Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CNSC Exam 2021 > Chapter MC Questions / Practice Test (No Answers) > Flashcards

Chapter MC Questions / Practice Test (No Answers) Flashcards

1
Q

Which of the following is an example of a patient condition anticipated to manifest with a severe systemic inflammatory response?

a) Anorexia with BMI of 15
b) Major depression with compromised dietary intake and 5% loss of body weight
c) Homebound older adult with restricted access to food and 10% loss of body weight.
d) Thermal burn injury of second and third degrees covering 15% surface area.

A
  1. Chapter 9
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

A physician informs you that a patient has a serum albumin of 2.8 g/dL and prealbumin of 14 mg/dL and asks whether these laboratory findings means 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 hx, clinical dx, and laboratory signs of the inflammatory response would help you interpret these findings.
d) For most hospitalized patients, albumin and prealbumin have excellent sensitivity and specificity to identify malnutrition.

A
  1. Chapter 9
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which of the following is one of the best validated screening indicators for malnutrition risk?

a) Patient reports a non-volitional weight loss.
b) Patient reports following a low-carb, weight loss diet.
c) Patient is 2 days s/p laparoscopic cholecystectomy
d) Patient reports a recent flu-like febrile illness

A
  1. Chapter 9
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which of the following is a benefit of EN compared with PN or no nutrition?

a) Maintenance of normal GB function
b) Reduced GI bacterial translocation
c) More efficient nutrient metabolism
d) All of the above

A
  1. Chapter 10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

High-protein hypocaloric EN feeding providing 65% to 70% of energy needs, as determined by indirect calorimetry, is recommended for ICU patients with which of the following conditions?

a) Malnutrition
b) Obesity
c) Liver failure
d) Acute respiratory distress syndrome (ARDS)

A
  1. Chapter 10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for aspiration include all of the following except:

a) Malnutrition
b) Use of naso-/oro-feeding tube
c) Bolus EN feeding
d) Supine position

A
  1. Chapter 10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A 55-year-old man presented to the hospital after a traumatic fall from a ladder while working at home. 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 removal of 200 mL gastric content. The patient’s abdomen was soft and nondistended. Nephrology was consulted, and the patient was started on continuous venovenous 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 restricted in protein or electrolytes
d) A formula not restricted in fluid or protein but restricted in electrolytes

A
  1. Chapter 11
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A 60-year-old, critically ill patient has been tolerating a standard 1 kcal/mL enteral feeding formula well for the past week. She begins having frequent bouts of loose stools, requiring placement of a rectal tube. What should be the clinician’s next suggestion?

a) Change to 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

A
  1. Chapter 11
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should a clinician do when considering the use of enteral formulas marketed for specific disease conditions?

a) Use formulas as indicated by the product manufacturer to meets patient’s needs
b) Use standard 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.

A
  1. Chapter 11
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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 MedSystems, 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 bicarbonate solution, allow it to sit for 1 to 2 hours (or longer) and then flush with warm water.

A
  1. Chapter 12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

You perform a telephone evaluation of a patient who relates increased redness, pain and swelling around his existing low-profile gastrostomy tube (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 enteral tube feeds. In fact, the patient states that he has gained over 20 pounds. You would proceed as follows:

a) Congratulate him on gaining the weight and tell him to continue his present tube feeding plan.
b) If possible, have him come to the clinic or call the clinician 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 few days.

A
  1. Chapter 12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

An 18-year-old female patient with cystic fibrosis had a standard-profile, solid internal bumper, 20-Fr percutaneous endoscopic gastrostomy (PEG) tube placed 1 year ago because of her inability to take enough energy orally and weight loss. She has done very well, 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 with solid internal bolster
b) Standard-profile, 20-Fr PEG with balloon internal bolster
c) Low-profile, 20-Fr PEG with solid internal bolster
d) Low-profile, 20-Fr PEG with balloon internal bolster

A
  1. Chapter 12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which of the following actions is most appropriate for enhancing gastric emptying during the administration EN?

a) Keeping the bed in Trendelenburg position
b) Decrease the rate of a continuous feeding infusion, or change from bolus to continuous feeding.
c) Switch to enteral formulations with higher fat content
d) Switch to enteral formulation with higher protein content

A
  1. Chapter 13
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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 the patient’s medication administration record to determine whether hyperosmolar agents are being administered
c) Change to a peptide-based enteral formulation.
d) Use an antimotility agent

A
  1. Chapter 13
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which of the following methods is not recommended to minimize contamination of enteral feeding formula?

a) Washing hands and donning clean gloves before preparing enteral formula
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.

A
  1. Chapter 13
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the optimal nutrition support for malnourished patient when the enteral nutrition is not feasible for a prolonged period?

a) Central parenteral nutrition (CPN)
b) Nasogastric enteral tube feedings
c) Post-pyloric enteral tube feedings
d) Peripheral parenteral nutrition (PPN)

A
  1. Chapter 14
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In which patient condition or treatment could PN elicit an improved patient outcome?

a) Cancer chemotherapy
b) Preoperative care of surgery patients with upper GI cancer
c) Allogeneic bone marrow transplantation
d) Critical illness

A
  1. Chapter 14
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CPN is contraindicated in which of the following conditions?

a) Do no resuscitate (DNR) status
b) Peritonitis
c) Intestinal hemorrhage
d) High-output fistulas

A
  1. Chapter 14
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A
  1. Chapter 14
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which of the following may increase the risk of phlebitis with peripherally administered parenteral nutrition (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 the PPN

A
  1. Chapter 15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the smallest pore size filter that is recommended for TNA?

a) 0.22 microm
b) 0.5 microm
c) 1.2 microm
d) 5 microm

A
  1. Chapter 15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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 the sodium salt
c) Increased amino acid concentration
d) Increased temperature

A
  1. Chapter 15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

According to recommendations by the National Advisory Group on Standards and Practice guidelines for parenteral nutrition formulations and the American Society for Parenteral and Enteral Nutrition (ASPEN) parenteral nutrition safety consensus, the amount of dextrose used in preparation of a PN formulation is required to appear on the label as:

a) The percentage of original concentration and volume (ie: dextrose 50% water, 500 mL)
b) The percentage of final concentration after admixture (ie: dextrose 25%)
c) Grams per liter of PN admixed (ie: dextrose 250 g/L)
d) Grams per day (ie: dextrose 250 g/d)

A
  1. Chapter 15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which of the following is the most appropriate VAD strategy for a patient requiring long-term PN therapy?

a) Use a midclavicular catheter as a cost-effective measure
b) Place a percutaneous non-tunneled catheter to initiate PN then replace it with an implanted port.
c) Place a single-lumen, tunneled cuff catheter.
d) Place a triple-lumen, antibiotic-coated catheter to ensure adequate access for future needs.

A
  1. Chapter 16
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Thrombotic occlusions are most commonly treated with which of the following?

a) Thrombolytics
b) Anticoagulants
c) 10% hydrochloric acid
d) Sodium bicarbone

A
  1. Chapter 16
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which of the following practices has been shown to reduce the risk for catheter-related bloodstream infections (CRBSIs)?

a) Systematic use of antimicrobial prophylaxis at the time of insertion or access
b) Routine replacement of central venous access devices (CVADs)
c) Use of the “Central Line Bundle” of insertion and maintenance practices.
d) Selection of an internal jugular site as opposed to subclavian site

A
  1. Chapter 16
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which of the following is the most common metabolic complication associated with PN?

a) Hyperglycemia
b) EFAD
c) Azotemia
d) Hyperammonemia

A
  1. Chapter 17
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

One day after initiating PN in a critically ill patient, the patient’s laboratory values are as follows: serum potassium, 3.1 mEq/L (normal: 3.4 0 4.8 mEq/L); serum phosphorus 1.6 mg/dL (normal: 2.5 - 4.8 mg/dL); and serum magnesium, normal. The PN regime is providing protein 90g, dextrose 150g, no lipid, minimum volume, potassium 80 mEq, phosphate 40 mmol, and standard doses of sodium, magnesium, calcium, vitamins and trace elements. The patient weighs 60 kg and has a BMI of 18.0. The most appropriate response to these laboratory data is:

a) Increase potassium and phosphate in the PN, and decrease macronutrient doses with tonight’s PN bag
b) Provide supplemental IV doses of potassium and phosphate today, but do not change the macronutrient doses with tonight’s PN bag.
c) Increase potassium and phosphate in the PN, and advance dextrose to 225g with tonight’s PN bag.
d) Provide supplemental IV doses of potassium and phosphate today, and advance dextrose to 225g with tonight’s PN bag.

A
  1. Chapter 17
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which of the following measures would be considered most beneficial in a patient who develops cholestasis while receiving long-term PN that is infused over 12 hours nightly?

a) Stop all oral and enteral intake
b) Switch from a cyclic to continuous method of PN administration
c) Decrease lipid injectable emulsion (ILE) dose from 1.5 g/kg/day to 1 g/kg twice weekly.
d) Increase protein dose from 1 g/kg/d to 2 g/kg/d.

A
  1. Chapter 17
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

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 of at least 2 g/kg/d
b) Provide more than 20 mEq calcium per day.
c) Add injectable vitamin D to the PN formulation
d) Provide 20 to 40 mmol phosphorus per day.

A
  1. Chapter 17
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

An alert and oriented adult patient is receiving a continuous infusion of a standard, fiber-containing EN formulation through an 8-Fr NG tube. Drugs administered by bolus administration through the side port of the tube are phenytoin suspension 400 mg daily and nizatidine 150 mg every 12 hours. The feeding tube becomes occluded and must be removed. A new tube is placed because a long-term tube will not be considered until after a swallow study is completed 2.5 weeks from now. Which of the following measures is most appropriate for preventing occlusion of the new tube?

a) Replace the 8-Fr with an 18-Fr NG tube
b) Flush the feeding tube with 15 ml water before and after administering each med
c) Discontinue the fiber-containing enteral feeding formulation, and initiate feeding with a fiber-free formula
d) Hold the feeding infusion for 2 hours before and after administering phenytoin

A
  1. Chapter 18
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

The EN formulation for a home patient receiving EN through a percutaneous gastrostomy was recently changed from a high-protein, fiber-containing, 1 kcal/ml formula to the only 1.5 kcal/ml formulation available in the local store. the new product is marketed for use in patients with compromised pulmonary function and contains low amounts of CHO, 55% energy from fat, about 15% less protein per day than the 1 kcal/ml formula, and no fiber. What component of the new formulation is most likely to contribute to interactions resultings from slow gastric emptying.

a) Lower fiber content
b) Lower protein content
c) Higher fat content
d) Higher energy density

A
  1. Chapter 18
33
Q

Which of the following is the preferred method of administering a hospitalized patients antihypertensive mediation when TF is started due to poor oral intake?

a) By the oral route
b) As an oral liquid via the feeding tube
c) As a crushed tablet via the feeding tube
d) By the IV route

A
  1. Chapter 18
34
Q

A medication that is ordered as a liquid to be administered via the feeding tube is available in the pharmacy in the IV form, as a capsule (powdered drug in a hard gelatin capsule), and as a film-coated tablet. What is the most appropriate and cost-effective choice for administration of this medication?

a) Administer the IV form via the IV route
b) Administer the IV form via the feeding tube
c) Make a slurry of the capsule’s powder and administer via the feeding tube
d) Crush the tablet to a fine powder and administer via the feeding tube.

A
  1. Chapter 18
35
Q

Which of the following claims for a dietary supplement would most likely cause the US FDA to consider that the supplement should be regulated as a drug rather than as a dietary supplement?

a) Supports strong bones and teeth
b) Treats influenza
c) Promotes urinary health
d) Improves immune function

A
  1. Chapter 19
36
Q

Which of the following best describes dietary supplement use in the US?

a) Only a minority of the population uses dietary supplements
b) Most patients report their dietary supplement use to their PCPs
c) Most patients think that their health care providers are knowledgeable about dietary supplements.
d) Many patients using prescription medicines concomitantly use dietary supplements.

A
  1. Chapter 19
37
Q

Even if Current Good Manufacturing Practices (CGMPs) promulgated by the Dietary Supplement Health and Education Act of 1994 (DSHEA) are properly implemented, which of the following is likely to occur?

a) A dietary supplement product adulterated with a prescription drug such as sibutramine is being marketed and sold.
b) A dietary supplement product is analyzed and found to have much less of the active ingredient than what is indicated on the label.
c) A dietary supplement product is analyzed and found to have much more of the active ingredient than what is indicated on the label.
d) A dietary supplement product is marketed and sold, but there are no studies to confirm its efficacy for any condition.

A
  1. Chapter 19
38
Q

Which of the following statements is true regarding the nutrition status of the pregnant woman and its impact on the fetus?

a) Obese pregnant women should lose weight during pregnancy to improve fetal outcomes
b) The fetus is a “perfect parasite” and the nutrition status of the mother is of no consequence.
c) Appropriate weight gain for women of all BMIs ranges is essential to fetal health.
d) Poor maternal health and nutrition status has only short-term impact on the fetus.

A
  1. Chapter 20
39
Q

Which of the following statements about energy needs during pregnancy is true?

a) Energy requirements are the same for pregnant and nonpregnant women
b) Energy needs are increased only during the second and third trimesters of pregnancy.
c) Compared with non-obese women, energy requirements are lower for obese women to promote weight loss during pregnancy.
d) Energy goals should only focus on non-protein energy intake

A
  1. Chapter 20
40
Q

Which of the following parameters is appropriate for monitoring glycemic control of pregnant women receiving nutrition support?

a) Urine glucose
b) Urine lactic acid
c) Serum glucose
d) Serum insulin

A
  1. Chapter 20
41
Q

What are the goals for protein support for adults with delayed healing of pressure injuries/ulcers?

a) Adequate protein: 0.8 g/kg/d
b) Adequate protein: 1.0 to 1.2 g/kg/d
c) Adequate protein: 1.25 to 1.5 g/kg/d
d) Adequate protein: 0.6 g/kg/d

A
  1. Chapter 21
42
Q

Which of the following should be offered to provide elemental zinc for pressure injuries/ulcers healing?

a) Zinc sulfate: 220 mg/d
b) Zinc gluconate: 84 mg/d
c) Daily MVI with minerals supplement
d) Zinc chloride: 170 mg/d

A
  1. Chapter 21
43
Q

All wounds begin as acute wounds. Which of the following distinguishes an acute wound from a chronic wound?

a) An acute wound will generally heal within 2 to 3 days’ whereas a chronic wound will likely take 7 to 10 days to heal.
b) Acute wounds are related to an initial injury, whereas chronic wounds develop due to an underlying pathological process.
c) The microenvironments of the 2 types of wounds are different, with acute wounds having few inflammatory mediators present
d) Both B and C

A
  1. Chapter 21
44
Q

Which of the following is most strongly correlated with improved mortality of TBI?

a) Strict avoidance of PN
b) Early initiation of nutrition
c) High protein content in nutrition formula
d) Supplementation of vitamins C and E

A
  1. Chapter 22
45
Q

Which of the following commonly used medications in TBI is not associated with a reduction in measured energy expenditure?

a) Propranolol
b) Mannitol
c) Pentobarbital
d) Rocuronium

A
  1. Chapter 22
46
Q

Metabolic changes following SCIs depend on the level of cord injury and the extent of injuries. Which of the following statements is true?

a) The energy expenditure following SCI is approximately 48% higher than that following TBI.
b) To accurately assess the energy requirements for a patient with SCI, multiply the resting energy expenditure (calculated with the Harris-Benedict equation) by an injury factor of 1.6 and then again by an activity factor of 1.2
c) A modified BMI scale has been proposed for individuals with SCI, with healthy normal categorized as BMI 18 to 22.
d) Patients with chronic SCI require approximately 30 to 33 kcal/kg/d depending on their physical activity.

A
  1. Chapter 22
47
Q

Which of the following statements regarding a subarachnoid hemorrhage (SAH) is false?

a) High doses of folic acid should be administered to reduce the likelihood of a second hemorrhagic stroke.
b) Energy expenditure is higher for patients with SAH than for those with ischemic stroke.
c) Concentrated EN may be necessary if fluid intake is restricted to minimize cerebral edema.
d) Bedside or formal swallow studies should be performed to confirm that the patient does not have dysphagia before an oral diet is initiated.

A
  1. Chapter 22
48
Q

Which of the following characterizes the current understanding of systemic inflammatory response?

a) Overstimulated immune system
b) Mixture of immune stimulation and suppression
c) Initial immune suppression followed by stimulation
d) Immune suppression

A
  1. Chapter 23
49
Q

Why is hemodynamic stability an important consideration before initiating EN?

a) To avoid overfeeding
b) Hemodynamic instability is an indication for PN
c) GI perfusion may be compromised,
d) Patients cannot absorb any nutrients when they are underresuscitated.

A
  1. Chapter 23
50
Q

What is the best reason to conservatively prescribe energy in nutrition support regimens?

a) Glycemic control
b) To facilitate permissive underfeeding
c) Cost containment
d) To achieve goal infusions more efficiently

A
  1. Chapter 23
51
Q

A 56 year old man with long-standing T2DM presents with postprandial abdominal pain, nausea and vomiting. His DM is uncontrolled despite the use of insulin, and his glycosylated hemoglobin A1C IS 10%. He also has painful peripheral neuropathy in his legs as well as diabetic retinopathy. His GI symptoms have progressed over the past 6 months, and he now reports eating very little because he fears the abdominal pain and vomiting will worsen. The emesis occurs 30 minutes to 2 hours after eating, and it has the appearance of undigested food. A EGD is normal. Which diagnostic test is the ideal next step in determining the cause of his symptoms?

A
  1. Chapter 24
52
Q

A 35 year old white woman presents to the clinic with diarrhea, weight loss, and abdominal liver function tests. Her PCP also noted that the patient was vitamin D and iron deficient with anemia. On physical examination, the patient has a very pruritic maculopapular rash with vesicular eruptions on her lower legs. An EGD is performed, and a mosaic pattern with nodularity is noted in the second portion of the duodenum. Which of the following is most likely cause of the patient’s symptoms?

a) Crohn’s disease
b) Celiac disease
c) Whipple disease
d) Peptic ulcer disease

A
  1. Chapter 24
53
Q

A 19 year old woman with a history of Crohn’s ileitis since the age of 13 years presents for ongoing care. She has been on several medications for Crohn’s disease over the course of her diagnosis. Her disease is isolated to the terminal 30 cm of her ileum and ileocecal valve. Despite adequate medication compliance and dosing, her disease remains active. She complains of 4 to 5 loose, watery stools a day, bloating and mild abdominal pain. She has a microcytic anemia, signs of fat and lean muscle wasting, and osteopenia. She is determined to have failed medical management and undergoes a ileocecectomy. Which of the following vitamins is she most likely to eventually need to take as a supplement?

a) Folate
b) Vitamin B12
c) Vitamin A
d) Vitamin E

A
  1. Chapter 26
54
Q

Which of the following is an accurate marker of nutrition status in all patients with chronic liver disease with portal hypertension?

a) Serum prealbumin
b) Retinol-binding protein
c) Anthropometry
d) None of the above

A
  1. Chapter 27
55
Q

Which of the following statements is false regarding alcoholic hepatitis?

a) Virtually all patients with alcoholic hepatitis have some degree of malnutrition
b) The severity of liver disease generally correlates with the degree of malnutrition
c) Energy intake correlates with mortality
d) Protein delivery should be reduced to prevent portal systemetic encephalopathy (PSE)

A
  1. Chapter 27
56
Q

Which of the following statements is true regarding PN in the care of the inpatient with liver disease?

a) There is no role for PN in nutrition in liver disease
b) PN should be initiated in all hospitalized patients with liver disease
c) If a patient cannot tolerate EN, PN can provide necessary nutrition, but it should be discontinued in favor of EN ASAP.
d) When a patient cannot tolerate EN, he or she should receive PN for the duration of the hospitalization.

A
  1. Chapter 27
57
Q

A nutrition support clinician was consulted on the second day of hospitalization about a patient who presented with severe acute pancreatitis and required mechanical ventilation. A recent, dynamic contrast-enhanced computed tomography (CT) scan revealed necrosis involving 30% of the pancreatic gland and a small (4 cm) pseudocyst in the tail of the gland. Which of the following should the clinician recommend?

a) Continue NPO status with no enteral tube feeding, noting that the necrosis may required surgical intervention
b) Start the patient on PN because the patient is mechanically ventilated and has a pseudocyst
c) Place a NJ tube and begin enteral feedings, providing no more than 10 to 20 mL/hr.
d) Place a NG tube, being TF and advance to the nutrition goal over the first 24 to 48 hours.

A
  1. Chapter 28
58
Q

Which of the following nutrition regimens is appropriate for a patient with less than 2 Ranson criteria and an Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score of less than 9 (nonsevere) who has no pancreatic necrosis on a CT scan?

a) Begin volume resuscitation, provide narcotic analgesia, and advance to oral diet as soon as it is tolerated.
b) Begin PN in the first 24 hours of admission because the patient has acute pain.
c) Keep the patient NPO for at least 7 days.
d) Use PN in the first 24 hours, and then switch to an oral diet

A
  1. Chapter 28
59
Q

Which of the following is true?

a) The immune response of the gut remains intact when a patient is maintained of PN.
b) The immune response of the gut remains intact when a patient is maintained on EN.
c) Loss of gut integrity may allow bacteria of gut origin to infect distant organ sites, but this issue is improved with bowel rest..
d) Enteral feedings should be stopped if the ileus is noted radiographically.

A
  1. Chapter 28
60
Q

Which of the following metabolic alterations is most commonly observed in AKI?

a) Decreased energy expenditure
b) Metabolic acidosis
c) Decreased serum magnesium concentration
d) Metabolic alkalosis

A
  1. Chapter 29
61
Q

Which of the following parenteral AA preparations is most appropriate for a dialysis-dependent patient with renal failure?

a) Essential AAs only
b) Nonessential AAs only
c) Mixtures of essential and nonessential AAs
d) High BCAAs

A
  1. Chapter 29
62
Q

Which of the following is a measurement of body iron stores?

a) TIBC
b) Ferritin
c) Transferring
d) Ceruloplasmin

A
  1. Chapter 29
63
Q

What percentage of instilled dextrose is typically absorbed from peritoneal dialysate with a 6-hour dwell time?

a) 25%
b) 50%
c) 75%
d) 100%

A
  1. Chapter 29
64
Q

Which of the following answers best reflect dietary modifications that may prevent the development of nephrolithiasis-related renal failure?

a) A calcium-restricted diet with increased free-water intake
b) A low-fat diet with adequate phosphorus repletion and increased free-water intake.
c) A low-fat and oxalate- and calcium-restricted diet
d) A low-fat, oxalate-restricted diet and adequate hydration

A
  1. Chapter 30
65
Q

Because of the malabsorptive process present in SBS, patients have a high risk for micronutrient deficiencies. Which of the following answers is correct regarding the monitoring and repletion of micronutrients in SBS?

a) If patients are receiving PN, there is no reason to monitor micronutrients because the PN should satisfy all micronutrient needs.
b) Micronutrients should be checked periodically. Micronutrients can usually be repleted via the oral route.
c) Micronutrients should be checked monthly. Repletion should be administered in high doses both IV and orally.
d) Micronutrients should be checked annually, and all micronutrients should be repleted intravenously because patients with SBS cannot absorb micronutrients administered orally.

A
  1. Chapter 30
66
Q

Which of the following answers best describes how a clinician determines the most appropriate feeding route (ie, oral, enteral, parenteral or a combination) for a patient with SBS?

a) All patients with SBS need lifelong TPN; if their energy and protein needs are met with PN, they can eat whatever they want for comfort
b) To avoid the risk of PN-associated complications, PN should always be discontinued as soon as oral intake or EN is initiated.
c) The nutrition regime should be individualized to meet the needs of the particular person.
d) Insurance reimbursement plays the major role in deciding the feeding route.

A
  1. Chapter 30
67
Q

Which of the following characteristics of an initial enteral feeding regime would be most appropriate for a patient with SBS?

a) A fiber-free, energy-dense formula administered via bolus infusion
b) A hydrolyzed, elemental formula that is high in MCT oil
c) An isotonic, polymeric, fiber-containing formula administered via continuous gastric infusion
d) A semi-elemental, peptide-based formula administered nocturnally.

A
  1. Chapter 30
68
Q

Which of the following is a contraindication for organ transplantation?

a) DM
b) End-stage organ failure
c) Active infection
d) History of substance abuse

A
  1. Chapter 31
69
Q

Which of the following immunosuppressive agents is nephrotoxic and can cause hyperkalemia, hypomagnesemia, and hyperglycemia?

a) Sirolimus
b) Prednisone
c) Tacrolimus
d) Mycophenolate mofetil

A
  1. Chapter 31
70
Q

Which of the following best describes nutrient requirements during the acute posttransplant phase?

a) Moderate energy, high protein
b) High energy, low protein
c) Moderate energy, low protein
d) High energy, High protein

A
  1. Chapter 31
71
Q

Which of the following should be part of a nutrition care plan for a patient during an acute rejection episode that is being treated with high-dose corticosteroids?

a) Provide increased amounts of dietary CHO and monitor for signs of fluid overload
b) Provide increased amounts of dietary fat and monitor for signs of hyperlipidemia
c) Provide increased amounts of dietary CHO and monitor for signs of azotemia.
d) Provide increased amounts of dietary protein and monitor for signs of hyperglycemia.

A
  1. Chapter 31
72
Q

HIV infection is prevalent in which of the following populations?

a) Men who have sex with men
b) Urban heterosexuals in the lowest income strata
c) Black and Hispanic/Latino Americans
d) All of the above

A
  1. Chapter 32
73
Q

Which of the following is the goal of antiretroviral therapy?

a) To increase CD8+ T lymphocytes and decrease viral load (VL)
b) To increase both CD4+ T lymphocytes and vl
c) To increase CD4+ T lymphocytes and neutrophils
d) To increase CD4+ T lymphocytes and decrease VL

A
  1. Chapter 32
74
Q

Which of the following is predictive of the onset of wasting disease?

a) Hypogonadism
b) Hypermetabolism
c) Decreased food intake
d) All of the above

A
  1. Chapter 32
75
Q

Which of the following is a central feature of HIV lipodystrophy?

a) Abdominal obesity
b) Increases in specific fat depots
c) Subcutaneous adipose tissue loss
d) All of the above

A
  1. Chapter 32
76
Q

Hypertriglyceridemia is a frequent finding in which of the following patient populations?

a) Febrile HIV+ patients with septicemia
b) HIV+ patients with abdominal obesity receiving cART
c) Patients with HIV infection and wasting disease
d) All of the above

A
  1. Chapter 32
77
Q

Which of the following is true about the mechanisms that promote weight loss and malnutrition in patients with cancer?

a) Tumor-induced altered metabolism has been associated with increased energy expenditure
b) Inadequate nutrient intake and increased cytokine production can lead to weight loss.
c) Some cancer demonstrate increased glucose turnover compared with non-tumor-bearing patients with simple starvation.
d) All of the above

A
  1. Chapter 33
78
Q

EN is an appropriate therapy for which of the following patients?

a) A well-nourished patient with colon cancer undergoing chemotherapy
b) A severely malnourished gastric cancer patient with nausea and vomiting.
c) A moderately malnourished patient with head and neck cancer with dysphagia
d) A well-nourished recipient of a hematopoietic stem cell transplant (HSCT).

A
  1. Chapter 33
79
Q

Which of the following is true regarding a patient with newly diagnosed pancreatic cancer awaiting chemotherapy?

a) A nutrition assessment should be performed.
b) EN should be initiated because the patient will likely need nutrition support during chemotherapy
c) PN should be initiated because the patient will likely need nutrition support during chemotherapy.
d) PN should be initiated if surgical intervention is imminent.

A
  1. Chapter 33

CNSC Exam 2021 (50 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions