Multiple Choice Questions
Proteins perform all fo the following physiological functions except: A. Provide a major source of energy B. Maintain acid-base balance C. Contribute to immune defense D. Serve as a mode of transport for substances
A Answer page 98
Which of the following may increase the risk of phlebitis with PPN? A. Osmolarity equal to or less than 900 mOsm/L B. Potassium 100 mEq/L C. Calcium less than 5 mEq/L D. Addition of heparin to PPN
B Answer page 298
A 55 yo male presented to the hospial after traumatic fall from a ladder. A CT scan of the head showed significant subdural hematoma with midline shift. After admission to the ICU the patient was intubated and sedated, with an orogastric tube to suction and 200 mL of gastric content was removed. The patients abdomen was soft and nondistended. Nephrology was consulted, and the patient was started on continuous venous hemodialysis. What type of enteral formula would best meet his needs? A. A formula restricted in fluid, protein and electrolytes B. A formula not restricted in protein but restricted in fluid and electrolytes C. A formula restricted in fluid but not protein or electrolytes D. A fluid not restricted in fluid or protein but restricted in electrolytes
C Answer page 228
The rate of protein turnover in catabolic, critically ill patients: A. Does not change B. Decreases C. Increases D. Is not affected by nutrition support
C. Answer page 98
Thrombotic occlusions are most commonly treated with which of the following? A. Thrombolytics B. Anticoagulants C. 10% hydrochloric acid D. Sodium bicarb
A Answer page 322
Which of the following is the most common metabolic complication associated with PN? A. Hyperglycemia B. Essential fatty acid deficiency C. Axotemia D. Hyperammonemia
A Answer page 346
Assuming the same weight and serum sodium concentration, which of the following patients has the greatest free water deficit> A. A 35 year old man B. A 75 year old man C. A 35 year old woman D. A 75 year old woman
A Answer page 114
CPN is contraindicated in which of the following conditions? A. DNR B. Peritonitis C. Intestinal hemorrhage D. High output fistulas
A Answer page 286
What is the optimal nutrition support for a malnourished patient when EN is not feasible for a prolonged period? A. CPN B. NG feedings C. Postpyloric feedings D. PPN
A Answer page 286
What amount of retinol is equivalent to 24 mcg of beta-carotene from food? A. 2 mcg B. 4 mcg C. 2 mg D. 1 mg
A. Answer page 141
Which of the following is one of the best validated screening indicators for malnutrition risk? A. Patient repsorts convolutional weight loss B. Patient reports following a low-carbohydrate, weight loss diet C. Patient is 2 days s/p lap chole D. Patient reports a recent flu-like febrile illness
A. Answer page 186
Risk factors for aspiration include all of the following except: A. Malnutrition B. Use of naso-/oro-feeding tubes C. Bolus EN feeding D. Supine position
A. Answer page 213
Which of the following is the largest component of total energy expenditure (TEE)? A. RMR B? Thermogenic effect of digestion C/ Physical activity D. Metabolic stress
A. Answer page 28
You Are determining the energy intake target for a 53-year-old, critically ill, male patient who is about to start EN. He is 170 cm and weighs 150 kg. His BMI if 51.9 and his IBW is 70 kg. Body temp is 37.3C and minute ventilation is 12.5 L/min. Based on ASPEN guidelines, what energy value would you use as the basis for the feeding plan? A. 1750 kcal/d (25 kcal/kg IBW) B. 1225 kcal/day (70% calculated 25% kcal/kg IBW) C. 2250 kcal/day (25 kcal/lg AjBW) D. 2615 kcal/day (Penn state equation)
A. Answer page 28
Which of the following nutrients is added to rehydration liquids to promote water absorption in patients with diarrhea? A. Sodium and glucose B. Amino acids C. Long-chain fatty acids D. Alcohol
A. Answer page 4
What are some fo the possible ramifications of activation of the enzyme, phospholipase A2? A. Cyclooxygenase (COX)-dependent, eicosanoid-mediated inflammatory reactions B. Enzymatic degredation of resolving and protecting C. Desaturation of linoleum acid within lipids D. Chylomicron maturation
A. Answer page 72
A 60 yo critically ill patient has been tolerating standard 1 kcal/mL formula well for the past week. She starts having frequent bouts of loose stools, requiring placement of a rectal tube. What should be the clinician's next suggestion? A. Change to a peptide-based formula B. Determine the cause of diarrhea C. Add pre- and probiotics to the feeding regimen D. Change to a fiber-supplemented formula
B Answer page 228
You perform a telephone eval of a patient who relates increased redness, pain and swelling around his existing low-profile G tube. He has not been seen in the clinic for more than 6 months and, when asked, states that he has been doing quite well on his TF. In fact, the patient states he has gained over 20 lbs. You would proceed as follows: A. Congratulate him on gaining the weight and tell him to continue his normal plan B. If possible, have him come to the clinic or call the clinic managing the tube to rule out buried bumper syndrome C. Direct him to put some triple antibiotic around the site and call back in a couple of weeks if the discomfort continues D. Tell him to put hot packs on it, take acetaminophen and rest for a fe wdays
B Answer page 252
In which patient condition or treatment could PN elicit an improved patient outcome? A. Cancer chemo B. Preop care of surgery patients with upper GI cancer C. Allogenic bone marrow transplant D. Critical illness
B Answer page 286
One day after initiating PN in a critically ill adult patient, the labs are as follows: K 3.1, phos 1.6, Mg normal. PN regimen providing protein (90 grams), dextrose (150 grams), no lipid, minimum volume, K 80 mEq, phosphate 44 mmol, standard Na, Mg, Ca, vitamins/elements. Pt weighs 60 kg and has a BMI of 18. The most appropriate response is: A. Increase K and phos in PN, and decrease macronutrient doses B. Provide supplemental IV doses of K and phos today, but don't change macronutrient doses in bag C. Increase K and phos in PN and advance dex to 225 g with tonight's bag D. Provide supplemental K and phos via IV and increase dex to 225 g with tonight's bag
B Answer page 346
Which of the following statements best describes the human gut microbiota? A. The human gut microbiota is established by age 3 years and few factors influence it B. Trillions of bacteria currently comprise the human gut microbiota C. The human gut microbiota is highly dependent on the host for survival but provides little benefit to the host D. The human gut microbiota is not influenced by the mode of infant delivery
B Answer page 58
Which of the following nutrients does not engage in conversion of homocysteine to methionine? A. Choline B. Vitamin D C. Vitamin B12 D. Folate
B. Answer page 141
High-protein hypocaloric EN feeding providing 65-70% of energy needs (as determined by IC) is recommended for IVU patients with which of the following conditions? A. Malnutrition B. Obesity C. Liver failure D. ARDS
B. Answer page 213
Which of the following actions is most appropriate for enhancing gastric emptying during the administration of EN? A. Keep the bed in Trendelenburg position B. Decrease the rate of continuous feeding infusion, or change from bolus to continuous C. Switch to an enteral formula with higher fat content D. Switch to an enteral formulation with higher protein content
B. Answer page 266
Which of the following is the most appropriate initial action for the management of tube feeding-associated diarrhea? A. Change to an enteral formulation with fiber B. Review med administration record to determine whether hyperosmolar agents are being administered C. Change to peptide-based enteral formulation D. Use an anti motility agent
B. Answer page 266
Which of the following is the most commonly used method for assessing energy expenditure? A. Indirect calorimetry (IC) B. Predictive equations C. The reverse Tick equation D. Doubly labeled water
B. Answer page 28
Which of the following practices is most likely to succeed in improving oral nutrition intake in patients with a prolonged history of weight loss due to poor intake, nausea, and depressed appetite? A. Providing a high-energy oral liquid supplement 3 times daily B. Offering 6 small, low-fat meals daily C. Ordering fiber-supplemented snacks 3 times daily D. Planning primarily solid meals and limiting fluids
B. Answer page 4
Which of the following incorrectly pairs a metabolic process with its site of occurrence? A. Glycolysis and cytosol B. TCA cycle and mitochondrial membrane C. ATP phosphorylation and cytosol and mitochondria D. ETC and mitochondrial membrane E> oxidative decarboxylation of pyruvate and mitochondria
B. Answer page 42
Which of the following is least likely to occur during oxygen debt? A. Buildup of lactic acid B. Buildup of pyruvate C. Decrease in pH D. Increased fatigue E. Shortage of ATP
B. Answer page 42
Which of the following statements best describes a probiotic? A. A probiotic is a live organism used to make yogurt B. A probiotic is a "live nonpathogenic organism (bacteria or yeast) which when administered in adequate amounts confers a health benefit on the host? C. Probiotics are on the GRAS list and therefore can be safely provided to all humans receiving nutrition support therapy D. The mechanisms of probiotics are well known, making probiotic therapy a great addition to nutrition support therapy
B. Answer page 58
Which of the following statements is true relating to HCl and protein digestion? A. HCl aids in the conversion of pepsin to pepsinogen B. HCl denatures protein structures to make them more susceptible to enzymatic action C. HCl is secreted by the parietal cells within the duodenum in response to dietary proteins D. HCl's release is stimulated by the hormone insulin
B. Answer page 98
Which of the following methods is not recommended to minimize contamination of enteral feeding formulation? A. Washing hands and donning clean gloves before preparing enteral formulation B. Immediate use of enteral formula from a newly opened container C. Infusing reconstituted powdered formulas or formulas with added modular components in 1 bag for up to 8 hours D. Changing an "open" feeding container every 24 hours
C Answer page 266
PN should be discontinued when which of the following criteria are met? A. A clear liquid diet is ordered B. Tube feeding is initiated at 10% of goal rate C. Solid food is well tolerated by mouth D. Advancement to regular diet is poorly tolerated
C Answer page 286
What is the smallest pore size filter that is recommended for TNA? A. 0.22 um B. 0.5 um C. 1.2 um D. 5 um
C Answer page 298
Which of the following will increase the solubility of calcium and phosphate in a PN formulation? A. Use of calcium as chloride salt B. Use of phosphate as sodium salt C. Increased amino acid concentration D. Increased temperature
C Answer page 298
Which of the following is the most appropriate VAD strategy for a patient requiring long-term PN? A. Use of midclavicular catheter as a cost-effective measure B. Place of percutaneous non tunneled catheter to initiate PN and then replace it with an implanted port C. Place a single-lumen, tunneled cuffed catheter D. Place a triple-lumen, antibiotic-coated catheter to ensure adequate access for future needs
C Answer page 322
Which of the following practices has been shown to reduce the risk for catheter-related bloodstream infections (CRBSIs)? A. Systemic use of antimicrobial prophylaxis at the time of insertion or access B. Routine replacement of central venous access device (CVAD) C. Use of "Central Line Bundle" of insertion and maintenance practices D. Selection of an internal jugular site as opposed to subclavian site
C Answer page 322
Which of the following measures would be considered most beneficial in a patient who'd develops cholestasis while receiving long-term PN that is infused over 12 hours nightly? A. Stop all oral and enteral intake B. Switch from cyclic to continuous PN method C. Decrease ILE from 1.5 g/kg.day to 1 g /kg twice weekly D. Increase protein from 1 g/kg/day to 2 g/kg/day
C Answer page 346
Which of the following statements best describes a prebiotic? A. All fibers are considered probiotics B. Prebiotics are synthetic compounds C. Probiotics are dietary polysaccharides that escape digestion by the host enzymes, are fermented by the gut microbiota, and influence the gut microbiota pattern in a beneficial manner D. All probiotics are fermented to yield the same SCFAs
C Answer page 58
A patient with severe intractable nausea and vomiting is at risk for which of the following acid-base disorders? A. Hyperchloremic metabolic alkalosis B. Hyperchloremic metabolic acidosis C. Hypochloremic metabolic alkalosis D. Hypochloremic metabolic acidosis
C. Answer page 114
A physician informs you that a patient has a serum albumin of 2.8 mg/dL and prealbumin of 14 mg/dL and asks whether these laboratory findings mean the patient is malnourished. What is the most appropriate response? A. The patient's protein intake is inadequate, and the patient should receive prompt nutrition support B. Together, these markers indicate that the patient has moderate protein-energy malnutrition C. Consideration of medical history, clinical diagnosis, and laboratory signs of the inflammatory response would help you interpret these findings D. For most hospitalized patients, alumni and prealbumin have excellent sensitivity and specificity to identify malnutrition
C. Answer page 186
Which parameter is measured when using IC? A. Heat loss B. Catabolic rate C. Gas exchange D. Free energy balance
C. Answer page 28
Which of the following is true about the net chemical reaction of glucose catabolism? A. Pyruvate is the final product B. Oxygen is required for ATP synthesis C. Both water and CO2 are produced D. CO2 is produced but water is not E. Water is produced but CO2 is not
C. Answer page 42
How might propofol, when provided to patients within a 10% (w/v) lipid injectable emulsion (ILE), increase risk of hypertriglyceridemia? A. Propofol causes acute uptake of TGs by the microvilli of the small intestine B. Propofol is known to active the release of TGs from adipose tissue C. The increased presence of liposomes in the propofol ILE may interfere with chylomicron and pseudochylomicron metabolism D. The presence of sedative in the ILE prevents phospholipid formation, which results in an increased level of TGs in the blood
C. Answer page 72
Which ionized form of a SCFA is thought to be the most important to colonic health and why? A. myrisatate B. Caproate C. Butyrate D. Valerate
C. Thought to modify inflammatory activity and promote colonic health Answer page 72
What should a clinician do when considering the use of enteral formulas marketed for specific disease conditions? A. Use formulas a indicated by the product manufacturer to meet patient's needs B. Use standards polymeric formulas for all patients C. Use specialty formulas only when patients exhibit signs and symptoms of intolerance to standard polymeric formulations D. Evaluate the studies used to support the use of specialty formulas and apply clinical judgment to select the appropriate enteral product for the individual patient
D Answer page 228
If a nasoenteric feeding tube cannot be unclogged using water flushes, what is the next most reliable method for unclogging the tube before it is replaced? A. Administer cola through the tube, and let it sit for a few hours B. Administer Clog Zapper (CORPAK MedSytems, Buffalo Grove, IL) and flush within 30 to 60 minutes C. Wait a few hours to see whether the clog dissolves spontaneously D. Administer a mixture of pancreatic enzymes and bicarb solution, allow to sit for 1-2 hours (or longer) and then flush with warm water
D Answer page 252
According to recommendations by ASPEN, the amount of dextrose used in preparation of PN formulation is required to appear on the label as: A. Percentage of original concentration and volume (dextrose 50% water, 500 mL) B. Percentage of final concentration after admixture (dextrose 25%) C. Grams per liter of PN administered (dextrose 250 g/L) D. Grams per day (dextrose 250 g/day)
D Answer page 298
Which of the following PN modifications is recommended to help prevent and/or treat osteoporosis in a long-term PN patient? A. Maintain protein intake at least 2 g/kg/day B. Provide more than 20 mEq of calcium/da C. Add injectable vitamin D to PN formulation D. Provide 20-40 mmol phosphorus/day
D Answer page 346
The administration of 1 L of 0.9% NaCl to a normonatremic patient will increase the intravascular and interstitial fluid compartments by: A. 10000 mL and 0 mL B. 0 mL and 1000 mL C. 750 mL and 250 mL D. 250 mL and 750 mL
D. Answer page 114
The first B vitamin deficiency to manifest in people with alcoholism is usually: A. Niacin B. Panthotenic acid C. Vitamin B6 D. Thiamine
D. Answer page 141
Which of the following trace elements is regulated at the level of absorption but not excretion? A. Zinc B. Copper C. Manganese D. Iron
D. Answer page 141
Which of the following is an example of a patient condition anticipated to manifest with a severe systemic inflammatory response? A. AN with BMI of 15 B. Major depression with compromised PO intake and 5% wt loss C. Homebound older adult with restricted access to food and 10% wt loss D. Thermal burn injury of second and third degrees covering 15% of BSA
D. Answer page 186
Which of the following is a benefit of En compared with parenteral nutrition (PN) or no nutrition? A. Maintenance of normal gallbladder function B. Reduced GI bacterial translocation C. More efficient nutrient metabolism D. All of the above
D. Answer page 213
An 18 yo female with CF had a standard-profile, solid internal bolster, 20-Fr PEG tube placed 1 year ago because of her inability to take in enough energy orally and weight loss. She has done very wlel, with her weight stabilizing and no complications of the PEG. The original tube is now getting stiff and cracking and the patient wants a replacement tube. The patient has a very supportive family environment, is very active and is concerned about the cosmetic appearance of the tube itself. What type of replacement tube would you recommend? A. Standard-profile, 20-Fr, PEG tube with solid internal bolster B. Standard-profile, 20-Fr, PEG tube with balloon internal bolster C. Low-profile, 20-Fr, PEG tube with solid internal bolster D. Low-profile, 20-Fr, PEG tube with balloon internal bolster
D. Answer page 252
Which of the following statements explains why fermentable fiber is a beneficial addition to enteral formula? A. Colonic bacteria act on the fiber to produce short-chain fatty acids (SCFAs) that provide an energy source to the intestinal mucosa B. Colonic bacteria act on the fiber to produce SCFAsw, which, in turn, exert trophic effects on the intestinal mucosa C. Fermentable fiber may help control diarrhea by following gastric emptying D. all of the above
D. Answer page 4
During protein metabolism, BCAAs: A. Are extracted primarily by the liver after a protein-containing meal B. Are released by the skeletal muscle at a higher rate than other Gas C. Serve as the primary fuel sources for the enterocytes D. Produce oxidative wastes during metabolism within the skeletal muscle, which are removed by alanine and glutamine
D. Answer page 98