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CNSC Modules > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

1
Q

When should PN be used in Crohn’s disease?

A

Only after failure to tolerate EN

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2
Q

What is an indication for PN support in an adult cancer patient?

A

Abdominal tumor resulting in an unresolved small bowel obstruction for greater than 7 days.

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3
Q

The routine use of preoperative PN is indicated for patients with a non-functioning GI tract who are:

A

Severely malnourished

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4
Q

W when is PN indicated in severe burn patients?

A

Enteral nutrition is contraindicated or unlikely to meet nutrition needs

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5
Q

In the critically I’ll obese patient, specific guidelines for the provision of calories and protein have been recommended by both the Society of Critical Care Medicine and ASPEN. For a patient with a BMI >33.4, which of the following choices best reflects those recommendations for the provision of protein in EN and PN?

A

Greater than or equal to 2.0 g/kg IBW

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6
Q

A prefab ant patient is admitted with hyperemesis gravidarium (HG). What is a clinical indication for PN use?

A

Intolerance to EN and supportive care measures.

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7
Q

In the critically ill obese patient, specific guidelines for the provision of calories and protein have been recommended by both the SCCM and ASPEN. For a patient with a BMI of 33.4, what are the calorie recommendations for PN and EN?

A

11-14 kcal/kg actual body weight

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8
Q

What is an indication for the use of PN?

A

High output fistula

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9
Q

What PN formula can be safely administered through a peripheral line?

A

10% dextrose and 3% amino acid

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10
Q

Which central venous catheter is the least favorable for PN infusion?

A

Femoral catheter

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11
Q

According to the CDC , which of the following is true regarding PICC line care?

A

Remove the PICC line only if it is suspected or known source of infection.

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12
Q

When is it the most appropriate to start PN infusion in a patient with a new central venous catheter inserted at the bedside without fluoroscopy?

A

After chest X-ray confirms correct placement of catheter tip.

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13
Q

What is a disadvantage of a PICC line?

A

Limited self care ability

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14
Q

What is the most appropriate distal catheter tip placement of a peripherally inserted central catheter?

A

Superior vena cava

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15
Q

Branched chain amino acid (BCAA) formulas would be most appropriate for:

A

A cirrhotic patient with chronic encephalopathy who is intolerant of standard protein sources despite optimal pharmacotherapy.

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16
Q

In a patient with heptobiliary disease, which trace elements should be withheld or requires a dosage reduction when prescribing PN?

A

Copper and manganese

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17
Q

Which component is not a major source of aluminum contamination in PN solutions?

A

Lipid injectable emulsion (ILE)

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18
Q

A long term PN patient begins to experience Parkinson-like symptoms. Which trace element toxicity is most likely to present with these symptoms?

A

Manganese

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19
Q

When compared to the DRIs for fat soluble vitamins given orally, the DRIs for parenteral my administered fat soluble vitamins are:

A

Equal

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20
Q

When compared to DRIs for water soluble vitamins given orally, the DRIs for parenteral my administered water soluble vitamins are:

A

Higher

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21
Q

What best describes a lipid injectable emulsion produced by the transesterfication of fatty acids to form a composite triglyceride molecule?

A

Structured

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22
Q

The adverse effects of lipid injectable emulsion administration in adults is best prevented by

A

Avoiding serum triglyceride levels of >400 mg/dL

23
Q

Failure to provide linoleic and alpha linoleic acids with PN will most likely result in:

A

Essential fatty acid deficiency

24
Q

Which parental amino acid (AA) formulation should be used in a hospitalized adult patient with acute kidney injury?

A

Standard AA formulation

25
Q

The FDA currently recommends that daily intake of parenteral aluminum not exceed what amount?

A

5 mcg/kg/day

26
Q

What helps reduce the risk of calcium phosphate precipitation in PN?

A

Increased amino acid concentration

27
Q

Current recommendations regarding safe administration of lipid injectable emulsion include

A

ILE hang time up to 24 hours when included as a part of a total nutrient admixture (TNA)

28
Q

Which form of glutamine supplementation improves physical compatibility and stability for admixture in PN solutions?

A

Glutamine dipeptide

29
Q

Which component of PN is most likely to impact anticoagulation in a patient receiving warfarin?

A

Lipid injectable emulsion and vitamins

30
Q

What is the preferred approach recommended by the American Association of Clinical Endocrinologist (AACE) and the ADA for subcutaneous insulin administration in the hospitalized adult patient with diabetes mellitus?

A

Basal-bolus insulin therapy

31
Q

What is the glycemic target for the majority of critically ill adult patients?

A

140-180 mg/dL

32
Q

Creaming of a total nutrient admixture (TNA) appears as:

A

A translucent band at the surface of the emulsion separate from the remaining TNA dispersion.

33
Q

According to the United States Pharmacopeia (USP) Chapter 797, a PN solution prepared from 8.5% amino acid solution with electrolytes and 70% dextrose, with multivitamins, trace elements, and famotidine added would be classified as:

A

Medium risk

34
Q

According to the ASPEN PN safety consensus recommendations, which of the following best describes safe PN compounding?

A

Manual compounding of PN is appropriate when volumes of a PN component to be mixed are less than the ACD can accurately deliver.

35
Q

Which additive has the greatest risk of destabilizing the lipid injectable emulsion in a TNA?

A

Iron dextran

36
Q

According to the ASPEN safety consensus recommendations, what is not considered mandatory for the PN order?

A

Recommended laboratory monitoring

37
Q

According to the ASPEN safety consensus recommendations, what is not considered mandatory for the inpatient PN label?

A

Electrolyte content expressed in individual ions

38
Q

Your patient is receiving the following PN order. 2400 mL with 300 grams dextrose, 90 grams protein in addition to 225 mL 20% ILE. How many total calories and grams of fat is your patient receiving?

A

1830 kcals, 45 grams of fat

39
Q

A patient who weighs 75 kg is receiving 65 mL/hour of a 2-in-1 PN solution that contains 117 grams protein and 273 grams dextrose in addition to 250 ml of 20% ILE. What is the daily caloric intake of this regimen per kg of body weight?

A

25.3 kcals/kg

40
Q

According to the ASPEN safety consensus recommendations, which is the best method to express the dextrose content on the label of a PN formulation in order to avoid misinterpretation?

A

Grams per 24 hour nutrient infusion (e.g. 225 g/day)

41
Q

Which factor has been associated with an increase in prescribing errors related to PN formulations?

A

Calculation of PN dosages

42
Q

Rapid intravenous infusion of sodium or potassium phosphate may result in:

A

Tetany

43
Q

Rapid intravenous infusions of potassium phosphate may result in:

A

Thrombophlebitis

44
Q

What risk is associated with the abrupt cessation of a parenteral nutrition solution?

A

Hypoglycemia

45
Q

What is the most common complications associated with PN administration?

A

Hyperglycemia

46
Q

Cycling PN is recommended in :

A

Patients at risk for liver disfunction

47
Q

Which complication is most likely to occur when transitioning a critically ill adult patient from ON to EN?

A

Hyperglycemia

48
Q

While receiving PN, your patient develops metabolic acidosis. Which serum electrolyte level needs to be monitored?

A

Potassium

49
Q

What is considered to be the most serious complication of significant hyperphosphatemia?

A

Soft tissue vascular complications

50
Q

What biochemical evidence indicates essential fatty acid deficiency (EFAD)?

A

A triene to tetraene ratio of >0.2

51
Q

A patient int he ICU is receiving concurrent infusions of lipid injectable emulsion and propofol. These concurrent infusions could potentially cause:

A

Hypertriglyceridemia

52
Q

When initiating a PN regimen that contains regular insulin, how often should capilary blood glucose levels be monitored?

A

Every 6 hours

53
Q

In adult PN patients, intravenous lipid emulsion use should be limited when serum triglyceride levels rise above:

A

400 mg/dL

CNSC Modules (8 decks)

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