Enteral/Parenteral

Question 1

What is the main indication for parenteral nutrition (PN) in a hospitalized patient?
A) When the gastrointestinal tract is non-functional or cannot be used for ≥5–7 days
B) When a patient refuses enteral nutrition
C) For all critically ill patients in the ICU within the first 24 hours
D) For patients with mild dysphagia who can tolerate a pureed diet

Answer 1

A) When the gastrointestinal tract is non-functional or cannot be used for ≥5–7 days

Question 2

What is the most serious risk associated with rapid initiation of PN in a severely malnourished patient?
A) Hyperglycemia
B) Refeeding syndrome
C) Acute kidney failure
D) Severe hypocalcemia

Answer 2

B) Refeeding syndrome

Question 3

A critically ill patient is receiving continuous enteral nutrition via a nasogastric tube. Which complication may indicate the need to switch to post-pyloric feeding?
A) Persistent diarrhea
B) High gastric residual volume and risk of aspiration
C) Hypoglycemia
D) Micronutrient deficiency

Answer 3

B) High gastric residual volume and risk of aspiration

Question 4

What strategy can help reduce diarrhea in patients receiving enteral nutrition?
A) Decrease infusion rate and switch to a formula with soluble fiber
B) Increase the formula’s osmolality
C) Provide additional IV fluids
D) Increase protein concentration in the formula

Answer 4

A) Decrease infusion rate and switch to a formula with soluble fiber

Question 5

Which macronutrient is most often modified in enteral formulas for patients with chronic kidney disease?
A) Protein
B) Carbohydrates
C) Fats
D) Fiber

Answer 5

A) Protein

Question 6

A patient is receiving total parenteral nutrition (TPN) with glucose at 4 mg/kg/min and develops persistent hyperglycemia. What is the best approach?
A) Decrease the glucose infusion rate
B) Add insulin to the TPN solution
C) Switch to a lower-fat formula
D) Stop TPN and start enteral nutrition

Answer 6

A) Decrease the glucose infusion rate

Question 7

What is the most common metabolic complication associated with long-term total parenteral nutrition (TPN)?
A) Short bowel syndrome
B) Parenteral nutrition–associated liver disease
C) Severe hypocalcemia
D) Lactic acidosis

Answer 7

B) Parenteral nutrition–associated liver disease

Question 8

Which of the following patients is at the highest risk of developing refeeding syndrome?
A) An obese patient receiving high-calorie enteral nutrition
B) A severely malnourished patient receiving high glucose load via TPN
C) A hemodialysis patient with hyperkalemia
D) A septic patient on continuous enteral nutrition

Answer 8

B) A severely malnourished patient receiving high glucose load via TPN

Question 9

A patient with severe acute pancreatitis cannot tolerate oral intake. What is the most appropriate nutritional intervention?
A) Enteral nutrition via nasojejunal tube
B) Immediate total parenteral nutrition
C) High-calorie clear liquid diet
D) Nil per os (NPO) for 7 days

Answer 9

A) Enteral nutrition via nasojejunal tube

Question 10

Which of the following may indicate intolerance to enteral nutrition?
A) Gastric residual volume > 500 mL
B) Increased blood pressure
C) Elevated C-reactive protein
D) Hypocalcemia

Answer 10

A) Gastric residual volume > 500 mL

Question 11

Patient: 65-year-old woman with ischemic stroke and severe dysphagia.
Findings:

Unsafe for oral intake

Good glycemic control

No renal or hepatic dysfunction

Question: What is the most appropriate initial nutrition strategy?
A) Enteral nutrition via nasogastric tube
B) Total parenteral nutrition
C) Pureed oral diet with protein supplements
D) NPO until swallowing improves

Answer 11

A) Enteral nutrition via nasogastric tube

Question 12

Patient: 55-year-old male with 40% body burns, intubated in ICU.
Findings:

Increased energy needs

High protein losses

Unable to eat orally

Question: What is the most appropriate nutrition strategy?
A) Early enteral nutrition
B) Immediate total parenteral nutrition
C) IV fluids only
D) Oral diet as soon as possible

Answer 12

A) Early enteral nutrition

Question 13

Patient: 45-year-old woman with severe Crohn’s disease and high-output enteric fistula.
Findings:

High fluid and electrolyte losses

Non-functional gut

Significant weight loss

Question: What is the ideal nutritional approach?
A) Total parenteral nutrition
B) Enteral nutrition with polymeric formula
C) Soft oral diet
D) Fluid and electrolyte restriction

Answer 13

A) Total parenteral nutrition

Question 14

Patient: 70-year-old male with advanced esophageal cancer, unable to swallow.
Findings:

Short life expectancy

Functional gut

Significant weight loss

Question: What is the most appropriate nutrition strategy?
A) Enteral nutrition via gastrostomy
B) Total parenteral nutrition
C) IV fluids only
D) Protein restriction to prevent catabolism

Answer 14

A) Enteral nutrition via gastrostomy