NTR 604 Midterm
According to the reading from Brown et al, "Enteral Nutrition Formula Selection: Current Evidence and Implications for Practice": Which type of formula can be used in medically stable patients with a healed feeding tube site and no signs of infection. In addition, this type of formula is best suited for patients with safe food practices and tube maintenance techniques. A. Diabetes/glucose intolerance Formula B. Whole food/Blenderized Formula C. Renal Formula D. Polymeric Formula
B
How does body water, as a percentage of total body weight, change based on age and lifestyle factors? A. Decreases significantly with age and is lower in athletes than non-athletes. B. Decreases significantly with age and is higher in athletes than non-athletes. C. Increases significantly with age and is higher in athletes than non-athletes. D. Increases significantly with age and is lower in athletes than non-athletes.
B
Insensible water losses are lost via the: A. Mouth and anus B. Lungs and skin C. Kidneys and bladder D. Gastrointestinal tract
B
Parenteral nutrition is contraindicated in which of the following conditions? A. Peritonitis B. Do Not Resuscitate (DNR) status C. Intestinal hemorrhage D. High-output fistulas
B
The ASPEN Critical Illness Guideline states that enteral nutrition should be initiated within ________________ hrs of injury or admission and the feedings advanced to goal over the next _____________________ hrs. A. 12-24 hrs; 24-48 hrs B. 24-48 hrs; 48-72 hrs C. 48-72 hrs; 48-72 hrs D. 48-72 hrs; 24-48 hrs
B
The definition of chronic disease-related malnutrition refers to patients with which of the following condition descriptors? A. Acute illness (e.g. GI bleed in a patient with alcoholism) B. Low grade inflammatory states (e.g. rheumatoid arthritis or sarcopenic obesity) C. Weight loss related to persistently poor access to food D. High grade inflammatory states (e.g. adult respiratory distress syndrome)
B
The most common gastrointestinal complication related to enteral nutrition support is: Incorrect answer: A. Aspiration B. Diarrhea C. Constipation D. High gastric residuals
B
Which of the following approaches to enteral feeding would you recommend for a ventilator dependent, critically ill patient with delayed gastric emptying? A. Consider gastric feeding B. Use continuous tubefeeding, consider prokinetic medication C. Change to intermittent feeding schedule D. Change to an elemental formula
B
Which of the following electrolytes or minerals cannot be added to TPN solutions due to instability? A. Magnesium B. Bicarbonate C. Calcium D. Potassium
B
Which of the following has been associated with the development of hepatic steatosis in adult patients receiving parenteral nutrition? A. Iron deficiency B. Caloric excess C. Taurine deficiency D. EFA deficiency
B
Which of the following is a primary reason for administering home enteral or parenteral nutrition as a cyclic infusion? A. To enhance metabolism of nutrients B. To provide a more normal lifestyle C. To reduce the number of nursing visits D. To avoid electrolyte imbalances
B
Which of the following is the most sensitive indicator for determining iron status? Incorrect answer: A. Hemoglobin B. Serum ferritin C. Hematocrit D. Serum transferrin E. Serum iron
B
You visit a patient and observe that the skin is dry and thin, eyes and oral mucosa are dry, temp is 100.1 degrees F, blood pressure 98/50 mm Hg, pulse 118 bpm. What may be the problem? A. Respiratory alkalosis B. Dehydration C. Metabolic acidosis D. Overhydration
B
Which of the following are the most common electrolyte imbalances observed in patients with refeeding syndrome? A. Hypokalemia, hyperglycemia and hypocalcemia B. Hypoglycemia, hypokalemia and hypophosphatemia C. Hypokalemia, hypophosphatemia and hypomagnesemia D. Hyperkalemia, hypophosphatemia and hypermagnesemia
C
Which of the following electrolyte derangements is commonly seen in a patient with a high output nasogastric tube? A. Hypochloremia and hyperkalemia B. Hyperchloremia and hyperkalemia C. Hyperchloremia and hypokalemia D. Hypochloremia and hypokalemia
C
Which of the following explains why low serum calcium levels need to be adjusted in patients who also exhibit hypoalbuminemia? A. Calcium absorption decreases B. Calcium interferes with protein absorption C. Calcium is bound to serum albumin D. Calcium is chelated to phosphorus
C
Which of the following techniques is NOT recommended to reduce aspiration in tube fed patients? A. Monitor for dysphagia. B. Elevate HOB (head of bed) to 30-45 degrees. C. Administer a hypertonic formula. D. Check for abdominal distention every 4 hours.
C
Which of the following would have the largest % total body water? A. A 10 year old female B. A 50 year old obese man C. An athletic 40 year old man D. A 72 year old female
C
Which trace element needs to be initially given at higher levels when there is risk of refeeding syndrome? A. Chromium B. Copper C. Phosphorus D. Zinc
C
Why is hemodynamic stability an important consideration before initiating enteral nutrition? A. Hyperglycemia is common B. To avoid overfeeding C. GI perfusion may be compromised D. To avoid underfeeding
C
Clinical assessment should include examination of the hair, skin and mouth because they: A. Only show signs of the most severe nutrient deficiencies B. Can be examined without embarrassment to the patient C. Show signs that always indicate specific nutrient deficiencies D. Are susceptible to nutrient deficiencies because of rapid turnover
D
Early enteral nutrition support in critically ill patients results in positive clinical outcomes through all of the following proposed mechanisms EXCEPT: A. Preservation of gut barrier function B. Preservation of gastrointestinal mucosal integrity C. Preservation of mucosal immunological functions D. Exacerbation of the hypermetabolic response
D
Enteral nutrition by tube is not indicated in: A. Anorexia nervosa B. Cardiac cachexia C. Pneumonia D. Small bowel obstruction
D
How many calories does a 500 ml bottle of 10% lipid emulsion provide? A. 1000 kcal B. 1100 kcal C. 500 kcal D. 550 kcal
D
If a patient with severe diabetic gastroparesis requires enteral feeding, which of the following methods should be used to initiate enteral feeding? A. Intermittent or bolus feeding through a gastric tube B. Intermittent or bolus feeding through a jejunal tube C. Continuous feeding through a gastric tube D. Continuous feeding through a jejunal tube
D
JR is a 33 year-old man who was diagnosed as being HIV positive 1 year ago. JR's weight history is as follows: Height = 5'11 Current weight = 70 kg Usual weight (1 year ago) = 77 kg What is JR's percent weight change from his usual weight? A. 5.3% B. 10% C. 12% D. 9.1%
D
Monitoring for enteral tube feeding should include all of the following except: A. Assessing total nutrient intake B. Monitoring to detect signs of refeeding syndrome C. Assessing for signs of inadequate fluid intake D. Stopping TF for a residual of 100 ml
D
Redness and swelling of the lips and mouth and cheilosis may indicate a deficiency of: A. Zinc B. Thiamin C. Vitamin A D. B complex and vitamin B6
D
The major ion in intracellular fluid is: A. Chloride B. Calcium C. Sodium D. Potassium
D
The major ion responsible for determining the volume and osmolality of extracellular fluid is: A. Calcium B. Potassium C. Chloride D. Sodium
D
Where in the body is interstitial fluid located? A. In the blood and the lymphatic system B. Inside the organs C. Within body cells and the lymphatic system D. Between and around body cells
D
Which of the following has the greatest influence on total daily energy expenditure? A. Physical activity B. Stress metabolism C. Thermogenic effect of feeding D. Resting metabolic rate
D
Which of the following scenarios describes a safe home tube feeding practice? A. Formula poured from a ready to use can is hung at room temperature for 14 hours B. Canned formula refrigerated for 12 hours after opening is mixed with formula from a newly opened can C. Formula from a newly opened can is added to formula hanging in an infusion bag D. Formula poured from a can into a bag is hung for 8 hours
D
Which of the following situations would dictate use of parenteral nutrition instead of enteral? A. Patient is malnourished B. Patient needs bowel rest for 3-5 days for Crohn's exacerbation C. Patient will need nutrition support for months to years D. Patient's small intestine has been surgically removed
D
Which of the following statements explains why it is important to monitor calcium and phosphorus additives in a parenteral nutrition formula? A. Too much phosphorus could lead to refeeding syndrome. B. Calcium and phosphorus may not be absorbed. C. Too much calcium could delay wound healing. D. Calcium and phosphorus may form a precipitate.
D
Which organ(s) maintain acid-base balance by the regulation of hydrogen ions? A. Liver B. Lungs C. Hypothalmus D. Kidneys
D
A 15% amino acid solution (initial concentration) for parenteral nutrition provides: A. 150 gm protein per liter B. 15 gm protein per day C. 15 gm protein per liter D. 150 gm protein per day
A
A patient is receiving an intermittent tube feeding of 300 cc formula qid. The formula provides 1.5 kcal/ml and is 79% water. The patient's estimated daily fluid requirement is 1800 ml/day. How much additional water will be required per feeding? A. 215 ml per feeding B. 180 ml per feeding C. 100 ml per feeding D. 250 ml per feeding
A
An example of a patient condition that would be anticipated to exhibit a severe systemic inflammatory response would be which of the following? A. Thermal burn injury of second and third degrees covering 15% of body surface area. B. Homebound elder with restricted access to food and 10% loss of body weight. C. Anorexia nervosa with body mass index (BMI) of 15. D. Major depression with compromised dietary intake and 5% loss of body weight.
A
By what mechanism is thirst stimulated in the hypothalmus? A. Increase in serum osmolality B. Decrease in serum osmolality and an increase in extracellular volume. C. Increase in both serum osmolality and in extracellular volume. D. Decrease in serum osmolality
A
GM is a 35 year-old homeless man who presents to the Emergency Department with a red, swollen tongue, soreness of the lips and mouth, dermatitis and diarrhea. Which of the following vitamin deficiencies should be suspected in this patient? A. Niacin deficiency B. Folate deficiency C. Iron deficiency D. Vitamin C deficiency
A
Normal saline is an example of what type of fluid? A. Isotonic B. Hypertonic C. Hypotonic
A
One of the best validated screening indicators for malnutrition risk is what? A. Patient reports a nonvolitional weight loss of 10% of usual body weight. B. Patient is 2 days status post laparoscopic cholecystectomy. C. Patient reports following a low-carbohydrate weight loss diet. D. Patient reports a recent flu-like febrile illness.
A
Spongy, swollen gums, gums that bleed easily, skin that bruises easily might indicate a deficiency of: A. Vitamin C B. B complex and vitamin B6 C. Vitamin A D. Zinc
A
The enteral nutrition formulation for a home patient receiving tubefeeding through a gastrostomy was recently changed from a high-protein, fiber-containing 1 kcal/ml formula to a 1.5 kcal//ml formula. The new formula contains lower amounts of carbohydrate, 55% of calories from fat, about 15% less protein per day than the 1 kcal/ml formula and no fiber. What component of the new formula is most likely to contribute to interactions resulting from slow gastric emptying? A. Higher fat content B. Higher caloric density C. Lower fiber content D. Lower protein content
A
Which criteria is LEAST useful in establishing a nutrition diagnosis of malnutrition? A. Reduced serum albumin B. Weight loss C. Insufficient energy intake D. 2 + edema in lower extremities
A
Which of the following actions is most appropriate for improving gastric emptying during enteral feeding? A. Change from bolus to continuous feeding. B. Switch to an enteral formulation with a higher protein content. C. Switch to an enteral formulation with a higher fat content. D. Keep the bed in Trendelenburg position (head of bed is lower than feet).
A
Which of the following is the most common metabolic complication associated with parenteral nutrition? A. Hyperglycemia B. Essential fatty acid deficiency C. Hyperammonemia D. Azotemia
A
Which of the following methods is used most commonly to obtain placement for long-term enteral nutrition support? A. Gastrostomy B. Orogastric C. Nasogastric D. Jejunostomy
A
Which acid-base imbalance can result from diuretics use, nasogastric suctioning and loss of chloride? A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis
C
Diarrhea in critically ill patients is always a result of enteral nutrition (EN). True or False
False
Recent practice guidelines state that enteral nutrition should be delayed until 96 hours after admission because providing it earlier is associated with increased infections and infectious complications. True or False
False
Which of the following TPN formulations has the greater percent of total calories from fat? (all given in initial concentrations) A. 1000 ml 10% amino acids, 1000 ml D50W, 500 ml 20% lipid B. 500 ml 10% amino acids, 500 ml D70W, 500 ml 10% lipid C. 1000 ml 8.5% amino acids, 500 ml D70W, 500 ml 20% lipid D. 500 ml 8.5% amino acids, 500 ml D50W, 500 ml 10% lipid
C
A male patient is admitted to the ICU with pneumonia and the following signs and symptoms: prealbumin 8.0 (normal 16-40 mg/dl), BMI 18, past medical history indicated extensive bowel resection 6 months previously as a result of cancer diagnosis with extremely poor intake over the past 2 weeks. Usual body weight 195 lb (before resection), current weight 172. The most appropriate nutrition diagnosis would be: A. Disordered eating pattern B. Malnutrition C. Altered nutrition-related laboratory values D. Limited access to food
B
A patient is admitted to the medical intensive care unit (ICU) for sepsis and now requires the use of continuous intravenous (IV) insulin infusion for hyperglycemia management. What is the appropriate target glucose range for this patient? A. 115 - 135 mg/dl B. 140 - 180 mg/dl C. 80 - 110 mg/dl D. 185 - 210 mg/dl
B
A patient's hematologic lab values indicate low hemoglobin and low MCV (mean corpuscular volume). What nutritional deficiency might they have? A. Protein deficiency B. Iron deficiency C. Folate deficiency D. Vitamin B12 deficiency
B
A resident of a long-term care facility is receiving a nocturnal tubefeeding from 7pm to 9am. The formula has a concentration of 1.5 kcal/ml. What rate is required to provide 1650 kcal? A. 70 ml/hr B. 80 ml/hr C. 120 ml/hr D. 45 ml/hr
B
A small bore (diameter) nasogstric feeding tube has just been inserted. Which method should be used to determine it has been correctly placed in the stomach? A. Auscultation while insufflating air B, X-ray confirmation C. Aspirating gastric contents D. pH testing of gastric contents
B
A 80-year-old patient who experienced a cerebrovascular accident demonstrated normal laboratory values when an enteral feeding was initiated five days ago. Current laboratory values are: Serum sodium 146mEq/L (135-145mEq/L) Serum potassium 3.9mEq/L (3.5-5.0mEq/L) Serum creatinine 1.2mg/dl (0.84-1.21 mg/dl) Serum glucose 132mg/dl (<100 mg/dL) Blood urea nitrogen 43mg/dl (7-20mg/dl) A. The appropriate intervention would be to: decrease sodium intake B. Increase fluid intake C. reduce protein intake D. reduce carbohydrate intake
B
A continuous drip tubefeeding of a 1.2 kcal/ml formula is being infused at 90 ml/hr for 24 hours per day. The formula is 53% kcal from carbohydrate, 18% protein and 29% fat. How many calories and grams of protein are delivered in a 24 hour period? A. 2160 kcal and 82 grams protein B. 2592 kcal and 116 grams protein C. 2160 kcal and 97 grams protein D. 2592 kcal and 74 grams protein
B
What test is indicated when a patient receiving tube feeding and antibiotics develops diarrhea? A. Small bowel biopsy for celiac disease B. Stool culture for ova and parasites C. Stool for Clostridia difficile toxin D. Bacteria culture of formula
C
When evaluating a patient's current weight, the most useful comparison is to: A. Body mass index B. Adjusted body weight C. Usual body weight D. Ideal body weight
C
When starting a patient on continuous enteral feeding with a hypertonic formula, the formula should be: A. Full-strength, with a rapid increase in rate B. Half-strength, with a gradual increase in rate C. Full-strength, with a gradual increase in rate D. Half-strength, with a rapid increase in rate
C
A 24 hr UUN study was completed on a patient. The 24 hr urine sample yields a nitrogen loss of 11.8 gm nitrogen. You calculate from the patient's nutrition support regimen that he is receiving 72 gm protein. His protein balance study shows: A. Positive protein balance of 2 gm protein B. Negative protein balance of 37 gm protein C. Negative protein balance of 27 gm protein D. Negative protein balance of 2 gm protein
C
A 55-year old critically ill patient has been tolerating a standard 1 kcal/ml feeding formula well over the past week. She begins having frequent bouts of loose stools. What should be the clinician's next suggestion? A. Add pre and probiotics B. Change to a fiber-supplemented formula C. Determine the cause of the diarrhea D. Change to a peptide-based formula
C
A critical care patient has a serum albumin of 2.0 mg/dl and nursing report increased abdominal girth and edema of the extremities. This patient has: A. Metabolic water B. Dehydration C. "Third spacing" of fluids D. Insensible water loss
C
A patient's caloric needs are estimated at 1950 calories/day. Which amount of Osmolite 1.5 (1.5 kcal/ml) will best meet his calorie needs? A. Bolus at 400 ml qid. B. Continuous at 80 ml/hr for 24 hours/day. C. Continuous at 55 ml/hr for 24 hours/day. D. Bolus at 250 ml q 4 hours.
C
A patient's enteral feeding tube has become clogged. Attempts at unclogging with water flushes have not been successful. What is the next most reliable method for unclogging the tube before being replaced? A. Administer cola through the tube and let it sit for a few hours. B. Administer an acidic juice such as grapefruit or cranberry, let it sit for a few hours to dissolve the clot and then flush with water. C. Administer a mixture of pancreatic enzymes and bicarbonate solution, allow it to sit for 1 to 2 hours and then flush with water. D. Wait a few hours to see if the clog dissolves spontaneously.
C
An adult weighs 90 kg and is 6'1". This person's BMI would be classified as: A. Normal weight B. Underweight C. Overweight D. Obese
C
How would the body compensate for metabolic acidosis? A. Increased kidney excretion of bicarbonate B. Decreased kidney clearance of bicarbonate C. Increased ventilation of carbon dioxide D. Decreased ventilation of carbon dioxide
C
In patients with dehydration, what happens to serum proteins and electrolytes? A. They are increased due to increased urinary output B. They are decreased due to hemodilution C. They are increased due to hemoconcentration D. They are decreased due to poor nutritional status
C
Mr. H is a 65 year old male who drinks about 3 alcoholic drinks/day and sometimes more on weekends. He presents with symptoms including loss of balance, decrease in ankle and knee reflexes, confusion and pallor. These might reflect a deficiency of: A. Zinc B. Vitamin B6 C. Vitamin B12 D. Vitamin A
C
One month ago, a patient began receiving PN that delivers 2,300kcal/d. Since then, the patient has experienced undesirable weight gain. Which of the following formulations would be appropriated: A. 1800 ml of 25% D and 5% amino acids plus 250 ml of 20% lipid emulsion B. 1680 ml of 25% D and 5% amino acids plus 500 ml of 20% lipid emulsion C. 1800 ml of 20% D and 5% amino acids plus 250 ml of 20% lipid emulsion D. 1560 ml of 20% D and 5% amino acids plus 500 ml of 20% lipid emulsion
C
Patients receiving parenteral nutrition may experience complications that include a sudden change in their body temperature, new onset chills, leukocytosis, or unexplained hyperglycemia. Which of the following is most likely to cause these complications? A. Intra-abdominal infection B. Urinary tract infection C. Catheter-related blood stream infection D. Pneumonia
C
The kidneys compensate for a loss of body water by excreting: A. More dilute urine B. Additional fluid and electrolytes C. More concentrated urine D. Additional electrolytes
C
The purpose of nutrition screening is to: A. Categorize patients as high or moderate risk B. Determine a patient's nutrition problem. C. Identify patients at nutrition risk. D. Assess the patient's nutrition status
C
These statements about tube feeding administrations are true, except: A. Gastric feeding tubes allow continuous, intermittent or bolus feeding schedules B. The tube has to be flushed before and after medication is administered to avoid clogging of the tube C. Patients can stand, sit or lie flat on their bed when tube feeding D. The bolus feeding schedule often mimics meal times
C
This type of catheter is most appropriate for: A. Long term therapies ranging from several weeks to months B. Peripheral access C. Acute care and short duration therapy D. Long term care, site care only when accessed
C
What condition is evidenced by symptoms of mental confusion, muscle wasting, edema and peripheral neuropathy? A. Hypomagnesemia B. Hypokalemia C. Thiamin deficiency D. Niacin deficiency
C
What mineral deficiency may lead to hypogeusia? A. Selenium B. Copper C. Zinc D. Iron
C
You are seeing a 45 YO male who needs TPN due to a small bowel obstruction. Using 30 kcal/kg and 1.2-1.5 gm protein/kg, determine which formula will best meet his needs. Ht 5'11 Wt 195 lb A. 1000 ml 8.5% amino acids, 1000 ml D30, 520 ml 20% lipid B. 800 ml 10% amino acids, 800 ml D50, 280 ml 20% lipid C. 100 ml/hr for 24 hours of solution containing final concentration of 5% protein and 20% CHO; separately 250 ml 20% lipid is piggybacked over 10 hrs D. 125 ml/hr for 24 hours of solution containing final concentration of 5% protein and 15% CHO; separately 500 ml 10% lipid is piggybacked over 10 hrs
C
A positive acute phase reactant that is useful in detecting the presence of active inflammation is: A. Cholesterol B. Prealbumin C. Albumin D. C reactive protein
D
All of the following are attributes of closed enteral nutrition systems EXCEPT: A. Less nursing time involved B. Lower rates of contamination C. Ready to hang D. Easily adjusted/customized to meet patient needs
D
A patient is admitted to the hospital after three days of vomiting and diarrhea and has lost 4% of his body weight. Assessment of lab data would likely show: A. High albumin and low sodium B. Elevated calcium and low phosphorus C. Low albumin and low BUN D. Elevated sodium and elevated BUN
D
A patient with severe diarrhea has the following laboratory tests: Arterial pH - 7.21 (7.35-7.45) pCO2 = 28 (35-45 mm Hg) HCO3 = 14 (22-26 mEq/L) What is the acid-base disorder? A. Metabolic alkalosis B. Respiratory acidosis C. Respiratory alkalosis D. Metabolic acidosis
D
You are determining the energy intake target for a 53 year-old, critically ill, male patient who is about to start enteral feeding. He is 170 cm in height and weighs 150 kg. His body mass index (BMI) is 51.9 and his ideal body weight is 70 kg. Based on the American Society for Parenteral and Enteral Nutrition (ASPEN) guideline for calculating a goal energy intake for such a critically ill patient, what energy value would you use as the basis for the feeding plan? A. 2250 kcal (25 kcal per kg adjusted body weight) B. 2615 kcal (Penn State equation) C. 1225 kcal (70% of the calculated 25 kcal per kg ideal body weight) D. 1750 kcal (25 kcal/kg ideal body weight)
D
Albumin is neither sensitive to, nor specific for, acute protein malnutrition or the response to nutrition therapy. The lifetime time of albumin is approximately 21 days. During a critical illness, factors that alter serum albumin include the following: The acute-phase response, hydration, disease state, clinical condition, and leakage of albumin from intravascular to extravascular spaces. True or False
True
This is an example of refeeding guidelines for prevention and treatment of the refeeding syndrome in adult patient at risk. Days 1-3: Energy: start at 10kcal/kg/day, 50-60% CHO, 30-40% Fat, and 15-20% Prot. Days 4-6: Energy: start at 15-20kcal/kg/day, 50-60% CHO, 30-40% Fat, and 15-20% Prot. Days 7-10: Energy: start at 20-30kcal/kg/day, 50-60% CHO, 30-40% Fat, and 15-20% Prot. True or False
True
All patients who are defined as malnourished by ASPEN/AND criteria suffer from an inflammatory response. True or False
false