jksrd nut assessment

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jksrd
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135058
Filename:
jksrd nut assessment
Updated:
2012-02-26 20:10:25
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cnsc
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nutritional assessment
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  1. The following is likely not a tsik for refeeding syndome:
    (A) an elderly pt w/ severe dementia and signs of negelect
    (B) an anorexic pt
    (C) a pt w/ severe dysphagia d/t an esophageal mass
    (D) a trauma pt
    (D) a trauma pt
    (this multiple choice question has been scrambled)
  2. the least accurate method for assesicng energy requirments is
    (A) direct calorimetry
    (B) food intake records
    (C) IC
    (D) doubly labeled H20
    (B) food intake records
    (this multiple choice question has been scrambled)
  3. If refeeding is expected the following shoudl be limited initially
    A. 'lytes
    B. Dextrose
    C. protein
    D. Fat
    B. Dextrose
    (this multiple choice question has been scrambled)
  4. if a pt w/ short bowel syndrome who has required TPN for 2 years presents w/ dysguesia, diarrheaa and alopecia, which of the following nutrients is most likley deficient?
    A. zinc
    B. Selenium
    C. Chromium
    D. Mg2+
    A. zinc
    (this multiple choice question has been scrambled)
  5. BMI indicates
    A - the percentile rank of body weight
    B - the presence of obesity
    C - the percentage of IBW
    D - Body Composition
    B - the presence of obesity
    (this multiple choice question has been scrambled)
  6. Which of the following is a cuse of hepatic steatosis?
    A - Choline deficiency
    B - excessive AA infusion
    C - zc toxicity
    D - Gln deficiency
    A - Choline deficiency
    (this multiple choice question has been scrambled)
  7. in premature neonates, the use of adult Mvi is most likely to lead to
    A - liver failure
    B - dermatitis
    C - atelectasis (collapse of lung)
    D - metabolic ketoacidosis
    A - liver failure
    (this multiple choice question has been scrambled)
  8. the followign wt loss over 6 mo is considered severe:
    A - >10%
    B - >7.5%
    C - >2%
    D - >5%
    A - >10%
    (this multiple choice question has been scrambled)
  9. the best indicator of recent changes in nut'l intake/status is:
    A - tricep skinfold measurment
    B - BMI
    C- % IBW
    D - changes in UBW
    D - changes in UBW
  10. a pt suffering from this vitamin deficient us likely to present w/ swollen, inflamed, bleeding gums:
    A - Vit A
    B - Vit C
    C - vit B12
    D - Zc
    B - Vit C
    (this multiple choice question has been scrambled)
  11. During the early phase malnutrition, what amt of body pro stores is needed to provide substrate for gluconeogenisis during a 24 hr period?
    A - 10 g
    B - 150 g
    C - 75 g (unstressed)
    D - 300 g
    C - 75 g (unstressed)
    (this multiple choice question has been scrambled)
  12. which of the following is most closely associated w/ respiratory failure
    A - hypophosphatemia
    B - hypokalemia
    C - hypocalcemia
    D - hypomagnesemia
    A - hypophosphatemia
    (this multiple choice question has been scrambled)
  13. prealbumin is most likely to be elevated in which of the following dz states?
    A - renal dz
    B - liver dz
    C - thermal injury
    D - DM
    A - renal dz
    (this multiple choice question has been scrambled)
  14. a cachectic 42yof is readmitted 2 wks s/p exp lap w/ a suspected post-op SBO. She has lost an additional 8% of her body weight since her 1st admission to the hospital. she undergoes surgical repair of the obstruction and has a nasoenteric feeding tube placed in the OR. upon initiaion of nutrition support, which of the following would be a major concern?
    A- diarhea
    B - narcotic addiction
    C - rapid wt gain
    D - refeeding syndrome
    D - refeeding syndrome
  15. which of the following is the best objective indicator of malnutrition in liver dz when ascites is present?
    A - transthyretin
    B- serum albumin
    C - body weight as a % of ideal weight for height
    D - triceps skinfold thickness and MAMC
    D - triceps skinfold thickness and MAMC
  16. a pt with mental status changes (dementia), dermatitis, and diarheaa may have the following deficiency:
    A - thiamin
    B- niacin
    C - cyanocobalamin
    D - folic Acid
    B- niacin (pellegra) 4 D's
  17. which is the follwoing is a conditionally essential AA in a preterm infant?
    A- glycine
    B- taurine
    C- Gln
    D - arginine
    B- taurine
  18. a pt w/ vit A deficinecy is likely to manifest with the following symptom:
    A - alopecia
    B- glossitis
    C- cheilosis
    D- dermatitis
    D- dermatitis - also seen w/ EFA deficiency)
  19. the usual parenteral dosage of selenium is:
    A - 50-100 mcg
    B - 200-250 mcg
    C - 125-175 mcg
    D- 300-350 mcg
    A - 50-100 mcg - 55 mcg = RDA
    (this multiple choice question has been scrambled)
  20. Pts receiving long term TPN are most likely to have increased requirements above the RDA for:
    A - Cu
    B - Selenium
    C - Manganese
    D - Chromium
    B - Selenium
    (this multiple choice question has been scrambled)
  21. in Cancer pts, supplementation w/ zc resulted in:
    A - no improvement
    B - improved taste for all pts
    C - improved taste in pts that were zc deficient
    D - decreased taste perception
    C - improved taste in pts that were zc deficient
    (this multiple choice question has been scrambled)
  22. with erythropoetin therapy, supplementation w/ this nutrient is normally required.
    A - Cu
    B - zc
    C - Mvi
    D - Fe
    D - Fe
    (this multiple choice question has been scrambled)
  23. A deficiency of this vitamin can cause lactic acidosis and death:
    A - Vit B1
    B - vit C
    C - vit B12
    D -Vit D
    A - Vit B1 AEB Mvi shortage of 1990's
    (this multiple choice question has been scrambled)
  24. the use of intravenous albumin to correct hypoalbuminemia in pts w/ ESLD results in:
    A - dec rate of infection
    B - increased serum albumin temporarily
    C - dec LOS in hospital
    D - increased liver synthetic rate od transthyretin
    B - increased serum albumin temporarily
    (this multiple choice question has been scrambled)
  25. in a pt receiving PN w/ Mvi containing vit K, and warfarin, the most appropriate course of action would be to:
    A - utilize the old mvi which d/n have vit k
    B - provide pedi mvi as it ocntians less vit k
    C - maintain consistent vit k provision, even after PN stopped
    D - avoid vit supplementation altogether
    C - maintain consistent vit k provision, even after PN stopped and adjusted anti-coag tx as needed
    (this multiple choice question has been scrambled)
  26. Aluminum toxicity is most likely to occur in a pt with:
    A - cardiac dysfxn
    B - respiratory dysfxn
    C - renal dysfxn
    D - neurological dysfunction
    C - renal dysfxn - r/t inability to excrete
    (this multiple choice question has been scrambled)
  27. the following lab [ ] may be adjused for low albumin
    A - chromium
    B - phosphorus
    C - Ca2+
    D - calcitonin
    C - Ca2+
    (this multiple choice question has been scrambled)
  28. the adjusted ca2+ for a pt w/ a serum albumin [] of 2.4 and serum Ca2+ of 7.2 is ~ :
    A - 8.1
    B - 8.5
    C - 8.8
    D - 9.1
    • B - 8.5 - Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 (4.0 - serum albumin [g/dL])
    • where 4.0 represents the average albumin level in g/dL.
  29. the gallbladder is stimulated by:
    A- estrogen
    B- leptin
    c- pancrease
    C- CCK
    C- CCK
  30. the following would not be expected to reduce prealbumin levels:
    A - renal failure
    B - fluid overload
    C - presences of an abscess
    D - impaired liver dysfxn
    A - renal failure
    (this multiple choice question has been scrambled)
  31. the following is an inherant contaminant of PN solutions:
    A - glycerol
    B - aluminum
    c- Manganese
    D - Fe
    B - aluminum - most likely to be seirous in neonatal populations
  32. a pt that is 72 hours post trauma and resusciatation has an albumin of 2.4. the most likely cause is
    A - malnutrition
    B- trauma
    C- renal failure
    D - inadequete IV albumin provision
    B- trauma
  33. S/s of dehydration include:
    A - peripheral edema, flat neck veins, htn
    B - elevated BUN, GTN, elecated neck veins
    C - low serum Na, dry mucous membranes, elevated BUN
    D - elevated serum Na, flat neck veins, dry mucous membranes
    D - elevated serum Na, flat neck veins, dry mucous membranes
    (this multiple choice question has been scrambled)
  34. a low prealbumin in a critically ill pt is most often d/t:
    A - steroid provision
    B- malnutrition
    C - inflammatory process
    D - inadequete nitrogen provision
    C - inflammatory process - prealm is a (-) acute phase reactant
  35. the syndrome of SIADH is likely to present as:
    A - hyperkalemia
    B - hypokalemia
    C - hyponatremia
    D - hypernatremia
    C - hyponatremia
    (this multiple choice question has been scrambled)
  36. the following best predicts wiynd related complications
    A - Tricep skinfold
    B - serum albumin
    C - TLC (total lymphocyte count)
    D - %IBW
    B - serum albumin
    (this multiple choice question has been scrambled)
  37. diabetes insipidus is likely to present as:
    A - high urine output
    B - no classic presentations, hence difficult to dx
    C - low urine output
    D - normal urine output and 'lyte derangements
    A - high urine output from 4-12 L/dm also possibly hypernatremia
    (this multiple choice question has been scrambled)
  38. Dx EFA deficiency is done by:
    A - dry, flaky skin
    B - serum TAG level
    C - assesment of hari follicles
    D - triene to tetraene ratio
    D - triene to tetraene ratio
    (this multiple choice question has been scrambled)
  39. a TAG [ ] grater than ___mg/dL should preclude routine provision of IV lipids:
    A - 400
    B - 800
    C - 600
    D - 200
    A - 400
    (this multiple choice question has been scrambled)
  40. the following is most closely r/t muscle mass:
    A - serum creatinine
    B - UUN
    C - %UBW
    D - %IBW
    A - serum creatinine
    (this multiple choice question has been scrambled)
  41. the mmost common cause of hypernatremia in hospitalized pts is:
    A - innapropriate and inadequete provision of fluids
    B - high Na of nutrition support formulations
    C - inadaquete provision of Na in IV fluids
    D - excessive na in hospital diets
    A - innapropriate and inadequete provision of fluids
    (this multiple choice question has been scrambled)
  42. the following lab value is likely to be low in acute pancreatitis:
    A - Phosphorus
    B - LFT (gallstones and etOH abuse most common causes)
    C - Ca2+
    D - cholesterol
    C - Ca2+ - part of ransom's criteria
    (this multiple choice question has been scrambled)
  43. a NFPE would include:
    A - wt hx or changes
    B - presence of edema
    C- lab values
    D - current oral intake
    B - presence of edema
  44. a VLBW infant is defines as
    A - <2500 g
    B - <1000 g
    C - <1500 g
    D - <2000 g
    C - <1500 g
    (this multiple choice question has been scrambled)
  45. a subjective global assesment would include pt hx and which of the following?
    A - lab values
    B - physical exam
    C - current oral intake
    D - radiographic data
    B - physical exam
    (this multiple choice question has been scrambled)
  46. which of the following is a major contributor to the risk of malnutrition in hospitalized pts?
    A - immobilization
    B- hypothryoidism
    C - immunosuppression
    D - increased catabolic stress
    D - increased catabolic stress
  47. the most appropriaet formaul for a pt w/ SIADH is:
    A - standard, isotonic formula
    B - concentrated formula
    C - low 'lyte formula
    D - Dz specific formula
    B - concentrated formula
    (this multiple choice question has been scrambled)
  48. what is the most appropriate daily dose of protein for a pt w/ acute renal failure managed w/ continuous venovenous hemofiltration
    A - 1.0-1.2 g/kg
    B - 1.5-1.8 g/kg
    C - <0.5 g/kg
    D - 0.8 g/kg
    B - 1.5-1.8 g/kg
    (this multiple choice question has been scrambled)
  49. in designing a PN regimen for an adult burn pt, which of the following should be considered?
    A - energy needs may be increased to up to twice the basal rate
    B - nutrition support should be delayed until enteral feedings can be initiated as PN is contraindicated d/t possible sespsis
    C - non protein kcal should be provided as CHO administered at a rate of 7/mg/kg/min
    D - pro req are decreased
    A - energy needs may be increased to up to twice the basal rate
    (this multiple choice question has been scrambled)
  50. compared to term infants, premature infants need:
    A - additional Ca2+ and phosphorus for bone mineralization
    B - less fluid since their evaporative losses are decreased
    C - additional long chain FA for proper fat metabolism
    D - less pro since thier kidneys cannot properly process urea
    A - additional Ca2+ and phosphorus for bone mineralization
    (this multiple choice question has been scrambled)
  51. in ARF (acute renal failure), pro loss is most likely r/t whichof the following?
    A - hyperkalemia
    B- hyponatremia
    C - hypercatbolism
    D - metabolic alkalosis
    C - hypercatbolism
  52. in an infant w/ galactosemia,t he most appropriate formula is
    A - milk based
    B- Soy based
    C - PN
    D - fat free PN
    B- Soy based
  53. the EFA is:
    A - linolenic
    B - linoelic
    C - arachadnoic
    D- EPA
    B - linoelic (~5% of daily req)
    (this multiple choice question has been scrambled)
  54. the following pt may respond to supplemntal thiamine
    A - Guillian Barre
    B- Hodgkin's dz
    C - Wernicke's encephalopathy
    D - Wilson's dz
    C - Wernicke's encephalopathy
  55. in peds recieving a formula with high MCT [ ], the following hsoudl be closely monitored:
    A - def of water soluble vitamins
    B - def of fat soluble vitamin
    C - fecal fat
    D -Ca2+ def
    B - def of fat soluble vitamin
    (this multiple choice question has been scrambled)
  56. supplemental zc may impair absorption if this nutrient:
    A - Ca2+
    B- Cu
    C - phosphorus
    D - K+
    B- Cu
  57. the max protein administration in a neonate
    A - 1.8-2.5 g/kg
    B - 4-5 g/kg
    C - 3-4 g/kg
    D - 1-1.5 g/kg
    C - 3-4 g/kg
    (this multiple choice question has been scrambled)
  58. achlorrydria in the geriatric n will predispose this group to deficiency:
    A - Vit B12
    B - Vit B6
    C - vit B1
    D - vit B2
    A - Vit B12 (IF + H+ required for absorption)
    (this multiple choice question has been scrambled)
  59. the max protein provision in a nomral (pregnant) pt is:
    A - 1 g/kg
    B - 2.5 g/kg
    C - 2 g/kg
    D - 1.5 g/kg
    D - 1.5 g/kg
    (this multiple choice question has been scrambled)
  60. the following vitamin may be restricted in an ESRD pt requiring PN?
    A - Vit C
    B - vit B1
    C - vit A
    D - folate
    C - vit A
    (this multiple choice question has been scrambled)
  61. the best definition of basel energy expenditure is the amt of energy required to:
    A - faciliatate anabolism
    B - maintain current weight
    C - maintain normal bodily fx at a constant resting state
    D - minimize catabolism
    C - maintain normal bodily fx at a constant resting state
    (this multiple choice question has been scrambled)
  62. the following best meets the energy requirements if an elderly, critically ill pt that is 66" and 140#:
    A - 1900 kcal
    B - 2200 kcal
    C - 1300 kcal
    D - 1600 kcal
    D - 1600 kcal 25g/kg always choose this when its an option for non-obese adults
    (this multiple choice question has been scrambled)
  63. which of the following does NOT occur during stress from injury or infections
    A - pt is more resistant to insulin
    B - ketogenesis is accelerated
    C - BMR, blood glc, and FFA are elevated
    D - 2200 kcal
    B - ketogenesis is accelerated
    (this multiple choice question has been scrambled)
  64. which of the following would have the least potential for causing malabsorption if a fistula developed in the area?
    A - pancreas
    B - colon
    C - jejunum
    D - duodenum
    B - colon
    (this multiple choice question has been scrambled)
  65. if a plasma AA profile is obtained on a pt with hepatic encephalopathy, which of the following is the most likely result?
    A- wnl
    B - the ratio of BCAA to aromatic AA would be 4.0
    C - phenylalanine and tyrpisne will be increased while valine, leucine, and isoleucine will be decreased
    D - phenylalanine and tyrpisne will be decreased while valine, leucine, and isoleucine will be increased
    C - phenylalanine and tyrpisne will be increased while valine, leucine, and isoleucine will be decreased
  66. which of the following is not charcteristic of glucagon?
    A - is excreted from the pancreas
    B- is controlled by plasma glc
    C - increases during stress and sepsis
    D - stimulates target organs to store glc
    C - increases during stress and sepsis
  67. in pts w/ acute or chronic renal failure, which of the following is the most significant factor contributing to increased energy expenditure?
    A - hemodialysis
    B - meds
    C - severe azotemia
    D - concurent sepsis
    D - concurent sepsis
    (this multiple choice question has been scrambled)
  68. which of the following is a major contributor to protein cataboluism during the hypermetabolic stress response?
    A - utilization of AA for gluconeogenesis
    B - inc in insulin production
    C - utilization of AA for glycogenolysis
    D - dec in glucagon production
    A - utilization of AA for gluconeogenesis
    (this multiple choice question has been scrambled)
  69. which of the following forms of dialysis is most likely to exacerbate hyperglycemia?
    A - slow continuous ultrafiltration
    B - continuous arteriovenous HD
    C - intermitant PD
    D - intermitant HD
    C - intermitant PD
    (this multiple choice question has been scrambled)
  70. which of the following is not included int he anion gap?
    A - Bicarb
    B - Cl
    C - Na
    D - Phos
    D - Phos
    (this multiple choice question has been scrambled)
  71. which of the following most accurately describes pro metabolism associated w/ cancer cachexia?
    A - inc whole body turnover, dec catabolism, and decreased synthesis
    B - dec whole body turnover, decreased catabolism, and decreased synthesis
    C - inc whole body turnover, inc catabolism, and increased synthesis
    D - inc whole body turnover, inc catabolism, and decreased synthesis
    C - inc whole body turnover, inc catabolism, and increased synthesis
    (this multiple choice question has been scrambled)
  72. Mag depletion can occur in short bowel syndrome b/c mag:
    A - is excreted in urine
    B - complexes with unabsorbed CHO and is then excreted
    C - needs and intact bowel for absorption
    D - complexes with unabsorbed fat and is then excreted
    D - complexes with unabsorbed fat and is then excreted
    (this multiple choice question has been scrambled)
  73. which of the following best describes CHO administration in newborns?
    A - premature neonate s(<28 wks) are at risk for hypoglycemia and may need the addition of insulin therapy
    B - maximum dextrose delivery shoudl be 5/mg/kg/min
    C - initial delivery of dectrose should begin at 2-3 mg/kg/min
    D - [glc] less than 100 mg/dL are considered hypoglycemic
    A - premature neonate s(<28 wks) are at risk for hypoglycemia and may need the addition of insulin therapy
    (this multiple choice question has been scrambled)
  74. severe head injury pts exhibit which of the following?
    A - prolonged increase in BEE
    B - increase in total body water
    C - increase in GI motility
    D - decline in nitrogen losses
    A - prolonged increase in BEE
    (this multiple choice question has been scrambled)
  75. Na and water absorption is the most efficient in which segments of the intestine?
    A - ileum and colon
    B - duodenum and jejunum
    C - jejunum and ileum
    D - jejunum and colon
    A - ileum and colon
    (this multiple choice question has been scrambled)
  76. Which of the following is most characteristic of the
    adaptation that occurs in prolonged malnutrition?

    A. Depletion of body nitrogen
    B. Adaptation of brain to use ketones as fuel
    C. Repletion of glycogen stores
    D. Decreased utilization of body fate
    B. Adaptation of brain to use ketones as fuel
    (this multiple choice question has been scrambled)
  77. In a critically ill pt, lipogenesis is associated w/ which
    of the following RQ values?
    A – 0.7
    B – 0.85
    C – 0.95
    D – greater than 1.0
    D – greater than 1.0
    (this multiple choice question has been scrambled)
  78. Compared to pts w/o a colon, the presence of a colon in
    short bowel syndrome will:
    A – lead to more diarrhea
    B – increase absorption of calories from CHO
    C – Make defecation more convenient
    D – speed intestinal transit
    B – increase absorption of calories from CHO
    (this multiple choice question has been scrambled)
  79. In CRF, ___ levels will mobilize Ca++ from bones
    A – low K+
    B – high K+
    C – high PTH
    D – low PTH
    C – high PTH
    (this multiple choice question has been scrambled)
  80. Vitamin D and PTH do not regulate Ca2+ metabolism at
    which of the following sites?
    A – kidney
    B – bone
    C – liver
    D – intestine
    C – liver
    (this multiple choice question has been scrambled)
  81. Which of the following is not an effect of injury on
    muscle?
    A – AA are released from the m. in increased quantities
    B – oxidation of BCAA by skeletal muscke is decreased
    C – alanine and gln comprise approx 50-60% of AA released
    D – oxidation of BCAA by skeletal muscle is accelerated
    B – oxidation of BCAA by skeletal muscke is decreased
    (this multiple choice question has been scrambled)
  82. Which of the following the mainstay of tx for pts with cirrhosis and ascites?
    A - fluid restriction w/ diuretics
    B - Na+ restriction w/ diuretics
    C - pro restriction w/ diuretics
    D - pro and Na+ restirction w/o diuretics
    B - Na+ restriction w/ diuretics
    (this multiple choice question has been scrambled)
  83. which of the following feedings has been shown to consistently increase VCO2 and RQ in pts w/ pulmonary dyfxn?
    A - excessive caloric intake
    B - low fat: CHO
    C - inadequete caloric intake
    D - High fat:CHO
    A - excessive caloric intake
    (this multiple choice question has been scrambled)
  84. in pts w/ systemic inflammatory response syndrome, the body's greatest storage source of potential energy is minimally accesible 2/2:
    A - hypoalbuminemia
    B - gluconeogenesis
    C - hyperinsulinemia
    D - hypothermia
    C - hyperinsulinemia
    (this multiple choice question has been scrambled)
  85. the TEF increases nutritional needs by:
    A - 12-15%
    B - 6 -10%
    C - >20%
    D - 2-5%
    B - 6 -10%
    (this multiple choice question has been scrambled)
  86. which of the following is an effect of increased severity of stress in pts receiving nut'l support
    A - dec catecholamine excretion
    B - + nigtrogen balance
    C - dec prtoein degrdation
    D - inc pro synthesis
    D - inc pro synthesis
    (this multiple choice question has been scrambled)
  87. in pts w/ severe trauma, as the metabolic rate increases, which of the following is most likely to occur?
    A - inc in O2 consumption
    B - dec in 02 consumption
    C - dec in Co2 consumption
    D - inc in C02 consumption
    A - inc in O2 consumption
    (this multiple choice question has been scrambled)
  88. for a post op pt w/ a proximal small intestine enterocutaneous fistula who is to be enterally fed, what is ocnisdered to be the ideal location for placement of the feeding tube in relation to the fistula site?
    A - rectal
    B - proximal
    C - gastric
    D - distal
    D - distal
    (this multiple choice question has been scrambled)
  89. which of the following is an important metabolite of the conversion of arginine to citruline?
    A - ornithine
    B - arginosuccinate
    C - nitric oxide
    D - urea
    D - urea
    (this multiple choice question has been scrambled)
  90. hypercapnia in a pt on nutrition support is possibly d/t:
    A - inadequete fat kcal
    B - inadequete pro kcal
    C - excessive total kcal
    D - excessive CHO kcal
    C - excessive total kcal
    (this multiple choice question has been scrambled)
  91. following small bowel resection, most adult pts will expereince permanent severe malabsorption when the remaining small bowel is less than:
    A - 300 cm; 40% of small bowel
    B - 200 cm; 40% of small bowel
    C - 400 cm; 50% of small bowel
    D - 100 cm; 25% of small bowel
    D - 100 cm; 25% of small bowel; ~3 ft
    (this multiple choice question has been scrambled)
  92. a deficiency of which can result in abnormal prothrombin time?
    A - B12
    B - C
    C - B6
    D - K
    D - K
    (this multiple choice question has been scrambled)
  93. Gln may be contraindicated in
    A - hepatic failure
    B - respiratory failure
    C - heart failure
    C - short gut syndrome
    A - hepatic failure
    (this multiple choice question has been scrambled)
  94. the typical time of onset of regular insulin is
    A - 2-3 hr
    B - 6-7 hr
    C - 4-5 hr
    D - 30 min -1 hr
    D - 30 min -1 hr -peaks at 2-3 hrs and is effective for up to 6 hr
    (this multiple choice question has been scrambled)
  95. the primary intracellular cation is:
    A - K+
    B - Na2+
    C - magnesium
    D - Ca2+
    A - K+
    (this multiple choice question has been scrambled)
  96. the primary extracellular cation is:
    A - magnesium
    B - Na2+
    C - Ca2+
    D - K+
    B - Na2+
    (this multiple choice question has been scrambled)
  97. following a 72 hr fast the following becomes the major source of energy for the skeletal muscles
    A - ketone bodies
    B - glycogen
    C - pro
    D - glc
    A - ketone bodies
    (this multiple choice question has been scrambled)
  98. soluble fiber is metabolized by the colonocytes to _____
    A - TAG
    B - glc
    C - short chain FA, specifically butyrate, are a significant source of energy for the colonocytes
    D - free AA
    C - short chain FA, specifically butyrate, are a significant source of energy for the colonocytes
    (this multiple choice question has been scrambled)
  99. ___ is the primary source of AA mobilized for gluconeogenesis.
    A - adipose tissue
    B - liver
    C - skeletal muscle
    D - brain
    C - skeletal muscle
    (this multiple choice question has been scrambled)
  100. refeeding syndrome is characterized bu an intracellular shift of
    A - acetate, phos, Ca2+
    B - K+, Mag, phos
    C - K+, ca2+, Cl-
    D - mag, Cl-, phos
    B - K+, Mag, phos
    (this multiple choice question has been scrambled)
  101. the total body water of a normal weight adult is approximately
    A - 40-45%
    B - 50-60%
    C - 65 -75%
    D - 75-80%
    • B - 50-60%
    • 50 female, 60 male, 60 if not asked
  102. the following condition would not be expected to increase one's fluid requirements
    A - fever
    B -ileostomy
    C - high output fistula
    D - ventilator requirement
    D - ventilator requirement
    (this multiple choice question has been scrambled)
  103. a pt w/ NG suction output exceeding 2L/d is likely to manifest the following way
    A - respiratory alkalosis
    B - respiratory acidosis
    C - metabolic alkalosis
    D - metabolic acidosis
    C - metabolic alkalosis
    (this multiple choice question has been scrambled)
  104. the following is a measure of oxygenation
    A - CO2
    B - PaO2
    C - VO2
    D - FiO2
    B - PaO2
    (this multiple choice question has been scrambled)
  105. an ilesotomy pt receiving TPN is likely to need supplementation of the following:
    A - Na + and acetate
    B - K+ and acetate
    C - Na+ and sulfate
    D - K+ and Cl-
    A - Na + and acetate
    (this multiple choice question has been scrambled)
  106. a pt on POD1 hass a bp of 90/50 on high dose casopressors and 100% fi02 has a TF order of standard formula to begin at 15 mL/hr via NG tube. the HOB cannot be elevated d/t hypotension. the most appropriate course of action is:
    A - require that HOB is elevated
    B - start PN
    C - continue w/ enteral feeds as ordered
    D - hold TF until hemodynamically stable
    D - hold TF until hemodynamically stable
    (this multiple choice question has been scrambled)
  107. a pt w/ chronic or ESRD is most liekly to manifest w the following acid/base d/o:
    A - respiratory alkalosis
    B - metabolic alkalosis
    C - respiratory acidosis
    D - metabolic acidosis
    D - metabolic acidosis
    (this multiple choice question has been scrambled)
  108. insulin, particularly high levels, would
    A - promote lipolysis
    B - supress lipolysis
    C - suppress lipogenesis
    D - none of the above
    B - supress lipolysis
    (this multiple choice question has been scrambled)
  109. the following best characterizes the metabolic repsonse to stress
    A - dec emergy expenditure, decreased nitrogen losses
    B - inc emergy expenditure, increased nitrogen losses
    C - inc emergy expenditure, decreased nitrogen losses
    D - dec emergy expenditure, increased nitrogen losses
    B - inc emergy expenditure, increased nitrogen losses
    (this multiple choice question has been scrambled)
  110. long chain TAG are absorbed into the ___, MCT are absorbed into the____
    A - portal system; lymphatics
    B - lymphatics; portal system
    C - villi; micelles
    D - micelles; villi
    • B - lymphatics; portal system
    • LCT forms micelles w/ bile salts to lymphatics
  111. in a pt w/ pronounced fat malabsorption, which of the following is false?
    A - supplemental enzymes helpful
    B - MCT should be given to prevent EFA deficiency
    C - fat solubel vitamins shoudl be administered
    D - occ administration of IV lipid may be considered
    B - MCT should be given to prevent EFA deficiency
    (this multiple choice question has been scrambled)
  112. for a pt w/ renal failure requiring intermittant peritoneal dialysis, which of the following must be considered when selecting an enteral feeding formulation?
    A - TAG lost in the ultrafiltrate
    B - glc lost in the ultrafiltrate
    C - glc absorbed in the dialysate
    D - AA asborbed from the dialysate
    D - AA asborbed from the dialysate
    (this multiple choice question has been scrambled)
  113. loss of 50 cm of terminal ileaum often results in diarrhea d/t
    A - B12 def
    B - a lack of adequete absorption from this portion of the bowel
    C - effect of bile H+ on the colon
    D - effect of excess pro load on colon
    C - effect of bile H+ on the colon
    (this multiple choice question has been scrambled)
  114. which of the following is associated w/ an increased incidence of metabolic bone dz in premature neonates?
    A - prolonged use of PN
    B - hyperphosphatamia
    C - carnitine deficiency
    D - bronchopulmonary dysplasia
    A - prolonged use of PN
    (this multiple choice question has been scrambled)
  115. w/ fat malabsorption, as in short gut, the following may need to be restricted:
    A - Na+
    B - oxalate
    C - phos
    D - MCT
    B - oxalate (at high risk for kidney stones as this is absorbed more in SBS)
    (this multiple choice question has been scrambled)
  116. in a premature infant, evidence of metabolic bone dz is strongly suggested by which of the following?
    A - elevation in alk phos levels
    B - elevation in tocopherol levels
    C - elevation in serum Ca+ levels
    D - decline in serum Ca+ levels
    A - elevation in alk phos levels
    (this multiple choice question has been scrambled)
  117. the following is not a component of ketone bodies:
    A - oxalacetic H+
    B- acetone
    C - B-hysdroxybutric H+
    D - acetoacetic H+
    A - oxalacetic H+
  118. the following should be the primary foal in an acute trauma pt ay 89% IBW w/ an albumin of 2.4:
    A - replenish albumin
    B - prevent further wt loss
    C - minimize nitrogen losses
    D - promote wt gain
    C - minimize nitrogen losses
    (this multiple choice question has been scrambled)
  119. the most important foal in initial post-op management of a pt who has undergone extensive small bowel resection is to:
    A - individualize the oral diet to minimize diarhea
    B - replace fluid and 'lytes
    C - avoid PN to reduce risk of infection
    D - achieve a high enteral intake to stimulate intestinal adapatation
    B - replace fluid and 'lytes
    (this multiple choice question has been scrambled)
  120. diabetes may compromise wound healing by:
    A - reducing O2 deliver b/c of altered microvasculature
    B - slowing the rate of epithelization and vascularization
    C - indirect vasoconstriction, resulting in hypoxia
    D - causing tissue injury to surronding periperhal vasculature
    A - reducing O2 deliver b/c of altered microvasculature
    (this multiple choice question has been scrambled)
  121. which of the following is reccomended in the mgmt of decubitus ulcers:
    A - routine use of abx
    B - covering the wound securely w/ dsd
    C - supplemental vit C
    D - promotoion of tissue oxygenation by elimination of pressure
    D - promotoion of tissue oxygenation by elimination of pressure
    (this multiple choice question has been scrambled)
  122. hypomagnesiumemia and/or hyperkalemia following a transplant are likely d/t:
    A - dec RBC production
    B - cyclosporine
    C - renal insufficiency
    D - insulin use
    B - cyclosporine
    (this multiple choice question has been scrambled)
  123. PN solutions for bone marrow transplant pts often have to be concentrated b/c of:
    A - mucositis
    B - diarrhea
    C - hyperglycemia
    D - fluid overload
    D - fluid overload
    (this multiple choice question has been scrambled)
  124. in a neonatal pt, the following may not be a reasonable goal for nutrition support:
    A - minimize nitrogen losses
    B - maintain normal 'lytes
    C - provide 100% of estimated nutritional needs
    D - maintain fluid losses
    C - provide 100% of estimated nutritional needs
    (this multiple choice question has been scrambled)
  125. the following pt may be a candidate for PN:
    A - facial fractures
    B - pre-op
    C - hepatic encephalopathy
    D - hyperemesis gravidarum
    D - hyperemesis gravidarum
    (this multiple choice question has been scrambled)
  126. to dec post-op complication by ~10%, severely malnourished pts who require surgery should recieve pre-op PN for a minimum of how many days prior to surgery:
    A - 12-14
    B - 7-10
    C - 18-21
    D - 3-5
    B - 7-10
    (this multiple choice question has been scrambled)
  127. in trauma pts, early enteral compared to PN is:
    A - associated w/ improved nitrogen balance
    B - useful in decreasing septic complications
    C - associated w/ increased caloric intake
    D - beneficial only in less severely injured pts
    B - useful in decreasing septic complications
    (this multiple choice question has been scrambled)
  128. which of the following are risk factors associated with aspiration pna?
    A - decreased conciousnessm decreased gag reflec, mechanical ventilation
    B - inadaquete hydration, DM, decreased cough reflec
    C - fecal impaction, gastroenteritis, gastric atony
    D - slow feeding rate, gastric distention, C. Diff
    A - decreased conciousnessm decreased gag reflec, mechanical ventilation
    (this multiple choice question has been scrambled)
  129. a pt w/ acute pancreatities may benefit from:
    A - PPN
    B - enteral feeding distal to pyloric spinctor
    C - enteral feeding distal to ligament of treitz
    D - Central peripheral nutrition not containing lipids
    C - enteral feeding distal to ligament of treitz
    (this multiple choice question has been scrambled)
  130. most enteral feeding tubes are made of:
    A -polyurethane
    B - silicone
    C - Tungsten
    D - rubber
    A -polyurethane
    (this multiple choice question has been scrambled)
  131. which of the following is a method of transpyloric feeding tube placement?
    A - intubation w/ guidewire in place only
    B - endoscopy only
    C - fluoroscopy only
    D - endoscopy , fluoroscopy, or intubation w/ guidewire in place
    D - endoscopy , fluoroscopy, or intubation w/ guidewire in place
    (this multiple choice question has been scrambled)
  132. which of the following is an advantage of small bowel TF over gastric TF?
    A - permits use of intermittant drip feeding or bolus feedings
    B - easier to obtain enteral access
    C - more appropriate for pts w/ delayed gastric emptying
    D - more flecible feeding schedules
    C - more appropriate for pts w/ delayed gastric emptying
    (this multiple choice question has been scrambled)
  133. which of the following is not a complication of percuatenous gastrostomy:
    A - sinusitis
    B - bleeding
    C - colocutaneous or cologastric fistula
    D - periotonitis
    A - sinusitis
    (this multiple choice question has been scrambled)
  134. the preffered oral rehydration solution should be:
    A - hypertonic without Na+
    B - isotonic without Na+
    C - hypotonic without Na+
    D - isotonic w/ Na+ and CHO replacement
    D - isotonic w/ Na+ and CHO replacement
    (this multiple choice question has been scrambled)
  135. which of the following PN additives may cause thrombocytopenia
    A - insulin
    b- heparin
    c - folic H+
    d - L-cysteine
    b- heparin
  136. when maintained slightly above normal serum [], whcih of the following 'lytes reduces the amount of K+ required in critically ill pts?
    A - Mag
    B - Na+
    C - Cl-
    D - Ca++
    A - Mag
    (this multiple choice question has been scrambled)
  137. supplementation of which of the following AA could cause hyperammonemia
    A - Arginine
    B - Glutamine
    C - Glyncine
    D - Alanine
    B - Glutamine
    (this multiple choice question has been scrambled)
  138. which of the following vitamins is most likely to suffer extensive photodegredation if the PN bag is left exposed to light?
    A - vitamin D
    B - vitamin A
    C - niacin
    D - biotin
    B - vitamin A
    (this multiple choice question has been scrambled)
  139. replacement of a portion of long chain FA w/ omega 3 (marine oil derived) fatty acids will result in :
    A- reducing all systemic cytokine levels
    B- reducing the systemic level of IL6
    C - leukocytes generating significantly high amts of the proinflammatory leukotriene B4
    D - leukocytes generating significantly high amts of the less biologically active leukotirene B5
    D - leukocytes generating significantly high amts of the less biologically active leukotirene B5
  140. a pt undergoing chemo/rad for cancer in the region of the mediastinum is receiving TPN and complains of wt loss as well as pain and swelling in her neck and right arm. The likely cause of this is
    A - catheter related complication
    B - low albumin and fluid shifts
    C - pneumothorax at time of catheter infection
    D - malnutrition
    A - catheter related complication
    (this multiple choice question has been scrambled)
  141. Which of the following is best suited for growth of
    specific bacteria and yeasts?
    A - Insulin
    B - lipid emulsion only
    C - Dextrose and AA only
    D - dextrose, AA and lipid emulsion
    B - lipid emulsion only
    (this multiple choice question has been scrambled)
  142. Which of the following is the recommended maximal hang
    time in hours for lipid emulsions when they are infused alone?
    A - 18
    B - 12
    C - 36
    D - 24
    B - 12
    (this multiple choice question has been scrambled)
  143. When added to PN regimens, which of the following
    therapies have demonstrated therapeutic effects in pts w/ bone marrow
    transplants?
    A - Growth hormone
    B - structured TAG
    C - ascorbic H+ supplementation
    D - Gln supplementation
    D - Gln supplementation
    (this multiple choice question has been scrambled)
  144. In hypoalbuminemic pts, the use of albumin w/ PN solutions
    has consistently demonstrated which of the following?
    A - improved serum albumin []
    B - reduced mortality
    C - improved nitrogen balance
    D - reduced infectious complications
    A - improved serum albumin []
    (this multiple choice question has been scrambled)
  145. The most appropriate parental AA solution for the
    undialyzed pt w/ ARF contains:
    A - 24% of aa BCAA
    B - essential AA only
    C - a balance of essential and non-essential AA
    D - a low amt of aromatic AA
    C - a balance of essential and non-essential AA
    (this multiple choice question has been scrambled)
  146. Which of the following d/n characterize immune enhancing formulas?
    A - they contain more nitrogen than standard enteral formulas
    B - They have been shown to decrease infection rates in certain pt populations
    C - they are high in linoleic H+
    D - they typical contain more nitrogen then essential AA such as gln and arginine
    C - they are high in linoleic H+
    (this multiple choice question has been scrambled)
  147. Which of the following best characterizes use of 3-1
    total nutrient admixtures?
    A - increased risk of precipitations of calcium salts
    B - increased risk of Catheter thrombosis
    C - increased risk of catheter related infections
    D - decreased AA stability
    A - increased risk of precipitations of calcium salts
    (this multiple choice question has been scrambled)
  148. Which of the following is least characteristic of the fat
    source in enteral nutrition?
    A - fish oils oxidize quickly and cannot be used in oral solutions because of poor taste
    B - MCT are used in elemental formulas b/c of their easy digestibility and absorption
    C - N-3 FA such as those found in canola or fish oils are added to immune enhancing formulas to decrease the inflammatory response
    D - MCT from coconut oil are added to prevent EFA deficiency
    • D - MCT from coconut oil are added to prevent EFA
    • deficiency
  149. Which of the following is least characteristic of the fat
    source in enteral nutrition?
    A - fish oils oxidize quickly and cannot be used in oral solutions because of poor taste
    B - MCT from coconut oil are added to prevent EFA deficiency
    C - MCT are used in elemental formulas b/c of their easy digestibility and absorption
    D - N-3 FA such as those found in canola or fish oils are added to immune enhancing formulas to decrease the inflammatory response
    B - MCT from coconut oil are added to prevent EFA deficiency
    (this multiple choice question has been scrambled)
  150. The most appropriate formula for a pt w/ CHF or liver dz is likely to be:
    A - concentrated low Na+ formula
    B - standard isotonic formula
    C - low Cho/high fat formula
    D - Concentrated low CHO formula
    A - concentrated low Na+ formula
    (this multiple choice question has been scrambled)
  151. What is the suggested adult parental thiamine daily dose mg - ? A - 1.5
    B - 3.0
    C - 5.0
    D - 8.0
    B - 3.0
  152. Which of the following is not characteristic of elemental formulas?
    A - are rarely taken orally d/t unpleasant taste
    B - less $$ than polymeric formulas
    C - are made of free AA
    D - are indicated in pts w/ short bowel syndrome
    B - less $$ than polymeric formulas
  153. Which of the following enteral formulations would most likely reduce fecal energy loss in pt w/ short bowel syndrome and an intact colon?
    A - high protein, low sodium
    B - high fat, low sodium
    C - High CHO, low fat
    D - high fat, low CHO
    C - High CHO, low fat
    (this multiple choice question has been scrambled)
  154. A standard 1 kcal/mL formula w/ 55 g pro/L delivered at 75 mL/hr will provide
    A - 1320 kcal, 99 g pro
    B - 1800 kcal, 73 g pro
    C - 1320 kcal, 73 g pro
    D - 1800 kcal, 99 g pro
    D - 1800 kcal, 99 g pro
    (this multiple choice question has been scrambled)
  155. the most appropriate enteral formula for an infant w/ a chest tube is
    A - formula with high [ ] of LCT and low MCT
    B - use only parenteral
    C - Fat free formula
    D - formula with high [ ] of MCT and low LCT
    D - formula with high [ ] of MCT and low LCT
    (this multiple choice question has been scrambled)
  156. what is one advantage to using structured lipids?
    A - enhanced glc metabolism
    B - lower serum [TAG]
    C - prevention of carnitine deficiency
    D - prevention of EFA deficiency
    B - lower serum [TAG]
  157. diluting enteral formulas to reduce osmolality has been shown to result in
    A - improved GI tolerance
    B - improved GI tolerance in pts w/ hx of GI surgery
    C - a decrease in total energy and protein delivered
    D - reduced GI tolerance
    C - a decrease in total energy and protein delivered
  158. which of the following would approximate 100 kcal/kg in a 3.5 kg infant?
    A - 523 mL of a 20 kcal/oz formula
    B - 553 mL of a 20 kcal/oz formula
    C - 523 mL of a 24 kcal/oz formula
    D - 553 mL of a 24 kcal/oz formula
    A - 523 mL of a 20 kcal/oz formula
  159. in order to provide 1 mL H20 per kcal w/ a standard 1 kcal/mL formula at 80 mL/hr, approximately how much free water would be needed?
    A - 200 mL
    B - 300 mL
    C - 400 mL
    D - 500 mL
    B - 300 mL
  160. for pts w/ CF the following is most appropriate –
    A - elemental formula alone
    B - elemental formula w/ pancreatic enzyme supplementation
    C - parental nutrition
    D - standard, isotonic formula w/ pancreatic enzyme supplementation
    D - standard, isotonic formula w/ pancreatic enzyme supplementation
  161. the following is most likely to be supplemented in a dialysis pt:
    A - selenium
    B - Water soluble vitamins
    C - selenium
    D - vitamin A
    B - Water soluble vitamins
  162. A PN formula contains dextrose 16.5%, AA 4.25% at 80 mL/hr w/225 mL of 20% lipids. The calories and protein provided are:
    A - 1623 kcal w/ 65 g pro
    B - 1733 kcal w/ 77 g pro
    C - 1853 kcal w/ 82 grams pro
    D - 1913 kcal w/ 87 gm pro
    C - 1853 kcal w/ 82 grams pro
  163. Which of the following is a clinical benefit observed by adding gln-depeptide to a PN solution?
    A - unaltered intestinal permeability
    B - reduced glycemic complications
    C - increaser serum [prealbumin]
    D - reduced duration of PN
    A - unaltered intestinal permeability
  164. A PN formula contains dextrose 16.5%, AA 4.25% at 80 mL/hr w/225 mL of 20% lipids. Calculate the approximate osmolarity:
    A - 1150 mOSM
    B - 1250 mOSM
    C - 1375 mOSM
    D - 1450 mOSM
    B - 1250 mOSM There are 2 ways to do this calculation: 1 - 50 mOSMS per % dextrose/100 mOSM per % AA or 2 - the # of gm x 5 divided by the liters of dextrose and the # of AA x 10 divided by the liters of AA; remember lipids are isotonic. ‘lytes are negligible
  165. A PN formula contains dextrose 16.5%, AA 4.25% at 80 mL/hr w/225 mL of 20% lipids. If the solution is provided to a 55 kg man, the glc utilization rate would be in mg/kg/min -
    A - 3.5
    B - 4.0
    C - 4.5
    D - 5.0
    B - 4.0
  166. Which of the following best characterizes the source of CHO in enteral formulas?
    A - formulas intended for oral use may add sorbital
    B - most starches are derived from hydrolysis of cornstarch
    C - maltodextrin contributes more to mOsm than corn syrup
    D - Cho provide a smaller proportion of total kcal than fat in most formulas
    B - most starches are derived from hydrolysis of cornstarch
  167. The maximum glc utilization rate in adults in mg/kg/min is
    A - 4.0
    B - 4.5
    C - 5.0
    D - 5.5
    C - 5.0
  168. Which of the following is an adverse effect of excessive IV lipid emulsions?
    A - mitral stenosis
    B - thrombocytopenia
    C - abnormal brain development
    D - scaly eczematous dermatitis
    B - thrombocytopenia
  169. Because of the way that phosphorus dissociates, for every 12 mmol of phosphorus released form K+ phosphate ___ mEq of K+ are released
    A - 13.2
    B - 14.6
    C - 17.6
    D - 18.2
    C - 17.6 For every 3 mmol of phos = 4.4 mEq of K for K phos, 4 mEq Na for Na phos
  170. A pt is receiving NS at 75 mL/hr w/ 20 mEq KCl/L. this provides:
    A - 277 mEQ Na; 36 mEq KCL
    B - 139 mEQ Na; 36 mEq KCL
    C - 283 mEQ Na; 36 mEq KCL
    D - 283 mEQ Na; 40 mEq KCL
    A - 277 mEQ Na; 36 mEq KCL
  171. How man mL/L of fat emulsion are needed to provide a final [] of %% when using 20% intralipid as stock solutions?
    A - 200
    B - 500
    C - 325
    D - 250
    D - 250
  172. The normal daily Ca2+ requirements in mEq for a pt on PN w/ normal renal fx is
    A - 15
    B - 35
    C - 45
    D - 60
    A - 15
  173. In general, the following is true concerning IV lipids and pancreatitis:
    A - IV lipids should not be given as it may stimulate pancreatic stimulations
    B - IV lipids may be given up to 2x a week
    C - IV lipids are not routinely contraindicated provided TAG are wnl
    D - enteral lipids would stimulate the pancreas less than PN
    C - IV lipids are not routinely contraindicated provided TAG are wnl
  174. The following provides inherent vit K:
    A - IV gln
    B - IV lipids
    C - IV AA
    D - IV meds
    B - IV lipids
  175. The following best describes the available enteral modulars:
    A - intact pro, dextrose, and MUFA
    B - crystalline AA, glc polymers and MCT
    C - intact pro, glc polymers, PUFA and MCT
    D - hydrolyzed pro, dextrose and MCT
    C - intact pro, glc polymers, PUFA and MCT
  176. A critically ill pt receiving PN with an insulin gtt at 4u/ht blood glc ranging 125-150 mg/dL - has been started on enteral feeding following resumption of GI fx. Glucose is trending upwards, what is the most appropriate response?
    A - titrate insulin gtt prn to promote normal glc [] and decrease PN as EN is tolerated
    B - d/c EF
    C - begin sliding scale insulin
    D - begin long acting insulin
    A - titrate insulin gtt prn to promote normal glc [] and decrease PN as EN is tolerated
  177. The following should preclude initiation of EN;
    A - abdominal distention w/ ileus indicated on x-ray
    B - NG suction of >50 ml/day
    C - lack of bowel sounds
    D - sinus infection
    A - abdominal distention w/ ileus indicated on x-ray
  178. Nutrition support is indicated in which of the following pts?
    A - pt w. cervical carcinoma
    B - pt w/ permanent oropharyngeal dysfxn
    C - pt w/ superficial burns to lower extremities
    D - well nourished pt unable to eat 3-4 day
    B - pt w/ permanent oropharyngeal dysfxn
  179. In a pt w/ severe head injury, the following is likely to be best tolerated:
    A - NG feeding
    B - OG feeding
    C - NG feeding w/ prokinectic agents
    D - NJ feeding
    D - NJ feeding
  180. In a home PN pt displaying signs of liver impairments, the most appropriate course of action would be to:
    A - decrease CHO and fat kcal
    B - decrease pro and fat kcal
    C - increase fat kcal
    D - d/c fat kcal
    A - decrease CHO and fat kcal
  181. To be considered for PN reimbursement under medicate guidelines, the solution must contain:
    A - dextrose and lipids
    B - AA and lipids
    C - AA and dextrose
    D - ‘lytes
    C - AA and dextrose
  182. What is the major cause of morbidity in home PN pts?
    A - septicemia
    B - hyperkalemia
    C - hyperglycemia
    D - EFA deficiency?
    A - septicemia
  183. The most common hepatic complication of PN is
    A - choleostasis
    B - steatatosis
    C - fulminant liver failure
    D - hepatic encephalopathy
    B - steatatosis
  184. Under which of the following conditions will medicate reimburse enteral TF formulas and associated supplies for home use?
    A - pts wt > 10% IBW for 6 months
    B - oral intake >60% energy needs
    C - malnutrition has been documented during the preceding hospital stay
    D - anatomic or motility d/o will interfere w/ oral intake for >90 d
    D - anatomic or motility d/o will interfere w/ oral intake for >90 d
    (this multiple choice question has been scrambled)
  185. A common complication of a home PN is:
    A - catheter occlusion
    B - venous thrombosis
    C - pulmonary embolism
    D - catheter related infection
    D - catheter related infection
  186. In addition to QOL, cycling PN may provide the following in home PN pts
    A - decrease the risk of heart dz
    B - decreased risk of infection
    C - decrease risk of hepatic complications
    D - decrease risk of catheter occlusions
    C - decrease risk of hepatic complications
  187. w/ prolonged hyperbilirubinemia, a prudent step is to avoid routine:
    A - Cu, Mn
    B - Vit A, Cu,
    C - Chromium, vit D,
    D - Zc, chromium
    A - Cu, Mn
  188. home EN reimbursement is based on the following
    A - REE measurement
    B - degree of malnutrition
    C - formula composition and number of kcal
    D - number of kcal and gm of pro
    C - formula composition and number of kcal
    (this multiple choice question has been scrambled)
  189. the largest single payor of home EN and PN is
    A - medicare
    B - tricare
    C - Medicaid
    D - blue cross
    A - medicare
  190. in pts w/ small bowel resection, home PN will be covered if required for longer than ___ and if < ___ feet remaining post ligament of treitz
    A - 60; 6
    B - 90;2
    C - 90; 8
    D - 120; 6
    B - 90;2
  191. in a stable home EN pt, it would be most appropriate to routinely monitor
    A - ‘lytes, prealb
    B - UUN, wt
    C - LFT’s, prealb
    D - wt, I’s and o’s, bowel fx
    D - wt, I’s and o’s, bowel fx
  192. in a home PN pt 3-1 solution - the following should be added immediately before infusion
    A - fat
    B - Fe
    C - mvi
    D - pro
    C - mvi
  193. for an enterally fed home pt, a pump will be covered if
    A - intolerance to gravity feeds is demonstrated
    B - jejunal delivery of nutrients id required
    C - PEG delivery of nutrients is required
    D - it is requested by ordering physician
    A - intolerance to gravity feeds is demonstrated
  194. in a home PN pt displaying signs of metabolic bone dz, the following adjustment would be most appropriate:
    A - inc pro
    B - dec Phos
    C - dec pro
    D - provide PN over 24 hrs
    C - dec pro
    (this multiple choice question has been scrambled)
  195. a pt is receiving PN that provides NaCL 50mEq/L, KCl 20 mEq/L, Kphos 30 mEq/L. lab values are Na 140; K 4.0 Cl- 119; CO2 11 an appropriate adjustment would be to
    A - inc KCL to 40 mEq/L
    B - reduce the NaCL to 25 mEq/L
    C - change the NaCL to NA acetate
    D - change the KCl to NaCL
    C - change the NaCL to NA acetate
    (this multiple choice question has been scrambled)
  196. elevated LFT observed w/ initiation of PN occurs after a minimum of __
    A - 5d
    B - 1-4 wk
    C - 5-7 wks
    D - 3 mo
    B - 1-4 wk
  197. which of the following is not a nursing responsibility for monitoring jejuna tube feeding?
    A - examination of the abdomen
    B - measurement of residuals
    C - accurate intake and output records
    D - records of frequency, consistency and volume of stools
    B - measurement of residuals
  198. to minimize infections EF pts open system - should have bags and tubes changed q hours?
    A - 8
    B - 12
    C - 24
    D - 48
    C - 24
  199. an enterally fed pt suffering from constipation may benefit from
    A - increasing formula
    B - additional h20
    C - changing to bolus feeding
    D - routine enemas
    B - additional h20
  200. which of the following nutrition assessment measurements may be helpful in weaning a nutrition support pt from the ventilator?
    A - daily wts
    B - triceps skinfold
    C - BIA
    D - IC
    D - IC
  201. a pt receiving a standard EF consistently has a mag level of 3.0 mEq/dL a prudent first step would be to
    A - provide mag replacement as needed
    B - switch to a low ‘lyte EF
    C - order routine Mag administration
    D - ensure that meds w/ supplement Mg have been held
    D - ensure that meds w/ supplement Mg have been held
    (this multiple choice question has been scrambled)
  202. EN supplementation in cancer pts w/ normal nutrition status has resulted in
    A - improved tolerance to cancer tx
    B - significantly improved endurance
    C - no benefit
    D - increased survival
    C - no benefit
  203. Blue food coloring should be used when
    A - pts are at risk for aspiration
    B - pts have hx of aspiration pna
    C - raising the HOB is contraindicated
    D - should not routinely be used in critically ill pts
    D - should not routinely be used in critically ill pts
  204. The following pt is most likely to have an accurate nitrogen balance assessment:
    A - fistula
    B - thermal injury
    C - respiratory failure
    D - renal failure
    C - respiratory failure
  205. Which of the following groups of pts I known to have the highest incidence of cholestasis during PN?
    A - trauma
    B - elderly
    C - IBD
    D - neonatal
    D - neonatal
  206. Using the nitrogen balance equation, what is the expected nitrogen balance is a pt w/ high insensible losses receiving 100 gm AA w/ 19 g urine nitrogen/24 hours?
    A - +1 gm
    B - +3 gm
    C - -3 gm
    D - -7 gm
    D - -7 gm
  207. The following parental catheter site has the highest infection risk:
    A - subclavian
    B - femoral
    C - basilic picc -
    D - internal jugular
    B - femoral
  208. Which of the following factors is not implicated in the development of thrombophelbitis w/ PN
    A - properties and size of the vein
    B - CA+ and K+ content
    C - [lipid emulsion]
    D - osmolarity of solution
    C - [lipid emulsion]
  209. GI mucosal edema, 2/2 hypoalbuminemia may result in
    A - excess fluid retention
    B - severe diarrhea
    C - microbial infection
    D - mucosal sloughing
    B - severe diarrhea
  210. Bolus, intermittent or continuous feeding may be employed with:
    A - gastrostomy tube
    B - nasoduodenal tube
    C - NJ tube
    D - jejunostomy
    A - gastrostomy tube
  211. Which of the following is most likely to slow gastric emptying:
    A - low fat enteral feeding
    B - IV zc
    C - elevated plasma insulin
    D - hyperglycemia
    D - hyperglycemia
  212. Which of the following is an advantage of peripherally inserted over centrally inserted central venous catheters:
    A - have fewer mechanical complications
    B - are used for extended period
    C - cab use lower extremity veins
    D - are higher in cost but do not require MD to insert
    A - have fewer mechanical complications
  213. Which of the following precautions is required to percent central venous catheterization related infections during insertion?
    A - aseptic techniques only
    B - use of OR suite
    C - sterile gloves and small fenestrated drape
    D - sterile gloves, gown, large drape and mask
    D - sterile gloves, gown, large drape and mask
  214. Which of the following is the most significant risk factor for catheter related infections?
    A - catheter composition
    B - catheter location
    C - pt dx
    D - catheter care technique
    D - catheter care technique
  215. The following d/n help determine renal solute load:
    A - pro
    B - Na+
    C - K+
    D - Ca2+
    D - Ca2+
  216. Which of the following is most likely to contribute to PN associated alterations in renal tubular fx?
    A - hyperoxularia
    B - Selenium toxicity
    C - Gln deficiency
    D - Bacteremia/fungemia episodes
    D - Bacteremia/fungemia episodes
  217. Which of the following is a common contributor of occlusion to small bore feeding tubes?
    A - use of high fat formulas
    B - aspiration for measurement of gastric residuals
    C - tube type and composition
    D - location of tube tip
    B - aspiration for measurement of gastric residuals
    (this multiple choice question has been scrambled)
  218. it is difficult to compare studies on aspiration pna b/c:
    A - gastric residuals are not consistent in volume
    B - the is inconsistency in defining aspiration
    C - not all hospitals have nutrition services to compare the feedings
    D - some studies compare gastrosotomy to jejunostomy feedings
    B - the is inconsistency in defining aspiration
  219. contamination of enteral feeding is likely to be d/t:
    A - contamination occurring during manufacturing process
    B - organisms on hands of healthcare worker
    C - inherent flora on enteral access device
    D - respiratory infection of pt
    B - organisms on hands of healthcare worker
  220. in a preterm infant, ___ is conditionally essential and may also help w/ Ca2+ and phos solubility:
    A - carnitine
    B - cysteine
    C - taurine
    D - tryptophan
    B - cysteine
  221. a pt undergoing chemo/rad for cancer in the region of the mediastinum is receiving TPN and complains of wt loss as well as pain and swelling in her neck and right arm. The likely cause of this is
    A - low albumin and fluid shifts
    B - malnutrition
    C - pneumothorax at time of catheter infection
    D - catheter related complication
    D - catheter related complication
  222. The following should be performed to assess feeding tube placement prior to initiation of enteral feeding:
    A - radiographic confirmation
    B - auscultation
    C - pH assesment
    D - blue dye test
    A - radiographic confirmation
  223. The following is not a complication of ventral venous access?
    A - air embolus
    B - vein thrombosis
    C - occlusion
    D - HTN
    D - HTN
  224. A pt has a NG tube placed and is immediately started on a standard formula at 10 mL/hr. the pt develops coughing, an inability to speak and decrease 02 sat. what should be done?
    A - r/o lung placement of NG tube
    B - d/c EN
    C - continue to increase enteral feed per protocol while monitoring
    D - start PN
    A - r/o lung placement of NG
  225. A - Rapid administration of feeding
    B - lack of soluble fiber
    C - medications
    D - gravity feeding
    C - medications
  226. A generally accepted guideline to decrease the risk of aspiration in enterally fed pts is to:
    A - routinely add prokinetic medication
    B - avoid gastric feeding in all pts, and only use post-pyloric
    C - check residuals q4hr and hold if >40 min
    D - maintain HOB >30 degrees at all times
    D - maintain HOB >30 degrees at all times
  227. The most common cause of hyponatremia is
    A - insufficient Na provision
    B - insufficient H2O provision
    C - excessive Na provision
    D - excessive H2O provision
    D - excessive H2O provision
  228. The following medications can provide a significant amt of kcal:
    A - propofol
    B - propanolol
    C - ativan
    D - steroids
    A - propofol
  229. Sulfasalazine will increase requirements for
    A - thiamine
    B - carnitine
    C - B12
    D - folic acid
    D - folic acid
  230. Loop diuretics cause urinary losses of
    A - Cu
    B - Ca2+
    C - bicarb
    D - vit C
    B - Ca2+
  231. In the kidney, spironolactone can modulate the excretion of which ions?
    A - Na, Cl
    B - Na, K+
    C - Phos, Ca2+,
    D - K+, Mag
    B - Na, K+
  232. Fe should not be provided via jejuna access b/c
    A - it may cause dumping
    B - an acidic environment is needed for absorption
    C - it requires IF
    D - Fe absorption begins in stomach
    B - an acidic environment is needed for absorption
  233. Which of the following medications may cause carnitine deficiency?
    A - caffeine
    B - phenytoin
    C - Pheonbarbital
    D - Valproic Acid
    D - Valproic Acid
  234. Azathioprine will predispose one to a deficiency in
    A - folic H+
    B - thiamine
    C - vit B6
    D - Ca2+
    A - folic H+
  235. This drug, used in the tx of tuberculosis, forms a complex with pyridoxine:
    A - neomycin
    B - phenylpropanolamine
    C - isoniazid
    D - colchicine
    C - isoniazid
  236. This drug, used in the tx of tuberculosis, forms a complex with pyridoxine:
    A - neomycin
    B - phenylpropanolamine
    C - isoniazid
    D - colchicine
    C - isoniazid
  237. The additional of aluminum hydroxide based medication may lower
    A - K+
    B - phos
    C - Mag
    D - Ca2+
    B - phos
  238. The following medication will decrease folate []:
    A - metoclopramide
    B - methotrexate
    C - calproic acid
    D - cisapride
    B - methotrexate
  239. A low albumin may be a concern when providing:
    A - phenytoin
    B - lorazapam
    C - oxycodone
    D - roxicodone
    A - phenytoin
  240. Dehydration and malnutrition resulting from withholding or withdrawing artificial nutrition and hydration in the terminal pt is most likely to :
    A - be grounds for malpractice
    B - facilitate comfort in the dying process
    C - cause a painful and agonizing death
    D - result in s/s including thirst, hunger, cramping, nausea, seizures
    B - facilitate comfort in the dying process
  241. Which of the following best describes the use of artificial nutrition and hydration?
    A - ethically speaking, withholding is equivalent to withdrawing
    B - it is ethically permissible to withhold from certain pts but, once started, may never be withdrawn
    C - it is considered ordinary tx and may never be withheld or withdrawn
    D - professional organization share the opinion that, if a dying pt cannot eat or drink appropriately it should always be initiated
    A - ethically speaking, withholding is equivalent to withdrawing
  242. Which of the following is the primary ethical principle underlying the decision to forgo nutrition support for the terminally ill?
    A - neurological brain death
    B - level of physical suffering
    C - right of self determination
    D - level of psychological suffering
    C - right of self determination
  243. In a terminally ill cancer pt, use of EN or PN is most likely to provide
    A - increased QOL
    B - decreased QOL
    C - fewer medical complications
    D - enhanced physical and emotional well being
    B - decreased QOL
  244. In the dilemma of whether to continue or withdraw nutrition support in a pt who is in a permanently unconscious states, which of the following is the most important factor in the decision making process
    A - attending MD order
    B - federal laws that prohibit the withdrawal of nutrition support once ins instituted
    C - individual state laws
    D - pt’s advance direction and consultation w/ family about what the pts wishes are
    D - pt’s advance direction and consultation w/ family about what the pts wishes are
  245. Which of the following is a purpose of an advanced direction?
    A - to prohibit the withdrawal or withholding of artificial nutrition or hydration
    B - to allow a durable power of attorney to be appointed for a pt to make all medical decisions for the pt
    C - to provide an outline of each states laws re: withdrawal or withholding of artificial nutrition
    D - to provide MD with guidance from the pt as to tx and non-tx preference in the event the pt loses decision making capacity
    D - to provide MD with guidance from the pt as to tx and non-tx preference in the event the pt loses decision making capacity
  246. The following agency regulates medical foods:
    A - ADA
    B - ASPEN
    C - FDA
    D - dept of health
    C - FDA

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