraindication. Paralytic ileus, nonresponsive intractable vomiting and diarrhea, and intestinal obstruction distal to tube are all contraindications to enteral feeding. Severe dysphagia may be a reason to consider enteral feeding in order to bypass the oral route.

Question 15

Formulas containing crystalline amino acids are termed:

Accepted Answer

Formulas containing crystalline amino acids are referred to as elemental formulas, which contain amino acids in their simplest form. Formulas containing crystalline amino acids are called elemental formulas. These formulas provide protein in the form of individual amino acids, as opposed to intact protein. Semi-elemental formulas contain small peptides in addition to amino acids, while modular formulas provide individual amino acids and small peptides in separate components.

Question 16

Your patient has Crohn's disease and presents with severe malabsorption Which of the following formulas would be best for this patient?

Accepted Answer

The patient with severe malabsorption due to Crohn's disease would benefit from a hydrolyzed formula, which is already partially broken down and easier for the body to absorb. This type of formula is typically recommended for those with malabsorption issues or impaired digestive function. Hydrolyzed formulas are partially or completely broken down into smaller proteins, which can be easier for patients with malabsorption issues to digest and absorb. This is especially important for patients with Crohn's disease, as they may have difficulty absorbing nutrients due to inflammation in the intestines. Intact formulas contain whole proteins and may be more difficult for these patients to digest. Immune enhancing and lactose free formulas may be beneficial for certain patients, but do not specifically address malabsorption issues.

Question 17

How much additional water would a patient with an energy requirement of 2400 kcal/day need if 2400 mL of a standard formula (85% water) were administered daily?

Accepted Answer

The patient needs 2400 mL of water per day. The standard formula provides 2400 mL x 0.85 = 2040 mL of water. Therefore, the patient needs an additional 2400 mL - 2040 mL = 360 mL of water per day.

Question 18

Concern about the adverse side effects of long-chain fats has given rise to formulas supplemented with _____ to boost immunity

Accepted Answer

Omega-3 fatty acids have been shown to have immune-boosting properties and can be added to formulas as a supplement to counteract any potential negative effects of long-chain fats. MCT oil is also a popular supplement for its easy absorption and metabolism, but it is not specifically known for its immune-boosting properties. FOS (fructooligosaccharides) is a prebiotic that can improve gut health, but it is not directly related to immunity. CHO (carbohydrates) are a macronutrient and do not have any specific immune-boosting properties. Omega-3 fatty acids have been shown to have immune-boosting properties and are a safer alternative to long-chain fats. MCT oil may also be added to formulas, but it does not specifically boost immunity. FOS (fructooligosaccharides) and CHO (carbohydrates) are not typically added to formulas for immune-boosting purposes.

Question 19

If a physician places a feeding tube through the skin and into the stomach without a surgical incision and using an endoscope, it is most specifically referred to as:

Accepted Answer

The description given is most specifically referring to a percutaneous endoscopic gastrostomy (PEG) tube placement. A gastrostomy is a general term for a surgical opening into the stomach for feeding, which does not involve an endoscope. Nasogastric and orogastric tubes are typically placed through the nose or mouth, not through the skin, and do not require an endoscope. This procedure is specifically referred to as a percutaneous endoscopic gastrostomy (PEG), which involves placing a tube into the stomach through the skin without a surgical incision but using an endoscope. Nasogastric and orogastric refer to inserting a tube through the nose or mouth respectively, and gastrostomy refers to a surgical incision being made.

Question 20

A formula feeding that is administered within the space of a few minutes is a:

Accepted Answer

A bolus feeding is a rapid administration of formula within several minutes, typically delivered via syringe or feeding pump. This is in contrast to a continuous feeding, which is delivered slowly over a longer period of time. A single feeding refers to one feeding session, but does not specify the speed of delivery. A complete feeding could refer to either a single feeding or a series of feedings, but again does not specify the speed of delivery. "Quick delivery system" is not a commonly used term in the context of enteral feeding. A bolus feeding is a large amount of formula that is administered quickly, usually within 10-20 minutes. It may be given several times a day and is often used for people who have difficulty tolerating smaller, more frequent feedings. Single and complete feedings are not used to describe the speed of administration, and "quick delivery system" is not a commonly used term in the context of enteral feedings.

Quiz 5: Enteral and Parenteral Nutrition Support