Chapter 11: Parenteral and Enteral Nutrition

Using D50W (50% dextrose in water), how many milliliters are required to compound a PN order for 525 g of dextrose? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

1050

A patient needs 110 grams of protein/day. If the pharmacy stocks Aminosyn 10%, how many milliliters of fluid will be supplied by the protein component? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

1100

An ICU patient requires 2,645 non-protein kcal/day. The patient is receiving 1,526 kcal from dextrose and 890 kcal from protein. How many kcal should be provided by the lipids? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

1119

A patient is receiving 650 mL of 10% lipids on Tuesdays and Thursdays. How many calories is the patient receiving from the lipids each week? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

1430

The pharmacy receives the following PN order. Using Aminosyn 15%, calculate how many milliliters of amino acids should be added to the PN. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.) Item/Quantities: Dextrose 270g Amino Acids 60g Sodium chloride 38 mEq Sodium acetate 16 mEq Potassium 40 mEq Magnesium sulfate 10 mEq Phosphate 21 mmol Calcium 4.45 mEq MVI-12 5mL Trace Elements 1mL Vitamin K-1 0.5mg Famotidine 10mg Regular Insulin 40 Units Sterile Water qs ad 980 mL

400

A patient will receive 114 grams of protein in the PN bag. How many calories are provided by the protein component? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

456

A PN contains 7 mL of potassium phosphate (each milliliter contains 3 mmol of phosphate and 4.4 mEq of potassium). The patient's daily potassium requirement is 42 mEq. How many milliliters of potassium chloride (2 mEq/mL) should be added to the PN to meet the potassium requirement? (Answer must be numeric; no units or commas; round the final answer to the nearest TENTH.)

5.6

A patient is receiving 275 mL of 20% lipids. How many calories is the patient receiving from the lipids? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

550

Using a 10% lipid emulsion, how many milliliters (mL) are required to provide 680 caloires? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

618

The pharmacist will add 60 mEq of sodium to the PN; half will be given as sodium acetate (2 mEq/mL) and half as sodium chloride (4 mEq/mL). How many milliliters of sodium chloride will be needed? (Answer must be numeric; no units or commas; round the final answer to the nearest ONE DECIMAL PLACE.)

7.5

A patient is receiving 500 mL of 10% Intralipid on Saturdays along with his normal daily PN therapy of 1,580 mL of D20W, 520 mL FreAmine 15% and 30 mL of electrolytes. What is the daily mount of calories provided by the lipids? (Answer must be numeric; no units or commas; round the final answer to the nearest TENTH.)

78.6

A pediatric patient is starting enteral nutrition with Nutren 2.0 premixed formula. the patient weighs 21 pounds and requires 1.4g/kg/day of protein. If Nutren 2.0 provides 16g/dL of protein, how many milliliters of Nutren 2.0 are required per day to meet the patient's protein requirement? (Answer must be numeric; no units or commas, round the final answer to the nearest WHOLE number.)

84

Calculate LM'S corrected calcium. (Answer must be numeric; no units or commas; round the final answer to the nearest TENTH.) Ca = 8.2 Albumin = 2.8

9.2

Calculate the corrected calcium for a patient with the following lab values. (Answer must be numeric; no units or commas; round the final answer to the nearest ONE DECIMAL PLACE.) *I'm just typing what you need, not all 20 lab values* Ca (mg/dL) = 7.8 (8.5 - 10.5) Albumin (g/dL) = 2.2 (3.5 - 5)

9.2

Which of the following represent additional items that may be added to a patient's total parenteral nutrition? (Select ALL that apply) A. Multivitamins B. Electrolytes C. Trace Elements D. Insulin E. Dopamine

A. Multivitamins B. Electrolytes C. Trace Elements D. Insulin

Which of the following is the principal extracellular cation? A. Potassium B. Manganese C. Magnesium D. Calcium E. Sodium

E. Sodium

Which of the following is the principal intracellular cation? A. Manganese B. Sodium C. Potassium D. Calcium E. Magnesium

Potassium

PV is a 46-year-old male (274 pounds) who has been admitted for bowel resection surgery. Post surgery, he is to be started on PN therapy. The physician wants the patient to receive 1.2g/kg/day of protein. Calculate his daily protein requirement in grams. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

149

A pharmacist mixes 200 mL of 20% dextrose with 100 mL of 5% dextrose. What is the final dextrose concentration (%w/v)? (Answer must be numeric; no units or commas.)

15

A pharmacy is preparing a PN order for 330 g of dextrose. How many milliliters of dextrose are required if the stock concentration of dextrose is 20%? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

1650

Using the Harris-Benedict equation below, calculate the resting basal energy expenditure for a major trauma patient (stress factor 1.8). The patient is a 58-year-old male who weighs 190 pounds and is 5'11". Activity factor is 1.2. (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.) BEE (males): 66.47 + 13.75 (Weight in kg) + 5.0 (Height in cm) - 6.76 (age in years) BEE (females): 655.1 +9.6 (weight in kg) + 1.85 (height in cm) - 4.68 (age in years)

1764

A patient requires 36 mmol of phosphate and 90 mEq of potassium in her PN. The pharmacy has stock solutions of potassium phosphate (3 mmol of phosphate and 4.4 mEq potassium per mL) and potassium chloride (2 mEq potassium/mL). How many milliliters of potassium chloride are required? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

19

Choose the correct indications for parenteral nutrition (PN) therapy. (Select ALL that apply.) A. Severe gut dysfunction due to various conditions, such as Crohn's disease, ulcerative colitis, obstruction and malabsorption. B. Inability to maintain nutritional requirements through oral or enteral feedings. C. All patients in ICU D. A patient who will be NPO for three days secondary to surgery E. A patient with mild acute pancreatitis

A. Severe gut dysfunction due to various conditions, such as Crohn's disease, ulcerative colitis, obstruction and malabsorption. B. Inability to maintain nutritional requirements through oral or enteral feedings.

A pharmacist receives an order for parenteral nutrition that includes 850 mL of D50%. The pharmacist checks the supplies and finds that the closest available strength is D70%. How many milliliters of D70% will provide an equivalent energy requirement? A. 405 mL B. 607 mL C. 350 mL D. 500 mL E. 850 mL

B. 607 mL

The pharmacist needs to add an additional 400 calories to a PN. If the pharmacist is using a 10% lipid emulsion, how many milliliters are required to meet the remaining calories? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

364

GO is a 71-year-old female admitted to the hospital with bowel obstruction. She will be NPO for an extended period of time and will require PN therapy. She weighs 57 kg. Calculate her estimated fluid requirements using the formula 1500 + 20 mL (wt in kg - 20). (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

2240

How many milliliters of 20% injectable lipid emulsion are required to provide 736 calories? (Answer must be numeric; no units or commas; round final answer to the nearest WHOLE number.)

368

DY is a 22-year-old female (154 pounds) in the ICU after a motor vehicle accident. She will be started on PN today. The prescriber has ordered 25 kcal/kg/day to be provided as a 2-in-1 PN solution with standard electrolytes. The pharmacist has several bags of 2-in-1 PN with standard electrolytes that were ordered for a different patient whose PN was discontinued yesterday. The PN bags are labeled D20% (w/v) and amino acid 7% (w/v). How many milliliters of this PN would be required to provide the daily caloric intake ordered for DY? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

1823

VH is a 37-year-old female receiving 334 grams of dextrose, 87 grams of amino acids and 310 mL of 10% lipids in her PN formula. What percentage of calories is provided by the protein content? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

19

A pharmacist has prepared a PN that contains 600 grams of dextrose. How many calories are provided by the dextrose? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

2040

A patient is to receive 10 mEq of calcium. The pharmacy has calcium gluconate 10% in stock, which contains 0.465 mEq/mL of calcium. How many milliliters of calcium gluconate are required? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

22

Calculate the total energy expenditure (TEE) for a patient with third degree burns on 50% of his body (stress factor 1.7). The patient is a 58-year-old male who weighs 190 pounds and is 5'11". Activity factor is 1.2. The BEE for this patient is 1,764 kcal/day, calculated using the Harris-Benedict equation. (answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

3599

How many kcals are provided by 91 grams of protein? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

364

A pharmacist is approached by a prescriber for help writing a parenteral nutrition order. The patient is currently receiving a 2-in-1 formula consisting of 425 grams of dextrose and 110 grams of protein. Dietary Progress Note: "Patient needs 2,400 calories per day. Recommend 10% Intralipid infusion to provide the remaining calories." Hospital policy is to infuse the daily lipid requirement over 12 hours to reduce infection risk. What rate (mL/hr) should the pharmacist recommend for the Intralipid to provide the necessary calories? (Answer must be numeric; no units or commas; round the final answer to the nearest WHOLE number.)

39

A patient requires 30 mmol of phosphate and 80 mEq of potassium in his PN. Potassium phosphate and potassium chloride will be used. How many milliliters of potassium phosphate and how many milliliters of potassium chloride are required? K-Phos = 3 mmol phosphate and 4.4 mEq potassium per mL and KCl = 2 mEq of potassium per mL. A. 15 mL potassium phosphate and 14 mL potassium chloride B. 10 mL potassium phosphate and 18 mL potassium chloride C. 18 mL potassium phosphate and 11 mL potassium chloride D. 5 mL potassium phosphate and 22 mL potassium chloride E. 11 mL potassium phosphate and 6 mL potassium chloride

B. 10 mL potassium phosphate and 18 mL potassium chloride

Choose the correct statement concerning parenteral nutrition (PN) therapy: A. Dextrose in PN provides 1.1 kcal/gram B. Amino acids in PN prode 4 kcal/gram C. Dextrose in PN provides 4 kcal/gram D. 10% fat emulsion provides 2.2 kcal/gram E. 20% fat emulsion provides 2.2 kcal/gram

B. Amino acids in PN prode 4 kcal/gram

Phosphate and calcium can precipitate in a PN bag and cause a pulmonary embolus. Which of the following can help reduce this risk? A. Keep the calcium:phosphorus ratio lass than 1:2 B. The calcium and phosphate added together should not exceed 45 mEq/L C. Choose calcium chloride over calcium gluconate D. Keep the pH above 6 E. Infuse the PN within 4 days of preparation

B. The calcium and phosphate added together should not exceed 45 mEq/L

After compounding a PN formula, the pharmacist notes that the solution is hazy and there is a precipitate visible when the bag is agitated. The precipitate is most likely to be which of the following? A. KCl B. NaCl C. MgCl D. NaPO4 E. CaPO4

E. CaPO4