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EN Flashcards

1
Q

What is the maximum hang time for closed-system enteral formulas?

1: Up to 24 hours
2: Up to 36 hours
3: Up to 48 hours
4: Up to 72 hours

A

3: Up to 48 hours

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2
Q

A 53 year old male patient with height 5’9” and weight 93 kg is receiving 1850 kcal per day from enteral nutrition. Which of the following best describes an estimate of his water requirement using common energy or weight based formulas?

1: Energy and weight based formulas produce similar estimated water requirements
2: Energy and weight based formulas produce dissimilar estimated water requirements
3: Weight based formulas may produce lower estimates of estimated water requirements
4: Energy based formulas may produce higher estimates of estimated water

A

2: Energy and weight based formulas produce dissimilar estimated water requirements

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3
Q

A 55 year old female with dysphagia who is afebrile and weighs 60 kg is on a standard 1.0 kcal/mL enteral formula at 180 mL/hr over 10 hours nightly. Which of the following water volumes would best meet her daily estimated fluid requirements?

1: 0 mL
2: 100 mL
3: 300 mL
4: 1000 mL

A

3: 300 mL

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4
Q

Which of the following is NOT a perceived benefit of early enteral feeding in critically ill patients?

1: May prevent of translocation of gut bacteria
2: Reduces atrophy of intestinal villae
3: Fewer infectious complications than parenterally fed patients
4: Increases intestinal permeability

A

4: Increases intestinal permeability

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5
Q

Which of the following parameters is NOT useful in assessing the efficacy of enteral nutrition in pregnancy?

1: Maternal weight gain
2: Fetal growth
3: Serum Albumin
4: Nitrogen balance

A

3: Serum Albumin

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6
Q

Which of the following enteral formulas is most efficacious in a patient with diabetic gastroparesis?

1: Standard, polymeric
2: High fiber
3: Elemental
4: High fat

A

1: Standard, polymeric

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7
Q

Lactose is a common ingredient in which type of enteral formula?

1: Semi-elemental formula
2: Standard adult formula
3: Standard infant formula
4: Elemental formula

A

3: Standard infant formula

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8
Q

Which of the following patient populations would most likely have difficulty tolerating a polymeric enteral formula?

1: Crohn’s disease
2: Intestinal lymphangiectasia
3: Gastroparesis
4: Celiac disease

A

2: Intestinal lymphangiectasia
Pts with intestinal lymphangiectasia have compromised lymphatic flow and increased pressure in the lymphatic system. Intestinal lymph flow and lymphatic pressure is increased during absorption of long-chain fats found in polymeric enteral formulas. This results in protein leakage into the intestinal lumen. A very low fat (<20 g) enteral formula or a formula higher in medium-chain fats may relieve pressure in the lymphatic system and reduce protein losses.

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9
Q

In patients with pancreatitis, which of the following parameters would be LEAST important in predicting tolerance of enteral feedings?

1: Disease severity
2: Duration of NPO
3: Abdominal pain
4: Triglyceride level

A

4: Triglyceride level

Serum triglyceride levels are routinely used to measure tolerance of parenteral rather than enteral nutrition.

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10
Q

Which of the following best describes the rationale for initiating enteral nutrition (EN)?

1: It may be implemented in patients who cannot or will not eat adequately
2: It is reserved for malnourished patients with an intact gastrointestinal tract
3: It should be implemented regardless of a patient’s hemodynamics
4: It is commonly used to treat specific disease manifestations

A

1: It may be implemented in patients who cannot or will not eat adequately

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11
Q

Tube feedings can be effectively used in which of the following conditions?

1: Intractable obstipation and vomiting
2: High output mid-jejunal fistula
3: Open abdomen
4: Short bowel syndrome (<50cm) without colon

A

3: Open abdomen

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12
Q

Which of the following is an indication to place a gastrojejunostomy feeding tube?

1: Hyperemesis gravidarum
2: Dysphagia
3: Gastroesophageal reflux
4: Diabetic gastroparesis

A

4: Diabetic gastroparesis

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13
Q

Gastric access devices known as buttons are at skin level and have many desirable features including:

1: can be capped when not in use.
2: must be exchanged in the operating room.
3: are often used for decompression of the small bowel.
4: attachment of the feeding tube connector is easily performed by the patient

A

1: can be capped when not in use.

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14
Q

What is the gold standard for determining proper position of a feeding tube placed at the bedside?

1: Radiographic confirmation
2: pH testing for acidity of aspirates
3: Aspiration of obvious gastric contents
4: Air sufflation and auscultation over the gastric bubble

A

1: Radiographic confirmation

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15
Q

Which of the following is a CONTRAINDICATION to a percutaneous endoscopic jejunostomy tube?

1: Gastroparesis
2: Partial gastrectomy
3: Refractory celiac disease
4: End-jejunostomy

A

4: End-jejunostomy

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16
Q

Compared to gastric feeding, small bowel feeding is associated with which of the following outcomes in critically ill patients?

1: Longer time to achieve target nutrition
2: Increased nutrient delivery
3: Increased gastroesophageal regurgitation
4: Increased rate of ventilator-associated pneumonia

A

2: Increased nutrient delivery

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17
Q

Which of the following interventions may assist with the prevention of inadvertent respiratory misplacement during nasogastric feeding tube insertion in an alert patient?

1: Administer IV metoclopramide
2: Keep patient NPO during insertion
3: Have the patient flex his head slightly forward
4: Place the patient supine for tube insertion

A

3: Have the patient flex his head slightly forward

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18
Q

Which of the following is least likely to facilitate transpyloric placement of a nasoenteric feeding tube?

1: Endoscopic placement
2: Prokinetic agents
3: Fluoroscopic Placement
4: Weighted tube tips

A

4: Weighted tube tips

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19
Q

Which of the following is least likely to be problematic for placement of a percutaneous endoscopic gastrostomy (PEG) tube in a patient with liver disease?

1: Ascites
2: Coagulopathy
3: Gastric varices
4: Hepatitis C

A

4: Hepatitis C

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20
Q

Which of the following is an advantage of a gastrostomy feeding tube compared to a nasogastric feeding tube?

1: Reduced incidence of aspiration
2: Is appropriate for long term feeding
3: More successful delivery of calories
4: Reduced incidence of gastric perforation

A

2: Is appropriate for long term feeding

21
Q

Which of the following is most often a CONTRAINDICATION to percutaneous endoscopic gastrostomy (PEG) tube placement?

1: Ascites
2: Partial gastrectomy
3: Obesity
4: Stroke

A

1: Ascites

22
Q

Which of the following is NOT pre-procedure care of a patient undergoing placement of a percutaneous endoscopic gastrostomy tube?

1: Obtaining informed consent
2: Obtaining an abdominal X ray
3: Administering an antibiotic on call
4: Confirming normal INR

A

2: Obtaining an abdominal X ray

23
Q

Which of the following is the preferred method of feeding tube placement when enteral nutrition is required for less than 4 weeks?

1: Laparoscopic
2: Open surgical
3: Nasal enteral tube
4: Percutaneous endoscopic jejunostomy

A

3: Nasal enteral tube

24
Q

What is the primary advantage of a direct percutaneous endoscopic placed jejunal tube (PEJ) versus a percutaneous endoscopic transgastric-placed jejunal tube (PEG-J)?

1: Easier to place
2: Reduced incidence of bleeding
3: Reduced incidence of migration
4: Reduced incidence of gastric outlet obstruction

A

3: Reduced incidence of migration

25
Q

Which characteristic of enteral formulas is MOST likely to increase splanchnic blood flow in a critically ill patient?

1: High fat
2: High carbohydrate
3: High fiber
4: High osmolarity

A

1: High fat

26
Q

Hospital-prepared enteral nutrition formulas should be stored at what temperature?

1: 4° C (39.2° F)
2: 6° C (42.8° F)
3: 8° C (46.4° F)
4: 10° C (50.0° F)

A

1: 4° C (39.2° F)

27
Q

An isotonic formula has an osmolality of approximately

1: 150 mOsm/kg.
2: 300 mOsm/kg.
3: 450 mOsm/kg.
4: 600 mOsm/kg.

A

2: 300 mOsm/kg.

28
Q

Which of the following best describes a recommended starter regimen for enteral nutrition?

1: Formula can be initiated at full strength with low rate
2: Formula should be diluted and initiated at goal rate
3: Formula should be co-administered with anti-diarrheal agent
4: Formula should always be started at isotonic strength with low rate

A

1: Formula can be initiated at full strength with low rate

29
Q

What is the most important intervention to reduce the risk of pulmonary aspiration during gastric tube feedings?

1: Elevate the head of bed 30 to 45 degrees.
2: Provide mouth care every 2-4 hours .
3: Turn the tube feeding off when repositioning the patient.
4: Hold tube feedings for residual > 200 mL

A

1: Elevate the head of bed 30 to 45 degrees.

30
Q

Which of the following medications has NOT been shown to lead to diarrhea in a patient receiving enteral nutrition?

1: Sorbitol-containing preparations
2: Alpha-2 adrenergic agonists
3: Antibiotics
4: Magnesium-containing preparations

A

2: Alpha-2 adrenergic agonists

31
Q

Tube feeding with a standard enteral formula is often held before and after administration of all the following medications EXCEPT

1: Warfarin
2: Metoprolol
3: Ciprofloxacin
4: Phenytoin

A

2: Metoprolol

32
Q

Which of the following alterations to the enteral formula most often reduces the risk for physical interaction between the formula and medications?

1: Switch to a free amino acid enteral formula
2: Switch to a fiber-containing enteral formula
3: Reduce fat content of the enteral formula
4: Increase total free water in the enteral formula

A

1: Switch to a free amino acid enteral formula

33
Q

Drugs in microencapsulated bead or pellet form are most effectively administered through large-bore feeding tubes, like gastrostomy tubes, when mixed with

1: orange juice.
2: gingerale.
3: oral electrolyte solution.
4: warm water.

A

1: orange juice.

34
Q

Which of the following enteral formulas is least likely to be contaminated with micro-organisms?

1: Reconstituted powdered formula
2: Decanted liquid formula
3: Ready to hang formula
4: Formula prepared in a blender

A

3: Ready to hang formula

35
Q

Which of the following best describes the absorption of small peptides and free amino acids contained in hydrolyzed enteral formulas?

1: The majority of small peptides and amino acids are absorbed through active transport across the gastric mucosa
2: Free amino acid absorption occurs more rapidly than an equivalent mixture of small peptides
3: Small peptide formulations have a higher osmolality and thereby less efficient absorption than free amino acid formulas
4: Although absorption may differ, there are no established clinical advantages to the use of small peptide over free amino acid formulas or vice-versa.

A

4: Although absorption may differ, there are no established clinical advantages to the use of small peptide over free amino acid formulas or vice-versa.

36
Q

Enteral formulas with intact protein are as effective as semi-elemental or elemental formulas for promoting remission of:

1: Crohn’s disease
2: Irritable bowel syndrome
3: Acute pancreatitis
4: Hepatic encephalopathy

A

1: Crohn’s disease

37
Q

Which of the following patients is most likely to benefit from immunonutrition?

1: Severe sepsis patient
2: Trauma patient with isolated orthopedic injuries
3: Medical intensive care unit patient
4: Trauma patient with abdominal and torso injuries

A

4: Trauma patient with abdominal and torso injuries

38
Q

Which of the following would be the most appropriate tube feeding formula for a patient with extensive second and third degree burns?

1: High fat
2: High nitrogen
3: Concentrated
4: High fiber

A

2: High nitrogen

39
Q

Length of stay and postoperative infection rates have been shown to DECREASE infectious complications in elective surgical patients receiving enteral nutrition supplemented with

1: arginine.
2: nucleotides.
3: ascorbic acid.
4: branched-chain amino acids.

A

1: arginine.

40
Q

Modular products are used to enhance the nutrient profile of a feeding regimen. Which of the following combinations represents modular products?

1: Safflower oil, protein, glucose, and selenium
2: Glucose, glutamine, water, and MCT oil
3: Protein, cholecalciferol, fiber, and safflower oil
4: MCT oil, glucose, fiber, and protein

A

4: MCT oil, glucose, fiber, and protein

41
Q

Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing infectious complications, length of hospital stay and even possibly reducing mortality. Which group of patients might be at significant risk from early enteral feeding?

1: Cancer patients who underwent surgery of the gastrointestinal tract
2: Patients with increasing vasopressor support
3: Traumatic brain injury patients with intracranial pressure controlled by hypertonic saline
4: Patients admitted to the hospital with acute on chronic pancreatitis

A

2: Patients with increasing vasopressor support

42
Q

A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding formula containing supplemental

1: arginine.
2: glutamine.
3: nucleic acids.
4: omega-3 fatty acids.

A

4: omega-3 fatty acids.

43
Q

The use of enteral nutrition formulas enriched with branched-chain amino acids is best used for patients with

1: cirrhosis.
2: hepatic failure.
3: liver transplantation.
4: refractory encephalopathy

A

4: refractory encephalopathy

44
Q

Enteral nutrition (EN) may be contraindicated in the early post-transplant period in adult patients with hematopoietic cell transplants because of

1: increased incidence of sinusitis with enteral feedings.
2: lack of benefit from enteral feedings in allogeneic patients.
3: gastrointestinal toxicities related to the conditioning regimen.
4: improved survival seen in autologous patients receiving parenteral nutrition

A

3: gastrointestinal toxicities related to the conditioning regimen.

45
Q

Which of the following medications would be appropriate to crush and deliver via an enteral feeding tube?

1: Nifedipine XL
2: Metoprolol immediate release
3: Enteric coated aspirin
4: Diltiazem CD

A

2: Metoprolol immediate release

46
Q

Which of the following describes an optimal method of preparing and administering medications via an enteral feeding tube?

1: Crush tablets and add them directly into the enteral formula
2: Administer liquid formulations undiluted to minimize fluid overload
3: Flush the tube with water before and after each medication administered
4: Add crushed tablets to liquid medications and administer the mixture all together

A

3: Flush the tube with water before and after each medication administered

47
Q

In patients with severe acute pancreatitis enteral nutrition has been documented to provide the following benefits over Parenteral nutrition EXCEPT:

1: Decreased infection rate
2: Decreased hospital length of stay
3: Decreased pain
4: Decreased mortality

A

3: Decreased pain

48
Q

In a patient with fat malabsorption, an enteral product containing which of the following can provide a concentrated source of energy?

1: Medium chain triglycerides
2: Free amino acids
3: Fructooligosaccharides
4: Long chain triglycerides

A

1: Medium chain triglycerides

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