Self assessment modules - questions i get wrong

Question 1

A patient has been receiving PN through a central venous catheter (CVC) for the past week while in the hospital. They now present with shortness of breath, cough, and cyanosis of the face, neck, shoulder, and arms. What type of device complication is characterized by this patient’s symptoms?

1: Tunnel infection
2: Pinch-off syndrome
3: Superior vena cava syndrome
4: Thrombosis

Answer 1

3: Superior vena cava syndrome

Question 2

A 75-year-old female with moderate malnutrition is status-post radical cystectomy with ileal conduit. She weighs 50kg, and she has a 20-gauge IV access in the left cephalic vein. She is initiated on a peripheral parenteral nutrition (PPN) solution at 125ml/h. This formula contains 210 grams of dextrose, 75 grams of amino acids, and 45 grams of IVFE. In the patient case above, what is the osmolarity of the daily PPN formula?

1: 600mOsm/L
2: 1200 mOsm/L
3: 1800 mOsm/L
4: 2400 mOsm/L

Answer 2

1: 600mOsm/L

Question 3

The use of 70% ethyl alcohol is most effective for clearing catheter occlusions due to precipitation of

1: calcium-phosphate.
2: lipid residue.
3: phenytoin.
4: tobramycin.

Answer 3

2: lipid residue.

Question 4

A PN-dependent patient with an average daily ileostomy output of 3L presents with BUN/serum creatinine ratio of 30:1 and mild hyponatremia. What is the most appropriate PN intervention for this patient?

1: Increase sodium, restrict protein
2: Increase sodium, increase fluid
3: Increase fluid, restrict protein
4: Decrease sodium, increase fluid

Answer 4

2: Increase sodium, increase fluid

Question 5

A patient receiving chronic PN therapy develops an intraluminal clot in his (or her) central venous access device. What is the most appropriate pharmacological intervention to clear this access device?

1: Heparin 100 units/mL
2: Alteplase 2mg/2mL
3: Argatroban 350 mcg/kg
4: Streptokinase 10,000 units

Answer 5

2: Alteplase 2mg/2mL

Question 6

The best approach to prevent PN-induced cholelithiasis is administration of

1: choline.
2: cholecystokinin-octapeptide (CCK-OP).
3: ursodiol.
4: oral or enteral feeding.

Answer 6

4: oral or enteral feeding.

Question 7

A 40-year-old male receiving chronic PN therapy (initiated 15 years ago) secondary to massive bowel resection develops metabolic bone disease. His current 12-hour cyclic PN formula provides 5 g/kg/day dextrose, 2 g/kg/day protein and 1 g/kg/day of fat. What is the most appropriate intervention to reduce hypercalciuria?

1: Increase calcium gluconate
2: Decrease phosphorus supplementation
3: Shorten PN infusion time to 10 hours
4: Decrease amino acid content of PN solution

Answer 7

4: Decrease amino acid content of PN solution

Question 8

The use of 0.1N hydrochloric acid is most effective for clearing catheter occlusions due to precipitation of

1: calcium-phosphate.
2: oxacillin.
3: heparin.
4: lipid residue.

Answer 8

1: calcium-phosphate.

Question 9

Catheter related thrombosis caused by fibrin build up within blood vessels adhering to a central venous catheter is called

1: fibrin sheath.
2: fibrin tail.
3: intraluminal thrombus.
4: mural thrombus.

Answer 9

4: mural thrombus.

Question 10

All of the following are potential causes of hyperglycemia in a patient receiving PN EXCEPT

1: carbohydrate administration >4-5 mg/kg/min
2: obesity.
3: sepsis.
4: renal failure.

Answer 10

4: renal failure.

Question 11

All of the following are risk factors for the development of rebound hypoglycemia after cessation of parenteral nutrition (PN) EXCEPT

1: malnutrition.
2: hepatic dysfunction.
3: hypertension.
4: renal insufficiency.

Answer 11

3: hypertension.

Question 12

Hyperglycemia is associated primarily with what type of sodium/fluid imbalance?

1: Hypertonic hyponatremia
2: Hypotonic hyponatremia
3: Isotonic hypernatremia
4: Hypertonic hypernatremia

Answer 12

1: Hypertonic hyponatremia

Question 13

Which of the following is NOT associated with a delayed bone age in a child with short stature?

1: Hypothyroidism
2: Precocious puberty
3: Cushing syndrome
4: Growth hormone deficiency

Answer 13

2: Precocious puberty

Question 14

. When reviewing a child’s growth chart data, the child’s weight-for-length curve is falling below the 3rd percentile. Which Z-score indicates severely wasted?

1: Z-score above 3
2: Z-score above 2
3: Z-score below -2
4: Z-score below -3

Answer 14

4: Z-score below -3

Question 15

What is the suggested daily amount of potassium required for maintenance in an infant receiving parenteral nutrition?

1: 0.8-1 mEq/kg
2: 2-4 mEq/kg
3: 5-6 mEq/kg
4: 7-8 mEq/kg

Answer 15

2: 2-4 mEq/kg

Question 16

What is the daily maintenance fluid requirement for a 5 kg infant?

1: 300 mL
2: 500 mL
3: 700 mL
4: 1000 mL

Answer 16

2: 500 mL

Question 17

On radiographic examination, a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum laboratory results show: Calcium: low. Phosphorus: low. Creatinine: normal. Alkaline phosphatase: high. 25-OH vitamin D: Low. 1,25 (OH)2 vitamin D: Low. PTH: high. Which of the following is the most likely diagnosis?

1: Renal tubular acidosis
2: Osteogenesis imperfecta
3: Vitamin D deficiency rickets
4: Vitamin D dependent rickets type 2

Answer 17

3: Vitamin D deficiency rickets

Question 18

What is the recommended daily enteral iron dose for preterm infants, one month after birth?

1: 0.5-1 mg/kg/d
2: 1-2 mg/kg/d
3: 2-4 mg/kg/d
4: 5-6 mg/kg/d

Answer 18

3: 2-4 mg/kg/d

Question 19

What distinguishes gastroesophageal reflux (GER) from gastroesophageal reflux disease (GERD) in infants?

1: GERD is characterized by the presence of significant complications
2: GER is associated with failure to thrive
3: GER is associated with arching of the back and irritability with no other symptoms
4: GERD typically requires surgical fundoplication

Answer 19

1: GERD is characterized by the presence of significant complications

Question 20

. Which of the following is recommended to prevent vitamin D deficiency in a 1-month-old infant fed human milk?

1: Supplement with 100 IU vitamin D per day
2: Supplement with 200 IU vitamin D per day
3: Supplement with 300 IU vitamin D per day
4: Supplement with 400 IU vitamin D per day

Answer 20

4: Supplement with 400 IU vitamin D per day

Question 21

In the hospital what is the hang time for expressed human milk when used for continuous enteral feedings?

1: 2 hours
2: 4 hours
3: 8 hours
4: 12 hours

Answer 21

2: 4 hours

Question 22

What should the MAXIMUM glucose infusion rate (GIR) be for a term infant receiving parenteral nutrition (PN)?

1: 4-8 mg/kg/min
2: 8-12 mg/kg/min
3: 14-18 mg/kg/min
4: 18-22 mg/kg/min

Answer 22

3: 14-18 mg/kg/min

Question 23

In an infant receiving parenteral nutrition (PN), what is the MINIMUM amount of lipid injectable emulsion (ILE) needed to prevent essential fatty acid deficiency (EFAD)?

1: 0.2-0.4 g/kg/day
2: 0.5-1g/kg/day
3: 1.1-1.5 g/kg/day
4: 1.8-2 g/kg/day

Answer 23

2: 0.5-1g/kg/day

Question 24

Standard neonatal parenteral amino acid solutions differ from standard adult parenteral amino acid solutions by having a higher content of

1: cysteine.
2: phenylalanine.
3: taurine and tyrosine.
4: methionine and glycine.

Answer 24

3: taurine and tyrosine.

Question 25

. What is the recommended daily intake of selenium for term infants receiving parenteral nutrition?

1: <1 mcg/kg/day
2: 2 mcg/kg/day
3: 3 - 4 mcg/kg/day
4: 5 - 6 mcg/kg/day

Answer 25

2: 2 mcg/kg/day

Question 26

Immediately following neonatal cardiac surgery, which of the following is the best estimate of parenteral caloric requirements?

1: 90-100 kcal/kg/day
2: 120-170 kcal/kg/d
3: 55-60 kcal/kg/d
4: 100-110 kcal/kg/d

Answer 26

3: 55-60 kcal/kg/d

Question 27

Pancreatic enzymes supplemented at high doses in children with cystic fibrosis could result in

1: steatorrhea.
2: meconium ileus.
3: fibrosing colonopathy.
4: cystic fibrosis related diabetes.

Answer 27

3: fibrosing colonopathy.

Question 28

Preterm infant formula or fortified human milk is used for premature infants during their first year of life. What is the rationale for this?

1: Preterm formula contains a higher percentage of carbohydrate as lactose, compared to term formula
2: After the first month, unfortified human milk may contain inadequate protein for the premature infant
3: Term formula contains more medium chain triglycerides than desired
4: Preterm formula is easier to absorb than unfortified human milk

Answer 28

2: After the first month, unfortified human milk may contain inadequate protein for the premature infant

Question 29

Which of the following does NOT describe the use of minimum enteral feeds in preterm neonates?

1: Prevents gut atrophy
2: Increases the risk of necrotizing enterocolitis
3: Improves feeding tolerance and time to full enteral feeds
4: Should be started as soon as medically feasible

Answer 29

2: Increases the risk of necrotizing enterocolitis

Question 30

A 2-month-old infant, who has been exclusively fed with cow’s milk based formula develops a full body rash. Which of the following would be the most appropriate next step?

1: Switch to a soy protein based formula
2: Switch to a high MCT oil formula
3: Switch to a protein hydrolysate based formula
4: Switch to a lactose free cow’s milk based formula

Answer 30

3: Switch to a protein hydrolysate based formula

Question 31

The biochemical defect in phenylketonuria (PKU) is a functional deficiency of the liver enzyme phenylalanine hydroxylase, which catalyzes the para-hydroxylation of phenylalanine to yield what amino acid?

1: Threonine
2: Alanine
3: Methionine
4: Tyrosine

Answer 31

4: Tyrosine

Question 32

Biliary atresia in infancy is most frequently associated with which of the following?

1: Fat malabsorption
2: Chylothorax
3: Zinc Deficiency
4: Essential fatty acid deficiency

Answer 32

1: Fat malabsorption

Question 33

. Which of the following is characteristic of cachexia in pediatric oncology patients?

1: Gradual weight loss
2: Maintenance of lean body mass at the expense of body fat
3: Decrease in energy expenditure
4: Progressive wasting of lean tissue and body fat

Answer 33

4: Progressive wasting of lean tissue and body fat

Question 34

Which of the following is considered to be diagnostic of infantile anorexia?

1: Refusal to eat adequate amounts of food for >1 month
2: Failure to eat adequately associated with childhood depressive disorder
3: Failure to gain weight after a traumatic event
4: Chronic weight loss associated with a malabsorptive disorder

Answer 34

1: Refusal to eat adequate amounts of food for >1 month

Question 35

In an intensive care setting, which of the following complications associated with malnutrition is most likely to occur as a result of the failure to begin nutrition support early in the treatment regimen?

1: Decreased systemic vascular resistance
2: Increased white cell production
3: Increased myocardial contraction
4: Increased serum levels of protein-bound drugs

Answer 35

4: Increased serum levels of protein-bound drugs

Question 36

Which of the following best describes enteral glutamine supplementation in the critically ill patient not in multi organ failure?

1: Enteral glutamine decreases mortality
2: Enteral glutamine decreases ventilator days
3: Enteral glutamine decreases hospital length of stay
4: Enteral glutamine decreases nosocomial infections

Answer 36

4: Enteral glutamine decreases nosocomial infections

Question 37

In pulmonary insufficiency, excessive calorie administration may cause increased blood pCO2 resulting in

1: metabolic acidosis.
2: metabolic alkalosis.
3: respiratory acidosis.
4: respiratory alkalosis.

Answer 37

3: respiratory acidosis.

Question 38

Which of the following is true of essential fatty acid deficiency (EFAD) in patients with cystic fibrosis (CF)?

1: Routine supplementation of omega-3 fatty acids is essential in the management of CF
2: EFAD usually does not manifest in CF patients until the second decade.
3: CF patients without pancreatic insufficiency rarely develop EFAD
4: EFA profiles have been shown to improve in CF patients after lung transplantation

Answer 38

4: EFA profiles have been shown to improve in CF patients after lung transplantation

Question 39

Which of the following blood chemistries will most effectively indicate the response to the protein component of nutrition support in a patient on hemodialysis?

1: Albumin
2: Prealbumin
3: Urea nitrogen appearance
4: Normalized protein equivalent of total nitrogen

Answer 39

4: Normalized protein equivalent of total nitrogen

Question 40

For a patient requiring nutrition support therapy, which of the following may be necessary for a patient with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT)?

1: Low potassium
2: Increased phosphorus
3: Low protein
4: Increased fluid

Answer 40

2: Increased phosphorus

Question 41

Which of the following has NOT been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving enteral nutrition?

1: Refeeding syndrome
2: Tube feeding syndrome
3: Underfeeding
4: Overfeeding

Answer 41

2: Tube feeding syndrome

Question 42

What is the recommended dietary protein intake in acutely ill adult patients receiving continuous renal replacement therapy (CRRT)?

1: 0.5-0.8 g/kg per day
2: 1.2-1.5 g/kg per day
3: 1.5-2 g/kg per day
4: 2.5-3 g/kg per day

Answer 42

3: 1.5-2 g/kg per day

Question 43

What are the protein requirements for a stable patient receiving peritoneal dialysis (PD)?

1: 0.6-0.8 grams per kilogram per day
2: 1.2-1.3 grams per kilogram per day
3: 1.5-1.8 grams per kilogram per day
4: 2.0-2.2 grams per kilogram per day

Answer 43

2: 1.2-1.3 grams per kilogram per day

Question 44

Which of the following is NOT a cause of protein-energy malnutrition in a patient with liver disease?

1: Malabsorption
2: Decreased caloric intake
3: Abnormal fuel metabolism
4: Reduced energy expenditure

Answer 44

4: Reduced energy expenditure

Question 45

Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in which type of liver disease?

1: Hepatic steatosis
2: Well-compensated cirrhosis
3: Decompensated cirrhosis
4: Fulminant hepatic failure

Answer 45

4: Fulminant hepatic failure

Question 46

Treatment for patients with overt hepatic encephalopathy who have impairments in cognitive and neuromuscular function include all EXCEPT:

1: Correction of electrolyte abnormalities
2: Treatment with lactulose or other FDA approved medication
3: Meal pattern of 3 meals and 3 snacks
4: Diet low in total protein

Answer 46

1: Correction of electrolyte abnormalities

Question 47

The highest prevalence and severity of weight loss is found in patients with which of the following types of cancer?

1: Lung and colon
2: Breast and ovarian
3: Prostate and testicular
4: Pancreatic and gastric

Answer 47

4: Pancreatic and gastric

Question 48

Supplementation with which of the following nutrients is routinely restricted during the early stages following hematopoietic stem cell transplantation (HSCT)?

1: calcium
2: Folate
3: Iron
4: Vitamin B12

Answer 48

3: Iron

Question 49

Which of the following acute changes in the serum chemistry profile would be expected in a patient who is experiencing tumor lysis syndrome(TLS)?

1: Hypercalcemia and hypomagnesemia
2: Hyperkalemia and hyperphosphatemia
3: Hypernatremia and hypermagnesemia
4: Hypocalcemia and hyperphosphatemia

Answer 49

2: Hyperkalemia and hyperphosphatemia

Question 50

Which of the following best describes the treatment of diarrhea in inflammatory bowel disease?

1: Cholestyramine is effective treatment for steatorrhea
2: Patients with diarrhea should be treated with prebiotics
3: Start antidiarrheal agents once infectious etiology is ruled out
4: Withhold pharmacological therapy until diarrhea exceeds 1 L/day

Answer 50

3: Start antidiarrheal agents once infectious etiology is ruled out

Question 51

In patients with severe acute pancreatitis, the use of enteral nutrition via nasojejunal feeding tube rather than parenteral nutrition is associated with

1: an increased incidence of hyperglycemia.
2: a lower risk of developing infectious complications.
3: a greater incidence of negative nitrogen balance.
4: a decreased frequency of pancreatic stimulation.

Answer 51

2: a lower risk of developing infectious complications.

Question 52

Gastric hypersecretions following significant small bowel resection can become problematic. Which of the following medications have shown to be the most successful in suppressing gastric hypersecretions?

1: Cholestyramine
2: Loperamide
3: Histamine2 receptor antagonists
4: Proton pump inhibitors

Answer 52

4: Proton pump inhibitors

Question 53

Which of the following metabolic complications is most likely to occur in patients with short bowel syndrome with small bowel bacterial overgrowth?

1: Metabolic acidosis
2: Respiratoryalkalosis
3: Metabolic alkalosis
4: Respiratory acidosis

Answer 53

1: Metabolic acidosis

Question 54

Calcium Oxalate Nephrolithiasis can occur in patients with short bowel syndrome (SBS) with a remnant colon who

1: eat a diet with 20-30% fat.
2: do not maintain adequate hydration.
3: have ileal resection < 100cm.
4: take 500 mg calcium 2-3 times per day.

Answer 54

2: do not maintain adequate hydration.

Question 55

Human immunodeficiency virus (HIV) associated lipodystrophy syndrome is most commonly associated with which of the following class of agents used to treat HIV infection

1: integrase strand transfer inhibitors (INSTIs).
2: non-nucleoside reverse transcriptase inhibitors (NNRTIs).
3: nucleoside reverse transcriptase inhibitors (NRTIs).
4: protease inhibitors (PIs).

Answer 55

3: nucleoside reverse transcriptase inhibitors (NRTIs).

Question 56

Zinc supplementation should be provided to patients:

1: with chronic wounds.
2: with unexplained skin rashes and alopecia.
3: who are elderly.
4: who have below normal zinc levels.

Answer 56

2: with unexplained skin rashes and alopecia.

Question 57

. Nutrition support for solid-organ transplant patients receiving cyclosporine may need to be modified due to the presence of

1: hyperkalemia.
2: hypoglycemia.
3: hypermagnesemia.
4: hypocholesterolemia.

Answer 57

1: hyperkalemia.

Question 58

A 51-year-old female who is 10 years post gastric bypass surgery for obesity presented with numbness and tingling in her distal lower extremities that had progressively worsened. She has been on an oral multivitamin supplement. She was significantly anemic and neutropenic. Her vitamin B12 level was normal as were her serum iron, ferritin, and transferrin levels. What nutritional deficiency is the most likely cause of all of these symptoms?

1: Thiamin
2: Zinc
3: Folate
4: Copper

Answer 58

4: Copper

Question 59

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

1: Sliding-scale insulin therapy
2: Basal insulin therapy
3: Bolus insulin therapy
4: Basal-bolus insulin therapy

Answer 59

4: Basal-bolus insulin therapy

Question 60

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

1: Glutamine dipeptide
2: Free glutamine
3: L-glutamine powder
4: Protein bound glutamine.

Answer 60

1: Glutamine dipeptide

Question 61

Which of the following factors has been associated with an increase in prescribing errors related to PN formulations?

1: Standardized PN order form
2: Calculation of PN dosages
3: PN components ordered as amount per day
4: PN components listed in same sequence on order form as PN label

Answer 61

2: Calculation of PN dosages

Question 62

According to the A.S.P.E.N. PN Safety Consensus Recommendations, which of the following is the best method to express the dextrose content on the label of a PN formulation in order to avoid misinterpretation?

1: Volume of the percent original concentration added (e.g., 500 mL of 50% dextrose)
2: Grams per liter (e.g., 250g/L)
3: Percent of final concentration after admixture (e.g., 35% dextrose)
4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)

Answer 62

4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)

Question 63

According to the A.S.P.E.N. PN Safety Consensus Recommendations all of the following are considered to be mandatory for the PN order form EXCEPT

1: Full generic name for each ingredient (unless brand name can identify unique properties of specific dosage form)
2: Recommended laboratory monitoring
3: Infusion schedule (continuous or cyclic)
4: Electrolytes ordered as complete salt form rather than individual ion

Answer 63

2: Recommended laboratory monitoring

Question 64

According to the A.S.P.E.N. PN Safety Consensus Recommendations all of the following are considered to be mandatory for the inpatient PN label EXCEPT

1: infusion rate expressed in mL/h.
2: beyond-use date and time.
3: size of in-line filter (1.2 or 0.22 micron).
4: electrolyte content expressed in individual ions.

Answer 64

4: electrolyte content expressed in individual ions.

Question 65

In the critically ill obese patient, specific guidelines for the provision of calories and protein have been recommended by both the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition. For a patient with a BMI > 30 kg/m2, which of the following choices best reflects those recommendations for parenteral and enteral nutrition?

1: 15-20 kcal/kg ideal body weight/day & less than 2.0 g/kg ideal body weight/day
2: 15-20 kcal/kg ideal body weight/day & greater than or equal to 2.0 g/kg ideal body weight/day
3: 22–25 kcal/kg ideal body weight/day & less than 2.0 g/kg ideal body weight/day
4: 22–25 kcal/kg ideal body weight/day & greater than or equal to 2.0 g/kg ideal body weight/day

Answer 65

4: 22–25 kcal/kg ideal body weight/day & greater than or equal to 2.0 g/kg ideal body weight/day

Question 66

Current recommendations regarding safe administration of intravenous fat emulsion (IVFE) include

1: IVFE hang time up to 24 hours when included as part of a total nutrient admixture (TNA).
2: IVFE hang time up to 24 hours when administered as an infusion separate from PN.
3: Use of a 0.22 micron filter when administering a TNA to remove microorganisms from a contaminated PN.
4: Use of a 1.2 micron filter when administering a TNA to remove microorganisms from a contaminated PN.

Answer 66

1: IVFE hang time up to 24 hours when included as part of a total nutrient admixture (TNA).

Question 67

Which of the following is a disadvantage of a peripherally-inserted central catheter (PICC)?

1: High rate of catheter malposition
2: High risk of pneumothorax
3: Requires repeated skin puncture
4: Only available with single lumen

Answer 67

1: High rate of catheter malposition

Question 68

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

1: Immediately
2: After auscultating for catheter tip placement
3: After chest X-ray confirms correct placement of catheter tip
4: After ensuring there were no complications with insertion

Answer 68

3: After chest X-ray confirms correct placement of catheter tip

Question 69

Which of the following reduces the risk of calcium phosphate precipitation in PN?

1: Increased amino acid concentration
2: Use of calcium chloride as the calcium salt
3: Increased temperature
4: Adding calcium salt immediately after adding phosphate salt

Answer 69

1: Increased amino acid concentration

Question 70

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

1: a patient with a recent diagnosis of hepatocellular cancer.
2: prevention of a first episode of hepatic encephalopathy in a patient who has undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
3: initial management of acute hepatic encephalopathy.
4: a cirrhotic patient with chronic encephalopathy who is intolerant of standard protein sources despite optimal pharmacotherapy.

Answer 70

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

Question 71

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

1: Zinc and manganese
2: Zinc and magnesium
3: Copper and manganese
4: Copper and magnesium

Answer 71

3: Copper and manganese

Question 72

Which of the following PN components is NOT a source of aluminum contamination?

1: Heparin
2: Albumin
3: Calcium Gluconate
4: Regular insulin

Answer 72

4: Regular insulin

Question 73

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

1: Manganese
2: Copper
3: Zinc
4: Selenium

Answer 73

1: Manganese

Question 74

When compared to the Dietary Reference Intakes (DRIs) for fat- soluble vitamins given orally, the DRIs for parenterally administered fat-soluble vitamins are

1: lower.
2: equal.
3: two times higher.
4: four times higher.

Answer 74

2: equal.

Question 75

When compared to the Dietary Reference Intakes (DRIs) for water-soluble vitamins given orally, the DRIs for parenterally administered water-soluble vitamins are

1: one-third.
2: one-half.
3: equal.
4: higher.

Answer 75

4: higher.

Question 76

According to 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

1: no risk.
2: low risk.
3: medium risk.
4: high risk.

Answer 76

3: medium risk

Question 77

According to the A.S.P.E.N. PN Safety Consensus Recommendations, which of the following best describes safe PN compounding?

1: The preparation with automated compounding devices (ACDs) ensures an error free process
2: All healthcare providers should have the ability to override soft and hard limit alerts from ACDs
3: Manual compounding of PN is appropriate when volumes of a PN component to be mixed are less than the ACD can accurately deliver
4: The preparation of compounded sterile preparations (CSPs) for all patient populations should be done at the same time

Answer 77

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

Question 78

Creaming of a total nutrient admixture (TNA) appears as

1: a translucent band at the surface of the emulsion separate from the remaining TNA dispersion.
2: yellow-brown oil droplets at or near the TNA surface.
3: a continuous layer of yellow-brown liquid at the surface of the TNA.
4: marbling or streaking of the oil throughout the TNA.

Answer 78

1: a translucent band at the surface of the emulsion separate from the remaining TNA dispersion.

Question 79

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

1: tetany.
2: hypercalcemia.
3: metabolic alkalosis.
4: vitamin D deficiency.

Answer 79

1: tetany.

Question 80

A patient receiving PN develops metabolic acidosis. Which serum electrolyte level needs to be monitored most closely?

1: Sodium
2: Chloride
3: Potassium
4: Magnesium

Answer 80

3: Potassium

Question 81

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

1: 2 mcg/kg/day
2: 5 mcg/kg/day
3: 7 mcg/kg/day
4: 10 mcg/kg/day

Answer 81

2: 5 mcg/kg/day

Question 82

Which of the following components is NOT a major source of aluminum contamination in parenteral nutrition solutions?

1: Potassium phosphate
2: Sodium phosphate
3: Calcium Gluconate
4: Lipid injectable emulsion (ILE)

Answer 82

4: Lipid injectable emulsion (ILE)

Question 83

Mr. Griffin suffered from a stroke two weeks ago and has significant dysphagia. An isotonic enteral formula has been infusing continuously at goal rate for two days along with an ordered 30 mL water flush three times daily. Mr. Griffin begins to complain of bloating and is mildly distended (to 4 cm from baseline) upon examination. He denies nausea, abdominal cramping or abdominal pain. His last 2 gastric residual volume checks were measured at 100mLs. Which of the following interventions would be the best initial strategy to reduce his unpleasant symptoms?

1: Determine last bowel movement and initiate a bowel regimen if constipation suspected
2: Hold enteral nutrition and initiate a pain reliever
3: Switch to a higher fiber enteral nutrition formula

Answer 83

1: Determine last bowel movement and initiate a bowel regimen if constipation suspected

Question 84

A terminally ill patient at home on hospice complains of nausea during enteral feedings. A decision is made to discontinue enteral feeding. Which of the following is true regarding the dying patient?

1: Intravenous hydration should be used to reduce symptoms of nausea, vomiting, diarrhea and respiratory distress
2: Dehydration, starvation, and ketosis produces a euphoric state that enhances the perception of hunger
3: The most common symptom when nutrition and hydration are withheld is dry mouth
4: Electrolyte imbalance should be expected and may produce a degree of analgesia

Answer 84

3: The most common symptom when nutrition and hydration are withheld is dry mouth

Question 85

Which is a benefit of using an electromagnetic placement device for nasogastric tube placement?

1: pH can be monitored
2: Checks the tip position relative to the pylorus
3: Provides a 3-dimensional localization
4: Shows a time-delayed perspective of the tube tip location

Answer 85

3: Provides a 3-dimensional localization

Question 86

In a patient with a newly placed gastrostomy or jejunostomy tube, observation of which of the following conditions at the tube exit site would signal concern for infection?

1: Serosanguineous drainage
2: Foul-smelling drainage
3: Coffee-ground drainage
4: Bile-colored drainage

Answer 86

2: Foul-smelling drainage

Question 87

. Which is considered appropriate management of hypergranulation around the PEG site?

1: Keeping the area dry
2: Using a tube stabilizing device
3: Applying an occlusive dressing
4: Cauterization with silver nitrate

Answer 87

4: Cauterization with silver nitrate

Question 88

A patient with oral cancer, who has gained 10 pounds since starting home bolus enteral feedings via gastrostomy tube complains of pain and pressure on the " inside of his stomach" but no redness or drainage at the exterior gastrostomy site. Which of the following is the most appropriate response for the clinician?

1: Tell the patient to take over the counter pain medication and rotate the G tube 180 degrees each day.
2: Refer the patient to the gastroenterologist or enterostomal nurse.
3: Decrease the infusion volume of the formula in half to avoid excessive distention of the stomach.
4: Change to a slower tube feed infusion by using a gravity bag for feedings.

Answer 88

2: Refer the patient to the gastroenterologist or enterostomal nurse.

Question 89

Which of the following is the most likely cause of watery diarrhea and bloating in the enterally fed adult patient?

1: lactose content of the enteral formula.
2: sorbitol content of liquid medications
3: sorbitol content of the enteral formula
4: lactose content of liquid medications

Answer 89

2: sorbitol content of liquid medications

Question 90

An enterally fed patient reports nausea and/or vomiting. If delayed gastric emptying is suspected as the causative factor, which of the following is LEAST likely to improve the patient’s symptoms?

1: Reduce or discontinue narcotic medications
2: Switch to a low fat enteral formula
3: Reduce the rate of enteral nutrition infusion
4: Switch to a more concentrated enteral formula

Answer 90

4: Switch to a more concentrated enteral formula

Question 91

Which type of insulin should be used when initiating enteral nutrition in a hospitalized diabetic patient?

1: Premixed NPH/Regular insulin
2: Regular Insulin
3: NPH Insulin
4: Insulin glargine

Answer 91

2: Regular Insulin

Question 92

An 82 year old woman s/p CVA with dysphagia and subsequent PEG tube placement weighing 45kg is initiated on tube feeds which provide 1500kcal and 63gm protein per liter. The team added a modular protein supplement providing 15gm additional protein per day. She’s discharging to home and will be taken care of by family. During tube feeding education what is important to discuss with the family to prevent tube feeding syndrome?

1: The importance of checking weekly weights
2: The importance of providing goal volume of formula each day
3: The importance of providing adequate free water each day
4: The importance of ensuring adequate bowel movements

Answer 92

3: The importance of providing adequate free water each day

Question 93

. Which of the following is a best practice recommendation in enteral nutrition (EN) formula safety?

1: Mix or reconstitute enteral formulations at the bedside.
2: Change the enteral feeding administration set every 24 hours with open systems.
3: Limit hang time of closed-system EN formulas to no more than 12 hours.
4: Store powdered formulas reconstituted in advance at room temperature for up to 24 hours.

Answer 93

2: Change the enteral feeding administration set every 24 hours with open systems.

Question 94

Which of the following should always appear on the label of an enteral feeding product given to a patient in the hospital?

1: Product name, rate, volume, additives, caloric density, date and time the formula was prepared and hung
2: Patient identification, product name, administration method, route, access device, date and time the formula was prepared and hung
3: Patient’s name, product name, rate, strength, osmolality, date and time the formula was prepared and hung
4: Patient’s name, room number, strength, additives, volume, date and time the formula was prepared and hung

Answer 94

2: Patient identification, product name, administration method, route, access device, date and time the formula was prepared and hung

Question 95

Which intervention assists with maintaining feeding tube patency in the adult patient?

1: Administer medications through feeding tube with 5 mL of water
2: Use a 20mL or smaller syringe to flush small-bore feeding tubes
3: Flush feeding tube with 30 mL of water every 4 hours during continuous feeding
4: Change feeding tube every 72 hours

Answer 95

3: Flush feeding tube with 30 mL of water every 4 hours during continuous feeding

Question 96

What intervention can be utilized to prevent feeding tube occlusion associated with gastric residual volume (GRV) assessment in the adult patient?

1: Feeding tube should be flushed with 30mL of water following GRV assessment
2: Place the patient in reverse Trendelenberg position prior to GRV assessment
3: Hold enteral feedings one hour prior to GRV assessment
4: Instill 60 mL of air into the tube prior to GRV assessment

Answer 96

1: Feeding tube should be flushed with 30mL of water following GRV assessment

Question 97

A patient with short bowel and an end-jejunostomy requires the use of oral rehydration solution (ORS) to help prevent dehydration. Which best describes the preferred composition of the ORS?

1: A glucose-free solution
2: A hyper-osmolar solution such as fruit juice or Kool-aid
3: A sodium concentration of 90-120 mEq/L
4: A commercially available sports drink

Answer 97

3: A sodium concentration of 90-120 mEq/L

Question 98

What is the optimal sodium concentration of an oral rehydration solution for patients with short bowel syndrome?

1: 54 - 80 mmol/L
2: 90 - 120 mmol/L
3: 134 - 160 mmol/L
4: 170 - 190 mmol/L

Answer 98

2: 90 - 120 mmol/L

Question 99

You receive a consult for recommendations for a patient with ongoing high residuals. The last three measurements are 350ml, 375ml, and 330ml. What is the most appropriate recommendation?

1: Add a promotility agent
2: Change to a lower fat formula
3: Change to a more concentrated formula
4: Use a smaller bore feeding tube

Answer 99

1: Add a promotility agent

Question 100

Copper deficiency is associated with

1: leukocytosis.
2: macrocytic anemia.
3: microcytic hypochromic anemia.
4: erythrocytosis.

Answer 100

3: microcytic hypochromic anemia.

Question 101

Which of the following conditions are most likely to result in malnutrition of mild to moderate inflammatory response?

1: Anorexia Nervosa
2: Cancer
3: Closed Head Injury
4: Sepsis

Answer 101

2: Cancer

Question 102

Which of the following is common in both acute illness or injury-related and social or environmental related malnutrition?

1: Ketosis
2: Hypoglycemia
3: Lipolysis
4: Hypermetabolism

Answer 102

3: Lipolysis

Question 103

Which of the following nutrition assessment tools includes evaluating subcutaneous fat and muscle wasting at multiple body sites to determine nutritional status?

1: Nutritional risk index (NRI)
2: Prognostic nutrition index (PNI)
3: Subjective Global Assessment (SGA)
4: Prognostic inflammatory and nutritional index (PINI)

Answer 103

3: Subjective Global Assessment (SGA)

Question 104

The subjective global assessment uses which of hte following to evaluate the nutritional status of patients?

1: Dietary intake, delayed hypersensitivity skin testing, and weight history
2: Weight history, dietary intake, and gastrointestinal symptoms
3: Laboratory indices, weight history, and gastrointestinal symptoms
4: Arm anthropometry, dietary intake, and laboratory indices

Answer 104

2: Weight history, dietary intake, and gastrointestinal symptoms

Question 105

Which of the following has been reported to be a significant independent predictor of morbidity and mortality in critically ill patients?

1: Albumin
2: Prealbumin
3: Transferrin
4: Retinol-binding protein

Answer 105

1: Albumin

Question 106

Which of the following has been shown to reduce plasma homocysteine concentrations?

1: Folic acid
2: Vitamin E
3: L-carnitine
4: Ascorbic acid

Answer 106

1: Folic acid

Question 107

In persons with phenylketonuria (PKU), tyrosine becomes an essential amino acid due to

1: an increase in the tyrosine hydroxylase enzyme.
2: a deficiency in the phenylalanine hydroxylase enzyme.
3: an increase in the phenylalanine hydroxylase enzyme.
4: a decrease in the tyrosine hydroxylase enzyme.

Answer 107

2: a deficiency in the phenylalanine hydroxylase enzyme.

Question 108

Which of the following are examples of conditionally indispensable amino acids?

1: Leucine and Isoleucine
2: Phenylalanine and Valine
3: Glutamine and Arginine
4: Histidine and Glutamate

Answer 108

3: Glutamine and Arginine

Question 109

Which of the following IV fluids most closely resemble jejunal and ileal electrolyte content?

1: Lactated Ringer’s
2: Normal saline
3: 1/2 normal saline
4: D5 0.45% Sodium chloride

Answer 109

1: Lactated Ringer’s

Question 110

. All of the following are clinical symptoms of syndrome of inappropriate antidiuretic hormone (SIADH) EXCEPT:

1: Increased urinary output
2: Increased urinary sodium
3: Hyponatremia
4: Increased urinary osmolality

Answer 110

1: Increased urinary output

Question 111

A 45 year old patient with normal liver and kidney function has nonhealing wounds and a suspected vitamin A deficiency. Supplementation of vitamin A (25,000 IU/day) should usually be given for a maximum of

1: 3 days.
2: 14 days.
3: 90 days.
4: 180 days.

Answer 111

2: 14 days.

Question 112

Lactic acidosis can be a result of which vitamin deficiency?

1: Folic acid
2: Vitamin E
3: Thiamin
4: Vitamin C

Answer 112

3: Thiamin

Question 113

In addition to aggressive refeeding, which of the following places a patient at high risk for hypophosphatemia?

1: Diabetic ketoacidosis (DKA)
2: Tumor lysis syndrome
3: Vitamin D deficiency
4: Acute kidney injury(AKI)

Answer 113

1: Diabetic ketoacidosis (DKA)

Question 114

The risk of metastatic calcification in soft tissues begins to increase when the product of serum calcium and phosphorous exceeds

1: 25.
2: 55.
3: 75.
4: 95.

Answer 114

2: 55.

Question 115

Copper toxicity is associated with

1: liver disease.
2: kidney disease requiring hemodialysis.
3: aggressive zinc supplementation.
4: lung disease.

Answer 115

1: liver disease.

Question 116

Hepatic encephalopathy is most likely to be improved by which of the following trace elements?

1: Selenium
2: Copper
3: Zinc
4: Chromium

Answer 116

3: Zinc

Question 117

How should a critically ill patient’s energy delivery be modified in response to resting energy expenditure (REE) measured by indirect calorimetry?

1: reduced by 10% if respiratory quotient exceeds 1.0.
2: increased by a stress factor of 1.2-1.5 for sepsis or trauma.
3: adjusted by a thermogenesis factor for enterally fed patients.
4: used as the caloric target without addition of stress or activity factors.

Answer 117

4: used as the caloric target without addition of stress or activity factors.

Question 118

A respiratory quotient (RQ) of 0.87 most likely suggests

1: primarily fat oxidation.
2: mixed substrate utilization.
3: primary carbohydrate oxidation.
4: primary protein oxidation.

Answer 118

2: mixed substrate utilization.

Question 119

Malnutrition is most common in which form of inflammatory bowel disease?

1: Crohn’s disease
2: Ulcerative colitis
3: Microscopic colitis
4: Collagenous colitis

Answer 119

1: Crohn’s disease

Question 120

What is the approximate normal length of small intestine in adults?

1: 150-200 cm
2: 300-600 cm
3: 700-900 cm
4: 1000-1200 cm

Answer 120

2: 300-600 cm

Question 121

What is the primary fuel of the colonocytes?

1: Medium chain fatty acids
2: Glucose
3: Glutamine
4: Short chain fatty acids

Answer 121

4: Short chain fatty acids

Question 122

Which of the following areas of the gastrointestinal tract has the LEAST impact on nutrient absorption and intestinal adaptation following significant intestinal resection?

1: Colon
2: Ileum
3: Jejunum
4: Ileocecal valve

Answer 122

3: Jejunum

Question 123

Valproic acid has been shown to induce a deficiency in which of the following nutrients?

1: Chromium
2: Carnitine
3: Leucine
4: Vitamin D

Answer 123

2: Carnitine

Question 124

The majority of dietary folate is reabsorbed via which of the following mechanisms?

1: Oncotic pressure
2: Enterohepatic circulation
3: Plasma hydrostatic pressure
4: Passive diffusion

Answer 124

2: Enterohepatic circulation

Question 125

Choline supplementation has been investigated as a treatment for which of the following disease states?

1: Myocardial infarction
2: Pancreatic insufficiency
3: Hepatic steatosis
4: Alcoholic encephalopathy

Answer 125

3: Hepatic steatosis

Question 126

Potential metabolic causes for a respiratory quotient (RQ) greater than 1 include all of the following EXCEPT

1: overfeeding.
2: hypoventilation.
3: excess CO2 production.
4: provision of excess sodium bicarbonate.

Answer 126

2: hypoventilation.

Question 127

The catabolic phase of the metabolic response to critical illness usually lasts

1: 1 day.
2: 3 days.
3: 5 days.
4: 7 days.

Answer 127

4: 7 days.

Question 128

Which of the following tests does not reflect selenium status?

1: Plasma selenium level
2: Erythrocyte concentration
3: Plasma glutathione peroxidase
4: Methionine

Answer 128

4: Methionine

Question 129

Treatment for gastric phytobezoars includes all of the following EXCEPT

1: flushing with cola.
2: enzymatic therapy with cellulase.
3: meat tenderizer that contains papain.
4: surgical removal of the bezoar.

Answer 129

3: meat tenderizer that contains papain.

Question 130

A patient awaiting liver transplant has been taking a diuretic to control ascites and peripheral edema. Which of the following acid-base disorders is expected?

1: Metabolic acidosis
2: Metabolic alkalosis
3: Respiratory acidosis
4: Respiratory alkalosis

Answer 130

2: Metabolic alkalosis

Question 131

Triglycerides that require bile acids to facilitate enzymatic digestion and absorption are typically

1: 3 carbons in length.
2: 6 carbons in length.
3: 9 carbons in length.
4: 14 carbons in length.

Answer 131

4: 14 carbons in length.

Question 132

A 50-year-old male weighs 80 kg. Calculate the estimated volume of his intravascular space.

1: 4 L
2: 8 L
3: 12 L
4: 16 L

Answer 132

1: 4 L

Question 133

When determining nitrogen balance, urea accounts for what percentage of total urine nitrogen losses?

1: 50%
2: 60%
3: 70%
4: 80%

Answer 133

4: 80%

Question 134

Which water-soluble vitamins do not require NA+ co-transporters for absorption?

1: Vitamin C and Vitamin B6
2: Vitamin E and Vitamin D
3: Vitamin B12 and Folic acid
4: B1 and Choline

Answer 134

3: Vitamin B12 and Folic acid

Question 135

Medium-chain triglycerides (MCTs) do not require the formation of micelles or bile salts for absorption because they are

1: fat-soluble.
2: 2-5 carbons in length.
3: water-soluble.
4: anti-inflammatory.

Answer 135

3: water-soluble.

Question 136

All of the following hydrolyze fat in the small intestine EXCEPT

1: pancreatic lipase.
2: cholesterol ester hydrolase.
3: phospholipase.
4: bile acids.

Answer 136

4: bile acids.

Question 137

The initial protein requirements for a critically ill trauma patient weighing 70 kg are

1: 55-70 grams.
2: 70-105 grams.
3: 105-140 grams.
4: 140-175 grams.

Answer 137

3: 105-140 grams.

Question 138

The primary fuel source for the brain after a 48 hour fast is

1: essential fatty acids.
2: ketone bodies.
3: carbohydrates.
4: amino acids.

Answer 138

2: ketone bodies.

Question 139

The only two organs in the body that have the necessary enzymes for gluconeogenesis are the liver and the

1: stomach.
2: brain.
3: kidney.
4: small intestine.

Answer 139

3: kidney.

Question 140

The acceptable macronutrient distribution range (AMDR)

1: is defined as the Tolerable Upper Intake level for a particular energy source.
2: has been set for Omega 3 fatty acids, Omega 6 fatty acids and total fat.
3: provides a guide to assist in the treatment of chronic diseases related to fat intake.
4: is also known as the Estimated Average Requirement (EAR).

Answer 140

2: has been set for Omega 3 fatty acids, Omega 6 fatty acids and total fat.

Question 141

The energy for glucose transport is provided by active transport of

1: potassium into the cell.
2: potassium out of the cell.
3: sodium into the cell.
4: sodium out of the cell.

Answer 141

4: sodium out of the cell.

Question 142

A 32-year-old female presents to the clinic seeking treatment for a sunburn-like rash. She also reports that she feels very sad and has no energy. Which of the following deficiencies should be considered?

1: Vitamin A
2: Vitamin K
3: Lipid
4: Protein

Answer 142

4: Protein

Question 143

Which of the following is NOT associated with a delayed bone age in a child with short stature?

1: Hypothyroidism
2: Precocious puberty
3: Cushing syndrome
4: Growth hormone deficiency

Answer 143

2: Precocious puberty

Question 144

What is the suggested daily amount of potassium required for maintenance in an infant receiving parenteral nutrition?

1: 0.8-1 mEq/kg
2: 2-4 mEq/kg
3: 5-6 mEq/kg
4: 7-8 mEq/kg

Answer 144

2: 2-4 mEq/kg

Question 145

On radiographic examination, a pediatric patient is found to have osteopenia and multiple fractures in various stages of healing. Serum laboratory results show: Calcium: low. Phosphorus: low. Creatinine: normal. Alkaline phosphatase: high. 25-OH vitamin D: Low. 1,25 (OH)2 vitamin D: Low. PTH: high. Which of the following is the most likely diagnosis?

1: Renal tubular acidosis
2: Osteogenesis imperfecta
3: Vitamin D deficiency rickets
4: Vitamin D dependent rickets type 2

Answer 145

3: Vitamin D deficiency rickets

Question 146

What is the daily maintenance fluid requirement for a 5 kg infant?

1: 300 mL
2: 500 mL
3: 700 mL
4: 1000 mL

Answer 146

2: 500 mL

Question 147

What is the recommended daily enteral iron dose for preterm infants, one month after birth?

1: 0.5-1 mg/kg/d
2: 1-2 mg/kg/d
3: 2-4 mg/kg/d
4: 5-6 mg/kg/d

Answer 147

3: 2-4 mg/kg/d

Question 148

A seven month-old infant fed reconstituted infant formula and other age-appropriate complementary foods may be at risk of over-supplementation with which of the following?

1: Vitamin A
2: Fluoride
3: Vitamin E
4: Iron

Answer 148

2: Fluoride

Question 149

What should the MAXIMUM glucose infusion rate (GIR) be for a term infant receiving parenteral nutrition (PN)?

1: 4-8 mg/kg/min
2: 8-12 mg/kg/min
3: 14-18 mg/kg/min
4: 18-22 mg/kg/min

Answer 149

3: 14-18 mg/kg/min

Question 150

In an infant receiving parenteral nutrition (PN), what is the MINIMUM amount of lipid injectable emulsion (ILE) needed to prevent essential fatty acid deficiency (EFAD)?

1: 0.2-0.4 g/kg/day
2: 0.5-1g/kg/day
3: 1.1-1.5 g/kg/day
4: 1.8-2 g/kg/day

Answer 150

2: 0.5-1g/kg/day

Question 151

Standard neonatal parenteral amino acid solutions differ from standard adult parenteral amino acid solutions by having a higher content of

1: cysteine.
2: phenylalanine.
3: taurine and tyrosine.
4: methionine and glycine.

Answer 151

3: taurine and tyrosine.

Question 152

What is the recommended daily intake of selenium for term infants receiving parenteral nutrition?

1: <1 mcg/kg/day
2: 2 mcg/kg/day
3: 3 - 4 mcg/kg/day
4: 5 - 6 mcg/kg/day

Answer 152

2: 2 mcg/kg/day

Question 153

Immediately following neonatal cardiac surgery, which of the following is the best estimate of parenteral caloric requirements?

1: 90-100 kcal/kg/day
2: 120-170 kcal/kg/d
3: 55-60 kcal/kg/d
4: 100-110 kcal/kg/d

Answer 153

3: 55-60 kcal/kg/d

Question 154

Pancreatic enzymes supplemented at high doses in children with cystic fibrosis could result in

1: steatorrhea.
2: meconium ileus.
3: fibrosing colonopathy.
4: cystic fibrosis related diabetes.

Answer 154

3: fibrosing colonopathy.

Question 155

A 2-month-old infant, who has been exclusively fed with cow’s milk based formula develops a full body rash. Which of the following would be the most appropriate next step?

1: Switch to a soy protein based formula
2: Switch to a high MCT oil formula
3: Switch to a protein hydrolysate based formula
4: Switch to a lactose free cow’s milk based formula

Answer 155

3: Switch to a protein hydrolysate based formula

Question 156

Biliary atresia in infancy is most frequently associated with which of the following?

1: Fat malabsorption
2: Chylothorax
3: Zinc Deficiency
4: Essential fatty acid deficiency

Answer 156

1: Fat malabsorption

Question 157

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

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

Answer 157

3: 48 hours

Question 158

A 53 year old male patient with height 5’9” and weight 93 kg is receiving 1850 kcals 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 of estimated water

Answer 158

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

Question 159

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 volumes of water flushes would best meet her daily estimated fluid requirements?

1: 100 mL
2: 300 mL
3: 600 mL
4: 1000 mL

Answer 159

2: 300 mL

Question 160

A patient is receiving enteral nutrition during her second trimester of pregnancy. Nutritional assessment data reflect an average maternal weight gain of 0.42 lbs per week, normal fetal growth, an albumin of 2.0 gm/dL, and a nitrogen balance of +2 gm/day. Based on the data provided, 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

Answer 160

3: Serum Albumin

Question 161

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

1: Crohn’s disease
2: Chyle leak
3: Gastroparesis
4: Celiac disease

Answer 161

2: Chyle leak

Question 162

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 enteric contents
4: Air sufflation and auscultation over the gastric bubble

Answer 162

1: Radiographic confirmation

Question 163

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: Decreased rate of ventilator-associated pneumonia

Answer 163

2: Increased nutrient delivery

Question 164

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

1: Endoscopic placement
2: Bedside electromagnetic imaging system
3: Fluoroscopic Placement
4: Weighted tube tips

Answer 164

4: Weighted tube tips

Question 165

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: Reduced difficulty of placement
2: Reduced incidence of bleeding
3: Reduced incidence of migration
4: Reduced incidence of gastric outlet obstruction

Answer 165

3: Reduced incidence of migration

Question 166

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

Answer 166

1: High fat

Question 167

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

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

Answer 167

1: orange juice.

Question 168

A patient with acute respiratory distress syndrome (ARDS) receiving enteral nutrition will benefit most from

1: supplemental arginine.
2: formulas containing omega-6 fatty acids.
3: formulas containing omega-3 fatty acids.
4: avoidance of overfeeding.

Answer 168

4: avoidance of overfeeding.

Question 169

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 nasoenteric feeding tubes.
2: lack of benefit with EN in this population.
3: potential mucosal toxities related to the conditioning regimen.
4: reduced mortality among autologuous patients receiving parenteral nutrition (PN).

Answer 169

3: potential mucosal toxities related to the conditioning regimen.

Question 170

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

Answer 170

3: Decreased pain

Question 171

A patient in a persistent vegetative state has made their wishes known regarding artificial nutrition and hydration whose wishes have been made known through an advance directive. The decision to terminate enteral feeding for this patient is based on the ethical principle of

1: justice.
2: autonomy.
3: beneficence.
4: nonmalfeasance

Answer 171

2: autonomy.

Question 172

A patient has an advanced directive stating a desire to forego medical technology, including nutrition and hydration, in order to prolong life. The patient is now in an irreversible vegetative state. In deciding whether to continue nutrition and hydration by medical means, the patient’s surrogate decision-maker must:

1: consult with a lawyer.
2: have a psychiatric evaluation to be declared competent to make any decisions in the patient’s care.
3: honor the patient’s expressed wish to withdraw nutrition and hydration by medical means.
4: decide, based upon own values, to make a decision to withdraw the patient’s nutrition and hydration by medical means.

Answer 172

3: honor the patient’s expressed wish to withdraw nutrition and hydration by medical means.

Question 173

In an older adult who requires long term EN, which of the following complications is most often overlooked?

1: Tube leaking
2: Constipation
3: Decreased urine output
4: Skin problems at tube site

Answer 173

3: Decreased urine output

Question 174

According to the 2012 National Inpatient Sample (NIS) of hospital discharges, what percentage of older adults greater than 65 years old, were diagnosed with malnutrition?

1: 10-20%
2: 30-40%
3: 50-60%
4: 70-80%

Answer 174

2: 30-40%

Question 175

Which of the following represents the core set of clinical and functional status elements which form the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid?

1: Minimum Data Set (MDS)
2: Resident Assessment Protocols (RAP)
3: UtilizationGuidelines
4: Trigger Legend

Answer 175

1: Minimum Data Set (MDS)

Question 176

Which of the following medications is most likely to contribute to hyponatremia in an older adult?

1: Hydrochlorothiazide
2: Amlodipine
3: Warfarin
4: Simvastatin

Answer 176

1: Hydrochlorothiazide

Question 177

Which of the following is most likely to be observed first, for a patient with no history of diabetes who is overfed?

1: Hepatobiliary effects
2: Hyperglycemia
3: Weight gain
4: Accumulation of carbon dioxide

Answer 177

2: Hyperglycemia

Question 178

A patient receiving digoxin and parenteral nutrition who is experiencing signs of digoxin toxicity should be assessed for

1: hypokalemia.
2: hypocalcemia.
3: hypermagnesemia.
4: hypophosphatemia.

Answer 178

1: hypokalemia.

Question 179

In which of the following older adult populations is toxicity with fat soluble drugs most likely?

1: Obese
2: Sedentary
3: Malnourished
4: Physically active

Answer 179

1: Obese

Question 180

Which of the following is NOT a component of the Comprehensive Geriatric Assessment tool?

1: Exercise level
2: Anthropometry
3: Quality of life
4: Biochemical markers

Answer 180

1: Exercise level

Question 181

What is the most widely used tool to measure generic health-related quality of life?

1: Katz ADL
2: Lawton-Brody IADL
3: FIM
4: SF-36

Answer 181

4: SF-36

Question 182

In a 100 kg afebrile person with intact skin, insensible fluid loss from lungs and skin is approximately

1: 500 mL/day.
2: 800 mL/day.
3: 1000 mL/day.
4: 1200 mL/day.

Answer 182

3: 1000 mL/day.

Question 183

A 68 year old woman with a history of cirrhosis is receiving enteral nutrition due to recent gastrointestinal surgery. She has worsening hepatic encephalopathy. Which of the following should be tried first?

1: Decrease in protein provision to 0.6 g/kg/d
2: Formula high in medium chain triglyceride content
3: Formula enriched with branched-chain amino acids
4: Lactulose and rifaximin therapy

Answer 183

4: Lactulose and rifaximin therapy

Question 184

When evaluating the home environment for a patient receiving parenteral nutrition, which of the following is required?

1: Access to telephone
2: Isolated infusion area
3: Back-up electrical generator
4: Dedicated refrigerator

Answer 184

1: Access to telephone

Question 185

The most common complication seen after percutaneous endoscopic gastrostomy (PEG) tube placement is:

1: Buried bumper syndrome
2: Peristomal infection
3: Gastric ulceration
4: Colocutaneous fistulas

Answer 185

2: Peristomal infection

Question 186

The maximum hang time an open system enteral feeding formulation container in the home setting is

1: 6 hours.
2: 12 hours.
3: 18 hours.
4: 24 hours.

Answer 186

2: 12 hours.

Question 187

Initially, how often should electrolytes be monitored in a patient on home parenteral nutrition support?

1: Daily
2: Weekly
3: Monthly
4: Bi-monthly

Answer 187

2: Weekly

Question 188

According to the Centers for Medicare and Medicaid Services, which of the following is an indication for home parenteral nutrition?

1: Bowel resection resulting in less than or equal to 5 feet small bowel beyond the ligament of Treitz
2: Gastrointestinal losses totaling 20% of oral intake
3: Need for bowel rest of 1-2 weeks duration
4: Failure to maintain weight on an oral die

Answer 188

1: Bowel resection resulting in less than or equal to 5 feet small bowel beyond the ligament of Treitz

Question 189

Upon initiation of home parenteral nutrition (HPN), initial laboratory data should be obtained

1: within 48 hours after initiation.
2: prior to initiation.
3: the day of initiation.
4: within 1 week of initiation.

Answer 189

2: prior to initiation.

Question 190

A patient on long-term home enteral nutrition suddenly develops nausea and vomiting. The most likely cause is

1: frequent use of sorbitol-containing medications.
2: gastric outlet obstruction.
3: low osmolarity formula.
4: sudden decrease in enteral feeding rate.

Answer 190

2: gastric outlet obstruction.

Question 191

The clinical manifestations of copper deficiency can be similar to what other micronutrient deficiency?

1: Vitamin B12
2: Manganese
3: Vitamin E
4: Zinc

Answer 191

1: Vitamin B12

Question 192

Which of the following is true concerning manganese and patients on long-term parenteral nutrition (PN)?

1: Manganese deficiency occurs in patients on PN for greater than 1 year
2: Hypermanganesemia has been reported only in patients with cholestasis
3: Manganese in commercial trace element preparations may result in hypermanganesemia
4: The best indicator of manganese status is serum manganese

Answer 192

3: Manganese in commercial trace element preparations may result in hypermanganesemia

Question 193

Which of the following conditions is most concerning for zinc deficiency?

1: Loss of taste sensation
2: Alopecia
3: Night blindness
4: Gonadal hypofunction

Answer 193

4: Gonadal hypofunction

Question 194

Which of the following is true concerning aluminum contamination in long-term parenteral nutrition (PN)?

1: The amount on the manufacturer’s label is greater than measured amounts
2: Each PN bag must provide the amount of aluminum per liter
3: The clinical manifestations of aluminum toxicity are specific and sensitive
4: Aluminum toxicity is the primary etiology of parenteral nutrition-associated bone disease

Answer 194

1: The amount on the manufacturer’s label is greater than measured amounts

Question 195

Which of the following is the MOST practical approach for managing micronutrients in long-term parenteral nutrition (PN) patients?

1: Obtain serum values for all vitamins and trace elements yearly
2: Perform a micronutrient assessment every 6 months
3: Provide micronutrients only when laboratory values indicate abnormal levels
4: A nutrition focused physical assessment should be performed annually to determine micronutrient deficiencies

Answer 195

2: Perform a micronutrient assessment every 6 months

Question 196

A malnourished patient with metastatic ovarian cancer is diagnosed with an inoperable partial mechanical small bowel obstruction. She is taking small amounts of a full liquid diet by mouth, but is unable to take enough nutrition to maintain her weight. She has lost 12% of her body weight in the past 2 months. According to current Medicare guidelines, this patient’s home parenteral nutrition (HPN) will be covered under which of the following circumstances?

1: The physician must write an order for the patient to be nil per os or "nothing by mouth"
2: Medical record must include a radiology report documenting the presence of partial small bowel obstruction
3: Medical record must document failure of an enteral tube feeding trial, or explain why an enteral feeding tube is not an option
4: No further documentation is necessary to confirm coverage

Answer 196

3: Medical record must document failure of an enteral tube feeding trial, or explain why an enteral feeding tube is not an option

Question 197

Serum conjugated bilirubin level is elevated in an adult patient with short bowel syndrome. The patient has been receiving a 12-hour cycle of 3-in-1 home parenteral nutrition (HPN) solution. The clinician’s initial plan may include

1: removal of all trace elements from HPN.
2: increasing lipid calories to prevent essential fatty acid deficiency.
3: evaluation for possible overfeeding of dextrose and/or intravenous fat emulsion.
4: addition of carnitine and choline to the HPN.

Answer 197

3: evaluation for possible overfeeding of dextrose and/or intravenous fat emulsion.

Question 198

When transitioning a patient from hospital to home parenteral nutrition (HPN) support, screening criteria should include which of the following?

1: Transportation needed to make it to lab draws
2: Presence of electricity and sanitary water supply in the home
3: Access to fingerstick glucose monitoring
4: A caregiver

Answer 198

2: Presence of electricity and sanitary water supply in the home

Question 199

Home-prepared or blenderized enteral nutrition (EN) formulations should be discarded after

1: 6 hours.
2: 12 hours.
3: 24 hours.
4: 48 hours.

Answer 199

3: 24 hours.

Question 200

Which of the following is true regarding parenteral nutrition (PN)-associated metabolic bone disease?

1: Cyclic PN reduces the risk of developing metabolic bone disease
2: Excessive dietary protein may lead to a positive calcium balance
3: All patients on PN for longer than 1 year should be recommended for dual-energy x-ray absorptiometry
4: Adequate supplementation of calcium and phosphorus is achieved with PN

Answer 200

3: All patients on PN for longer than 1 year should be recommended for dual-energy x-ray absorptiometry

Question 201

1: Frequent checking of residuals
2: Inadequate flushing of tube
3: The high protein high calories formula
4: Liquid medication administration vs. crushed tables mixed in water.

Answer 201

2: Inadequate flushing of tube

Question 202

Which of the following is true regarding the concept of quality of life in home parenteral nutrition (HPN) patients?

1: Most patients believe that the HPN access catheter has little effect on their self-image or self-esteem
2: Patients with chronic bowel disease seem to cope less effectively than patients with acute gastrointestinal trauma
3: Social isolation is not an issue since most infusions are cycled overnight
4: Adjusting to HPN is easier for patients who have HPN structured around their specific lifestyles

Answer 202

4: Adjusting to HPN is easier for patients who have HPN structured around their specific lifestyles

Question 203

Which of the following is true of aluminum toxicity in patients receiving long-term parenteral nutrition?

1: The clinical manifestations of aluminum toxicity are specific and sensitive
2: Aluminum toxicity is the primary etiology of parenteral nutrition-associated bone disease
3: Increased risk of aluminum toxicity exists in the setting of renal failure or iron deficiency anemia
4: Modern manufacturing practices have eliminated the risk of aluminum toxicity

Answer 203

3: Increased risk of aluminum toxicity exists in the setting of renal failure or iron deficiency anemia

Question 204

Which of the following is accurate about the use of ethanol as a lock solution?

1: Ethanol has no known microbial resistance
2: Ethanol has no known effect on coagulation
3: Ethanol has no known effect on biofilm formation
4: Ethanol has no known effect on fibrin deposition

Answer 204

1: Ethanol has no known microbial resistance