Nutrition

Question 1

FDA requirement for supplements

Answer 1

safe, but does not determine effectiveness

Question 2

what are the fat soluble vitamins

Answer 2

A, E, K, D

Question 3

role of vitamin A

Answer 3

vision

Question 4

role of vitamin E

Answer 4

antioxidant

Question 5

role of vitamin K

Answer 5

required for synthesis of clotting factors

Question 6

when may vit K need to be supplemented

Answer 6

warfarin (supratherapeutic INR)
infants

Question 7

sign of deficient vitamin K

Answer 7

hemorrhagic disease

Question 8

role of vitamin D

Answer 8

calcium absorption, bone health

Question 9

what is required for Vit D activation?
which precursor is monitored?

Answer 9

2 hydroxylation to activate
25(OH)D is monitored

Question 10

risk for vit D deficiency

Answer 10

limited sun exposure
kidney dysfunction
breastfed infant without supplementation

Question 11

what vit D level is considered deficient

Answer 11

<12 ng/mL

Question 12

what vit D level is considered inadequate

Answer 12

<20 ng/mL

Question 13

what vit D level is considered toxic

Answer 13

> 50 ng/mL

Question 14

preventative vit D dosing

Answer 14

600-1000U (15-25 mcg) QD

Question 15

high dose VIt D treatment is used if

Answer 15

Vit D <12ng/mL, symptomatic, or concomitant hypocalcemia

Question 16

high dose VIt D treatment dosing

Answer 16

50,000 U (1250 mcg) QW for 6-12 weeks

Question 17

low dose vit D treatment is used if

Answer 17

levels 12-20 ng/mL without symptoms or concomitant hypocalcemia

Question 18

low dose vit D treatment dosing

Answer 18

800-1000 U (20-25 mcg) QD for 3-4 months
not responding –> increase to 2000 U QD

Question 19

maintenance dose of vit D

Answer 19

600-2000 U (15-50 mcg) QD

Question 20

populations that may need higher vit D doses

Answer 20

obesity, malabsorption, gastrectomy

Question 21

what are the water soluble vitamins

Answer 21

thiamine/B1, riboflavin/B2, niacin/B3, pyridoxine/B6, cyanocobalamin/B12, folate/B9, vitamin C

Question 22

role of thiamine/B1

Answer 22

energy metabolism

Question 23

major sign and risk factor for thiamine deficiency

Answer 23

wernicke’s
alcohol use disorder

Question 24

role of riboflavin

Answer 24

component of 2 enzymes involved in energy production, cell function, growth, and development

Question 25

role of niacin

Answer 25

energy and development/function of cells

Question 26

sign of deficient niacin

Answer 26

pellagra

Question 27

role of pyridoxin

Answer 27

various

Question 28

signs of deficient B6

Answer 28

anemia, weakness, insomnia, cns dysfunction, peripheral neuropathy

Question 29

role of cyanocobalamin

Answer 29

various

Question 30

signs of deficient B12

Answer 30

megaloblastic anemia, peripheral neuropathy

Question 31

role of folate

Answer 31

makes dna and genetic material

Question 32

sign of deficient B9

Answer 32

megaloblastic anemia

Question 33

risks for deficient B9

Answer 33

poor diet, alcoholism, malabsorptive disorder

Question 34

when is folate supplement recommended

Answer 34

women of childbearing age and pregnancy

Question 35

role of vitamin c

Answer 35

antioxidant

Question 36

sign of vit C deficiency and who may need more supplementation

Answer 36

scurvy, smokers

Question 37

recommended supplement if pregnant and what supplement to avoid

Answer 37

prenatal avoid vit A (high conc teratogenic)

Question 38

what supplement is recommended in breastfeeding

Answer 38

iodine, choline

Question 39

what supplement is recommended for bariatric surgery

Answer 39

bariatric multivitamin vit a/d/e/k/b1/b12/folate etc.

Question 40

essential nutrients for elderly that may need supplementation

Answer 40

b12, b6, d, and calcium

Question 41

supplement for age-related macular degeneration

Answer 41

AREDs2

Question 42

which supplements might breastfed infants need

Answer 42

vitamin D and iron

Question 43

deficiencies in alcohol use disorder

Answer 43

thiamine, pyridoxine, folate

Question 44

outpatient supplement for AUD

Answer 44

multivit with thiamine, pyridoxine, and folate

Question 45

inpatient treatment for wernickes

Answer 45

200-500mg IV thiamine TID for 2-7 days then 250 mg IV QD for 3-5 days

Question 46

maintenance supplement for wernickes

Answer 46

100 mg thiamine po qd

Question 47

deficiency caused by antiepileptics

Answer 47

calcium

Question 48

deficiency caused by isoniazid

Answer 48

b6

Question 49

deficiency caused by loops

Answer 49

K and Mg

Question 50

deficiency caused by metformin

Answer 50

B12

Question 51

deficiency caused by methotrexate

Answer 51

folate

Question 52

deficiency caused by orlistat

Answer 52

beta-carotene, fat-soluble vitamins

Question 53

deficiency caused by PPIs

Answer 53

Mg, B12

Question 54

when is enteral nutrition considered

Answer 54

after 7 days if hospitalized consider earlier if ICU

Question 55

when to use enteral vs parenteral

Answer 55

if the gut works use it

Question 56

how to administer meds with an NG, ND or G tube

Answer 56

crush and flush

Question 57

DDIs where EN feeds need to be held 1-2 hours before and after dosing

Answer 57

phenytoin, quinolones, levothyroxine, warfarin

Question 58

typical kcal/ml range of EN formulas

Answer 58

1-1.8kcal/ml higher = more concentrated

Question 59

EN requirements for fluid restricted diets

Answer 59

lower volume formula

Question 60

EN requirements for renal disease

Answer 60

lower K and phosphate

Question 61

EN requirements for DM

Answer 61

more fat and fiber, fewer carbs

Question 62

EN requirements for burn/trauma patients

Answer 62

high protein

Question 63

EN requirements for pancreatitis

Answer 63

low fat

Question 64

bolus EN G tube administration rate

Answer 64

200-400 mL over 15-60 minutes

Question 65

continuous EN administration rate

Answer 65

start at 20mL/hr and uptitrate Q4H

Question 66

what to use if you have a clogged EN tube

Answer 66

cola, pancreatic enzymes, and sodium bicarb

Question 67

when to initiate PN in adults

Answer 67

nourished, stable-- 7 days nutritionally at risk-- 3-5 days baseline malnourished-- ASAP

Question 68

when to initiate PN in peds

Answer 68

infants-- 1-3 days children-- 4-5 days

Question 69

when to initiate PN in neonates

Answer 69

very LBW-- promptly after birth preterm/critically ill- whenever needed

Question 70

what is refeeding syndrome

Answer 70

severe reduction in K, phosphate, and Mg due to intracellular shift/repletion of stores during rapid initiation of nutrition

Question 71

max mOsm/L of EN that can be used in a peripheral line

Answer 71

900 mOsm/L

Question 72

minimum % of 3-in-1 components for stability

Answer 72

AA 4%, dextrose 10%, ILE2%

Question 73

what must be used if medications are added to a PN

Answer 73

1.2 um filter

Question 74

concerns with 3-in-1 PN

Answer 74

creaming & cracking

Question 75

how many kcal does protein provide

Answer 75

4kcal/gram

Question 76

how many kcal does dextrose provide

Answer 76

3.4 kcal/gram

Question 77

mOsm/% of protein

Answer 77

100

Question 78

mOsm/% of dextrose

Answer 78

50

Question 79

common lipid product and its kcal content

Answer 79

intralipid 20% 2kcal/mL

Question 80

what must be used when administering lipids in PN

Answer 80

1.2 um filter

Question 81

what may be a contraindication to lipid product

Answer 81

egg, soybean, and fish allergy

Question 82

max infusion rate for lipids in PN

Answer 82

peds: 0.15 g/kg/hr adults: 0.11 g/kg/hr

Question 83

monitoring for lipids in PN

Answer 83

IFALD, TGs, and EFAD

Question 84

when adding electrolyte to PN, consider precipitation of ____... and add what first to minimize risk

Answer 84

calcium phosphate precipitation add phosphate first