Midterm ch 3,4,6,15,22

Protein needs of premature infants are nearly ______ times higher than protein needs of term infants. a. 1.5-2 b. 4.5-5 c. 2.5-3 d. 3.5-4

1.5-2

The amount of energy in concentrated formulas is usually ______kcal/mL. a. 3.5-4.0 b. 1.0-1.5 c. 2.5-3.0 d. 1.5-2.0

1.5-2

The recommended maximum hang time of PN formula is: a. 12 hours for both ILE and 2 in 1 TNA b. 12 hours for ILE; 24 hours for a 2 in 1 TNA c. 24 hours for ILE; 12 hours for a 2 in 1 TNA

12 hours for ILE; 24 hours for a 2 in 1 TNA

For patients with a fasting blood glucose ≥200 mg/dL, it is recommended that carbohydrate infusion be limited to no more than ____ grams of dextrose on the first day of PN. a. 0 b. 50 c. 150 d. 100

150

Baby Boy A was born at 28 0/7 weeks and is now day of life 7. What is his postmenstrual age? a. 29 5/7 weeks b. 30 0/7 weeks c. 28 5/7 weeks d. 29 0/7 weeks

29 0/7 weeks

Parenteral solutions provide: a. 4 kcal/g of dextrose, 4 kcal/g of protein, 1.1 kcal/mL of 10% ILE b. 3.4 kcal/g of dextrose, 4 kcal/g of protein, 4.3 kcal/g of ILE c. 4 kcal/g of dextrose, 4 kcal/g of protein, 9 kcal/g of ILE d. 3.4 kcal/g of dextrose, 4 kcal/g of protein, 2 kcal/mL of 20% ILE

3.4 kcal/g of dextrose, 4 kcal/g of protein, 2 kcal/mL of 20% ILE

A patient is receiving an intravenous solution that provides 200 g of dextrose. How many calories does this provide the patient? a. 200 kcals b. 680 kcals c. 800 kcals d. 250 kcals

680 kcals

If a critically ill patient cannot meet at least 60% of his or her energy and protein needs through the enteral route, supplemental PN should be considered after what period of time? a. 7-10 days b. 3-5 days c. 10-14 days d. 1-2 days

7-10 days

Growth charts developed by which of the following are currently preferred in the preterm population? a. Fenton and Olsen b. World Health Organization c. Lubchenco d. Babson and Benda

Fenton and Olsen

Nonalcoholic fatty liver disease (NAFLD) differs from alcoholic liver disease (ALD) in that: a. NAFLD does not progress into steatohepatitis while ALD does b. NAFLD is not a risk factor for hepatocellular carcinoma while ALD is c. NAFLD has a slow progression while ALD does not d. NAFLD has an AST:ALT ratio of less than 1 while ALD has an AST:ALT ratio of greater than 1

NAFLD has an AST:ALT ratio of less than 1 while ALD has an AST:ALT ratio of greater than 1

All of the following are true about necrotizing enterocolitis (NEC) in preterm infants EXCEPT: a. NEC risk increases when preterm infants are fed too quickly b. NEC risk increases when preterm infants are fed with large volumes c. NEC risk increases with use of minimal enteral nutrition (MEN) feeds d. NEC risk increases when preterm infants are fed with a standardized feeding protocol

NEC risk increases when preterm infants are fed with a standardized feeding protocol

Joseph is a 50-year-old non-obese male in the ICU following severe trauma. He is currently on a mechanical ventilator. What formula is acceptable for calculating Joseph's energy needs? a. PSU 2010 b. 25-30 kcal/kg times a factor based on degree of injury c. 22-25 kcal/kg d. PSU 2003B

PSU 2003B

Which one of these routes of parenteral access is considered long term? a. Tunneled Hickman catheter inserted in the right chest with the tip terminating in the superior vena cava b. PICC line inserted into the basilic vein with the tip terminating at the junction of the right atrium and the superior vena cava c. Non-tunneled catheter inserted into the brachiocephalic vein with the tip terminating in the subclavian vein d. Femoral catheter inserted in the left femoral vein with the tip terminating in the inferior vena cava

Tunneled Hickman catheter inserted in the right chest with the tip terminating in the superior vena cava

Supplementation with which of the following nutrients may reduce mortality in critical illness? a. Arginine, zinc, copper, iron b. Vitamins A, D, E, K, selenium c. Vitamins C, E, zinc, copper, selenium d. Calcium, phosphorus, magnesium

Vitamins C, E, zinc, copper, selenium

Which is TRUE about enteral nutrition formulas in liver disease? a. A free water restricted formula is indicated with edema and hyponatremia b. A high BCAA formula is indicated for acute episodic hepatic encephalopathy c. A low protein formula is indicated for chronic hepatic encephalopathy d. A low fat formula is indicated due to fat malabsorption

a free water restricted formula is indicated with edema and hyponatremia

A 50-year-old woman will require enteral feeding support for three weeks due only to temporarily being unable to eat a normal diet. The preferred route for feeding would be: a. A percutaneous endoscopic gastrostomy b. A jejunostomy c. A nasoduodenal feeding tube d. A nasogastric feeding tube

a nasogastric feeding tube

The most common cause of acute liver failure is: a. Alcoholic steatohepatitis b. Viral hepatitis c. Acetaminophen toxicity d. Critical illness with multiorgan failure

acetaminophen toxicity

Typical electrolyte provision to preterm infants in the first one to two days after birth includes: a. Administration of sodium supplementation at 4 mEq/kg/day b. Administration of bicarbonate supplementation when blood pH falls below 7.4 c. Administration of calcium supplementation at 3 mEq/kg/day d. Administration of potassium supplementation at 3 mEq/kg/day

administration of calcium supplementation

The NUTRIC screening tool relies on which of the following indicators to assess nutritional risk? a. Age, APACHE score, SOFA, comorbidities b. Age, APACHE score, SOFA, day before admit to ICU c. Age, APACHE score, SOFA, weight loss d. B and C

b and c

Decreased morbidity and mortality is associated with maintaining blood glucose levels: a. Between 70 and 100 mg/dl b. Between 70 and 149 mg/dl c. < 70 mg/dl d. < 180 mg/dl

between 70 and 149 mg/dl

5-year-old with esophageal obstruction requiring long-term supplemental nutrition would benefit from the following nutrition support regimen: a. Continuous feeding via a PEG b. Bolus feeding via a PEG c. Continuous feeding per PEJ d. Bolus feeding per PEJ

bolus feeding via a PEG

The most common type of noninfectious mechanical complication of PN is: a. Catheter-related venous thrombosis b. Catheter embolism c. Catheter occlusion d. Pneumothorax

catheter occlusion

Portal hypertension is closely associated with all of the following EXCEPT: a. Coagulopathy b. Hepatorenal syndrome c. Ascites d. Esophageal, stomach, and rectal varices

coagulopathy

In parenteral nutrition solutions, protein is supplied mostly as: a. Tripeptides b. Hydrolyzed protein c. Intact proteins d. Crystalline amino acids

crystalline amino acids

The following is a negative consequence of propranolol use in burn patients: a. Increased blood pressure b. Decreased blood pressure c. Increased liver function test d. Increased lipolysis

decreased blood pressure

Benefits of early enteral feeding in premature infants include all of the following EXCEPT: a. Decreased need for respiratory support b. Prevention of gut atrophy c. Increased secretion of gastric hormones d. Improved weight gain

decreased need for respiratory support

A common complication of enteral tube feeding is: a. Hypoalbuminemia b. Refeeding syndrome c. Diarrhea d. Hyponatremia

diarrhea

If the mother of a premature infant is unable to provide breast milk, the substitutes that should be considered include: a. Donor milk and preterm infant formula b. Elemental and hypoallergenic infant formula c. Preterm and term infant formula d. Peripheral and central parenteral nutrition

donor milk and preterm infant formula

Which of the following is most often the best weight to use for estimating energy and nutrient requirements? a. Adjusted body weight b. Ideal body weight c. Lowest weight d. Dry weight

dry weight

Treatment for esophageal varices includes all of the following EXCEPT: a. Endoscopic band ligation b. Transjugular intrahepatic portosystemic shunt c. Early enteral nutrition with nasoenteric feeding d. Soft solid diet

early enteral nutrition with nasoenteric feeding

A patient with protein energy malnutrition is admitted to the hospital for severe pneumonia and is placed on a ventilator. He has no other organ system involvement. The method of feeding that should be considered at this point in his care is: a. Total parenteral nutrition b. Peripheral parenteral nutrition c. Enteral nutrition d. Delay feeding until he is off the ventilator

enteral nutrition

A hypocaloric high protein diet is never acceptable in critically ill patients. True False

false

An adult receiving fat-free PN formula may develop essential fatty acid deficiency within three days. True False

false

Commercial formulas were first used in the 1980's. True False

false

Given increases in glucose oxidation capacity during critical illness, glucose infusion rates can be increased up to 10 mg/kg/min. True False

false

IV lipids are a preferred source of energy during critical illness due to their immune properties. True False

false

If a patient requires a certain medication that the pharmacist deems compatible with PN, it may be added to the PN bag at the bedside. True False

false

Preterm infants require higher caloric intake when fed parenterally than when fed enterally. True False

false

Protein restriction is indicated in liver disease to prevent hyperammonemia in hepatic encephalopathy. True False

false

Serum albumin is a reliable indicator of nutritional status in the setting of liver disease. True False

false

Serum proteins are reasonable as indicators of nutritional status in burn patients. True False

false

The main cause of portal hypertension is fluid accumulation impairing hepatic blood flow. True False

false

Yellowing of the skin and eyes in liver diseases is due to hypercarotenemia because of inability of the liver to metabolize vitamin A. True False

false

Constipation is generally treated by a: a. High fiber diet b. Minimal-residue diet c. Low-residue diet d. Diet with adequate dietary fiber, fluid, and exercise

high fiber diet

the most common enteral formula to use with critically ill patients is: a. Fluid restricted b. Semi-elemental c. High protein, polymeric d. Immune-modulating

high protein, polymeric

Which of the following is TRUE about the fat provision of human milk versus preterm formula? a. Human milk contains medium chain triglycerides as the major fat source while preterm formula does not b. Human milk contains linoleic acid while preterm formula does not c. Human milk contains docosahexaenoic acid (DHA) and arachidonic acid (ARA) while preterm formula does not d. Human milk contains bile salt-activated lipases while preterm formula does not

human milk contains bile salt-activated lipases while preterm formula does not

The most common metabolic complication of PN is: a. Hyperglycemia b. Electrolyte abnormalities c. Hypervolemia d. Essential fatty acid deficiency

hyperglycemia

Low albumin in a critically ill patient is caused by: a. Inadequate fluid intake b. Illness, injury, and inflammation c. Inadequate calorie intake d. Inadequate protein intake

illness, injury, and inflammation

Altered metabolism with liver failure may be characterized by: a. Accelerated urea cycle activity b. Impaired gluconeogenesis c. Decreased fatty acid oxidation d. Increased hepatic protein synthesis

impaired gluconeogenesis

Which is the most likely cause of early satiety in patients with liver disease? a. Increased glycogen accumulation b. Increased fat accumulation in the liver c. Increased abdominal distention due to ascites d. Increased leptin concentration

increased abdominal distention due to ascites

The following is associated with oxandrolone use in critically ill burn patients: a. Increased lean body mass b. Decreased muscle protein synthesis c. Decreased catecholamine activity d. Decreased hyperglycemia

increased lean body mass

Ascites is associated with: a. Development exclusively in liver disease b. Increased renin-angiotensin-aldosterone system prompting kidneys to retain fluid and sodium c. Vasoconstriction of the peripheral arteriole and vessels in the splanchnic region d. Decreased lymph production

increased renin-angiotensin-aldosterone system prompting kidneys to retain fluid and sodium

Septic shock may result in: a. Increased gut perfusion b. Increased risk of necrotic bowel 0 c. Hypertension d. Hypoglycemia

increased risk of necrotic bowel

One benefit to providing 4 g/kg/day of amino acids to preterm infants is that it: a. Increases blood urea nitrogen b. Increases azotemia c. Increases metabolic acidosis d. Increases nitrogen balance

increases nitrogen balance

Standard enteral formulas contain: a. Amino acids b. Hydrolyzed protein c. Intact protein d. Oligopeptides

intact protein

The following can be an indicator of severe malnutrition risk in critically ill patients: a. Low albumin b. Mild edema c. Intake of less than 75% of requirement in ≥ 5 days d. Intake of less than 75% of requirement for ≥ 7 days

intake of less than 75% of requirement for > 7 days

Which of the following is TRUE about hepatic encephalopathy? a. It often leads to increased oral intake b. It is associated with alterations in the gut-liver axis c. It is a neuro-urological disorder characterized by renal impairment d. It dictates the nutritional management of liver disease

it indicates the nutritional management of liver disease

Which of the following is true about zinc supplementation during liver failure? a. It may improve copper absorption b. It may improve ammonia elimination by altering gut microbiota c. It is a coenzyme for glutamine synthetase, which removes ammonia from the blood d. It should be taken on an empty stomach to improve absorption

it is a coenzyme for glutamine synthetase, which removes ammonia from the blood

Which is TRUE about donor milk? a. It is typically preterm milk b. It is pasteurized prior to administration c. It needs to be fortified less frequently than preterm formula d. It results in improved growth in comparison to formula

it is pasteurized prior to administration

Which best characterizes the progression of nonalcoholic fatty liver disease (NAFLD) to nonalcoholic steatohepatitis (NASH)? a. It can be prevented with targeted drug therapy b. It may progress independent of age, gender, or ethnicity c. It may be mediated by proinflammatory cytokinesn d. The progression of NAFLD to NASH is inevitable

it may be mediated by proinflammatory cytokines

One benefit of early enteral nutrition is: a. It is useful in patients with increased abdominal distention b. It induces gut ischemia c. It induces the hyperemic response d. It minimizes aspiration risk

it reduces the hyperemic response

Which of the following is TRUE about postnatal diuresis in preterm infants? a. It is completed within 24 hour after birth b. It occurs as a result of the contraction of intracellular fluid c. It results in a loss of approximately 10% of birth weight d. It leads to an increase in fluid needs

it results in a loss of approx 10% birth weight

A patient who is expected to require enteral nutrition support for six weeks or more postoperatively due to planned gastric resection should receive the following mode of enteral support: a. Nasogastric tube b. Nasojejunal tube c. Gastrostomy (PEG) d. Jejunostomy (PEJ)

jejunostomy (PEJ)

Which of the following lab profiles is likely to be seen in decompensated cirrhosis due to alcoholic liver disease? a. Low glucose; elevated AST/ALT ratio, INR, and PT b. Elevated: INR, PT, AST/ALT ratio, glucose c. Elevated INR and PT; low AST/ALT ratio and glucose d. Low: INR, PT, AST/ALT ratio, glucose

low glucose; elevated AST/ALT ratio, INR, and PT

In order to be discharged from the NICU, one goal that a premature infant must achieve is: a. Maintain body temperature b. Sleep through the night c. Roll over d. Maintain body weight

maintain body temperature

Dietary management of nonalcoholic fatty liver disease includes all of the following EXCEPT: a. Weight management b. 2-3 cups of black coffee c. Increased physical activity d. Management of hypoglycemia during prolonged fasting

management of hypoglycemia during prolonged fasting

the role of the incubator in the management of preterm infants is to: a. Minimize heat loss b. Minimize urine loss c. Minimize fecal loss d. Minimize nutrient loss

minimize heat loss

For the patient with delayed gastric emptying, nausea and vomiting, or other indications of risk of aspiration, the tube should be placed through the: a. Mouth into the colon b. Mouth into the stomach c. Mouth into the esophagus d. Mouth into the duodenum or jejunum

mouth into the duodenum or jejunum

Which factors contribute to intrauterine growth restriction? a. Extended interpregnancy interval b. Maternal exercise c. Multiple gestation d. Paternal age

multiple gestation

What type of enteric tube enters the body at the nose and terminates at the stomach? a. Percutaneous endoscopic jejunostomy b. Percutaneous endoscopic gastrostomy c. Nasojejunal d. Nasogastric

nasogastric

Early care of the burn patient is aimed at all but which of the following? a. Parenteral nutrition b. Blunting the hypermetabolic response c. Surgical reduction of wound size d. Infection control

parenteral nutrition

Peripheral PN would be appropriate for: a. Patients on a fluid restriction b. Patients who will be on long-term PN c. Patients who will be on short-term PN d. Patients requiring very concentrated PN formula

patients who will be on short-term PN

Immunomodulating formulas containing omega 3 fatty acids are theorized to be beneficial in respiratory disease because they: a. Promote bronchial vasodilation to improve oxygenation and decrease ventilator days b. Are proinflammatory c. Are a precursor to arachidonic acid d. Reduce resolvins and protectins, which are proinflammatory

promote bronchial vasodilation to improve oxygenation and decrease ventilator days

Which is an appropriate nutrition intervention in decompensated liver disease? a. Provide an oral nutrition supplement to increase caloric intake b. Provide salt supplementation to improve hyponatremia c. Avoid evening snacking to improve glycemic control d. Consume large meals to ameliorate catabolism

provide an oral nutrition supplement to increase caloric intake

Loss of 10% of lean body mass is associated with which of the following? a. A 50% increase in mortality b. Decreased wound healing c. Reduced immune function d. Pressure sores

reduced immune function

Preterm infants often require PN in the NICU due to their: a. Decreased fluid needs b. Decreased electrolyte needs c. Small stomach capacity d. Mature GI tract

small stomach capacity

Treatment goals during the ebb phase include all but which of the following? a. Airway management b. Support of increased energy expenditure c. Restoration of tissue perfusion d. Fluid resuscitation and repletion of intravascular volume

support of increased energy expenditure

Why might the clinical team decide to withhold lipids from a patient receiving PN? a. The patient has essential fatty acid deficiency b. The patient is receiving propofol c. The patient has hypercholesterolemia d. The patient has hyperglycemia

the patient is receiving propanolol

Which of the following statements is TRUE about patients with end stage liver disease? a. There is an increased risk of hypoglycemia during fasting b. There is a universal decrease in resting energy expenditure c. End stage liver disease rarely affects nutrient intake d. There is decreased hepatic glycogen storage and decreased insulin resistance

there is an increased risk of hypoglycemia during fasting

Which of the following is appropriate nutritional intervention for acute hepatitis? a. Limit protein intake to prevent the development of hepatic encephalopathy b. Limit iron intake to prevent iron overload c. There is no standard nutrition therapy for acute hepatitis d. Limit fat intake to prevent hepatic damage due to fatty liver

there is no standard nutrition therapy for acute hepatitis

Placement of the enteral feeding tube beyond the stomach is indicated when: a. The small intestine is blocked. b. There is risk of aspiration. c. The patient will only require the feeding for a few days. d. The tube must remain in for a month or more.

there is risk of aspiration

The following is an advantage of small bowel feeding: a. They decrease reliance on PN b. They are more physiologic than gastric feedings c. Potential for bolus feeding d. They are more sensitive to volume and osmotic load

they decrease reliance on PN

A major drawback of long chain intravenous fat emulsions (IVFE) such as safflower and soybean based lipids is: a. They provide fewer calories per mL than other oils b. They cannot be given peripherally c. They cannot be mixed with dextrose and amino acids d. They have a proinflammatory effect

they have a proinflammatory effect

A patient receiving home PN has a fever. This may be a sign of a catheter-related bloodstream infection. True False

true

A sudden increase in abdominal girth may indicate the onset of sepsis. True False

true

Burn injuries are among the most hypermetabolic disease states. True False

true

Cysteine is added to the PN of preterm infants in order to optimize solubility. True False

true

During the catabolic response to stress, lipolysis provides free fatty acids and glycerol, which support gluconeogenesis. True False

true

Fetal weight gain is the most rapid rate of growth that humans will experience in their lifetimes. True False

true

Hemodynamic instability is a contraindication to early enteral feeding. True False

true

IV glutamine may be preferred over enteral glutamine in the ICU patient because it limits glutamine uptake by the enterocyte. True False

true

Immature kidneys have decreased ability to concentrate and dilute urine, leading to increased risk of serum electrolyte abnormalities. True False

true

Immune-modulating nutrients act at the systemic and cellular level by inducing macrophages, eicosanoids, and nitric oxide. True False

true

In a closed tube feeding system, formula can hang at room temperature safely for 24-48 hours. True False

true

Increased calcium and phosphorus needs of preterm infants can be met through the use of human milk fortifiers and preterm formulas. True False

true

Nonalcoholic liver disease occurs commonly with obesity and type 2 diabetes. True False

true

One reason that alcoholic liver disease compromises nutritional status is due to alcohol consumption displacing nutrient intake. True False

true

The goal of nutrition management of premature infants is to achieve weight gain, growth, and development potential to match intrauterine growth potential. True False

true

Monitoring of electrolytes in burn patients should be: a. As needed b. Daily c. Weekly d. Two to four times daily

two to four times daily

How can the clinician modify the PN regimen in the setting of PN-associated liver disease (PNALD)? a. Increase ILE dose to 2 g/kg/day b. Provide a double dose of multivitamins c. Use cyclical infusion d. Increase calories

use cyclical infusion