module 2

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jksrd
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module 2
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2012-03-11 14:07:17
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module 2 from aspen
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  1. Question: 1
    Which of the following additives has the greatest risk over time of destabilizing the intravenous fat emulsion (IVFE) in a total nutrient admixture (TNA)?

    1: Sodium chloride
    2: Calcium acetate
    3: Iron dextran
    4: Potassium phosphate
    3: Iron dextran
  2. Question: 2
    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
    2: Calculation of PN dosages
  3. Question: 3
    According to the A.S.P.E.N. Safe Practices Guidelines, 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 of original concentration added (e.g., 500 mL of 50% dextrose)
    2: Grams per liter (e.g., 250 g/L)
    3: Percent of final concentration after admixture (e.g., 35% dextrose)
    4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)


    4: Grams per 24-hour nutrient infusion (e.g., 225 g/day)
  4. Question: 4
    All of the following are considered to be mandatory for the PN order form EXCEPT

    1: general statement warning of the potential for PN formulation incompatibilities.
    2: contact number for the person writing the order.
    3: hangtime guidelines.
    4: recommended PN laboratory tests.


    4: recommended PN laboratory tests.
  5. Question: 5
    According to the A.S.P.E.N. Safe Practices Guidelines, the following are strongly recommended for inclusion on the PN label EXCEPT

    1: route of administration.
    2: dose of macronutrients for 24 hours.
    3: dosing weight.
    4: location of venous access device.


    4: location of venous access device.
  6. Question: 6
    What is the nutritional value of the following PN formula? 1000mL 30% dextrose, 800mL 15% amino acids, 200mL 20% IVFE.

    1: 1352 kcal, 200 grams carbohydrate, 68 grams protein, 40 grams fat
    2: 1692 kcal, 300 grams carbohydrate, 68 grams protein, 40 grams fat
    3: 1900 kcal, 300 grams carbohydrate, 120 grams protein, 40 grams fat
    4: 2000 kcal, 300 grams carbohydrate, 120 grams protein, 50 grams fat


    3: 1900 kcal, 300 grams carbohydrate, 120 grams protein, 40 grams fat
  7. Question: 7
    A patient is receiving 65 mL/hr of 7.5% amino acids and 17.5% dextrose of a 2-in-1 PN solution in addition to 250 mL of 20% IVFE. What is the daily caloric content of this regimen?

    1: 1345 kcal/day
    2: 1395 kcal/day
    3: 1846 kcal/day
    4: 1896 kcal/day
    4: 1896 kcal/day
  8. Question: 8
    What significant benefit has hypocaloric PN support shown in ICU patients with obesity?

    1: Reduction in mortality
    2: Reduction in length of stay in ICU
    3: Reduction of days on insulin therapy
    4: Reduction in ventilator days


    3: Reduction of days on insulin therapy
  9. Which of the following is an absolute indication for the use of PN?

    1: High output fistula
    2: Crohn's disease
    3: Pancreatitis
    4: Hyperemesis gravidarum


    1: High output fistula
  10. Question: 10
    In patients with ulcerative colitis, the use of PN as a primary treatment has been shown to be

    1: of no benefit in influencing the disease response.
    2: effective in reducing the inflammatory response.
    3: effective in reducing both operative and mortality rates.
    4: more effective than intravenous methylprednisolone in reducing the disease response.


    1: of no benefit in influencing the disease response.
  11. Question: 11
    When is PN indicated in severe burn patients?

    1: Total body surface area burn exceeds 20%
    2: As soon as possible after admission due to extremely high caloric needs
    3: EN is contraindicated or unlikely to meet nutrition needs
    4: Within 7-10 days after hospital admission


    3: EN is contraindicated or unlikely to meet nutrition needs
  12. Question: 12
    The routine use of preoperative PN is indicated for patients who are

    1: normally nourished.
    2: mildly to moderately malnourished.
    3: mildly malnourished with secondary co-morbidities.
    4: severely malnourished.
    4: severely malnourished.
  13. Question: 14
    Which of the following is an absolute indication for PN support in a cancer patient?

    1: Small bowel obstruction for seven days
    2: Metastatic cancer, receiving palliative care
    3: Receiving concurrent chemotherapy and radiation therapy
    4: Mild malnutrition, scheduled for surgery in three days


    1: Small bowel obstruction for seven days
  14. When should PN be used in Crohn's disease?

    1: As a primary therapy to rest the bowel
    2: Only after failure to tolerate EN
    3: To prevent associated malnutrition
    4: Preoperatively regardless of nutrition status
    2: Only after failure to tolerate EN
  15. Question: 16
    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.
    1: IVFE hang time up to 24 hours when included as part of a total nutrient admixture (TNA).
  16. Question: 17
    Which of the following is the most appropriate distal catheter tip placement of a peripherally inserted central catheter (PICC)?

    1: Cephalic vein
    2: Superior vena cava
    3: Internal jugular vein
    4: Supraclavicular vein
    2: Superior vena cava
  17. Question: 18
    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


    1: High rate of catheter malposition
  18. Question: 19
    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


    3: After chest X-ray confirms correct placement of catheter tip
  19. Question: 20
    According to the Centers for Disease Control and Prevention (CDC), which of the following is true regarding PICC line care?

    1: Routine placement is recommended to prevent catheter-related blood stream infections (CRBSIs)
    2: Remove the PICC line immediately if fever develops
    3: Use routine guidewire exchange of PICC line to prevent catheter-related blood stream infections
    4: Remove the PICC line only if it is suspected or known to be the source of infection


    4: Remove the PICC line only if it is suspected or known to be the source of infection
  20. Question: 21
    PN solutions containing a final dextrose concentration exceeding 20% should NOT be infused via a catheter inserted in which vein?

    1: Basilic
    2: Femoral
    3: Subclavian
    4: Internal jugular
    1: Basilic
  21. Question: 22
    Which of the following PN formulas can be safely administered through a peripheral catheter?

    1: 10% dextrose and 3% amino acid
    2: 20% dextrose and 3% amino acid
    3: 10% dextrose and 10% amino acid
    4: 20% dextrose and 10% amino acid


    1: 10% dextrose and 3% amino acid
  22. Question: 23
    A total nutrient admixture (TNA) contains which macronutrients?

    1: Water and amino acids
    2: Carbohydrates and amino acids
    3: Water, amino acids, and IV fat emulsion (IVFE)
    4: Carbohydrates, amino acids, and IVFE
    • 4: Carbohydrates, amino acids, and IVFE
  23. Question: 24
    Glutamine supplementation in PN is limited by

    1: the presence of intravenous fat emulsion (IVFE) in a total nutrient admixture (TNA) formula.
    2: expense of the commercially available product.
    3: physical stability after compounding.
    4: the presence of calcium in the PN.


    3: physical stability after compounding.
  24. Question: 25
    The primary difference between renal and standard intravenous amino acid formulas is that renal formulas contain a higher proportion of which type of amino acids?

    1: Non-essential
    2: Conditionally essential
    3: Essential
    4: Branched-chain


    3: Essential
  25. Question: 26
    Branched-chain amino acid 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.


    4: a cirrhotic patient with chronic encephalopathy who is intolerant of standard protein sources.
  26. Question: 27
    Failure to provide linoleic and alpha linolenic acids with PN will most likely result in

    1: metabolic acidosis.
    2: hyperglycemia.
    3: metabolic bone disease.
    4: essential fatty acid deficiency (EFAD).
    4: essential fatty acid deficiency (EFAD).
  27. Question: 28
    The adverse effects of intravenous fat emulsion (IVFE) administration in adults is best prevented by

    1: supplementing with L-carnitine.
    2: avoiding infusion rates >0.1 grams/kg/hour.
    3: using 10% IVFE preparations.
    4: avoiding serum triglyceride levels >400 mg/dL.
    4: avoiding serum triglyceride levels >400 mg/dL.
  28. Question: 29
    Which of the following best describes an intravenous fat emulsion (IVFE) produced by the transesterification of fatty acids to form a composite triglyceride molecule?

    1: Single oil
    2: Multi-oil
    3: Structured
    4: Physical mixture
    4: Physical mixture
  29. Question: 30
    Which of the following trace elements should NOT be added to the PN for a patient with hepatobiliary disease?

    1: Zinc and manganese
    2: Zinc and magnesium
    3: Copper and manganese
    4: Copper and magnesium
    3: Copper and manganese
  30. Question: 31
    Which of the following PN components is NOT a source of aluminum contamination?

    1: Heparin
    2: L-cysteine
    3: Potassium phosphate
    4: Regular insulin
    4: Regular insulin
  31. Question: 32
    A long term PN patient experiences extrapyramidal symptoms. Which trace element toxicity is most likely to present with these symptoms?

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


    1: Manganese
  32. Question: 33
    When compared to the Dietary Reference Intakes (DRIs) for fat-soluble vitamins given orally, the DRIs for parenterally administered fat-soluble vitamins are

    1: less.
    2: equal.
    3: two times greater.
    4: four times greater.


    1: less.
  33. Question: 34
    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: greater.


    • 4: greater.
  34. Question: 35
    According to 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.
    3: medium risk.
  35. Question: 36
    Which one of the following best describes a safe compounding practice for PN?

    1: The physical appearance of a final PN formulation containing amino acids, dextrose, and additives should be visually assessed to detect the presence of particulate matter.
    2: Visual assessment of the final formulation of a total nutrient admixture is not recommended as it is not anticipated that problems can be visually detected in an opaque dispersion.
    3: Manual methods for compounding PN formulations are no longer recommended; automated methods have been shown to be safer and more cost effective.
    4: Using brands of PN components (e.g., amino acids, dextrose, intravenous fat emulsion) from different manufacturers to compound PN formulations is a safe practice that should not raise concerns.


    1: The physical appearance of a final PN formulation containing amino acids, dextrose, and additives should be visually assessed to detect the presence of particulate matter.
  36. Question: 37
    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.


    1: a translucent band at the surface of the emulsion separate from the remaining TNA dispersion.
  37. Question: 38
    Which of the following complications is most likely to occur when transitioning a critically ill patient from parenteral to enteral nutrition?

    1: Hypocalcemia
    2: Hypercalcemia
    3: Hypoglycemia
    4: Hyperglycemia
    • 4: Hyperglycemia
  38. Question: 39
    Rapid intravenous infusion of sodium or potassium phosphate may result in

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


    1: tetany.
  39. Question: 40
    Which of the following should be monitored regularly in an adult patient receiving IVFE?

    1: Fecal fat
    2: Serum osmolarity
    3: Prothrombin time
    4: Retinol-binding protein


    3: Prothrombin time
  40. Question: 41
    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


    3: Potassium
  41. Question: 42
    Which of the following is a clinical sign of hyperphosphatemia?

    1: Tachycardia
    2: Tetany
    3: Hyperventilation
    4: Altered mental status
    2: Tetany
  42. Question: 43
    What laboratory findings are diagnostic for essential fatty acid deficiency?

    1: A serum triglyceride level < 100 mg/dL
    2: A lymphocyte absolute count < 1000/microliter
    3: A serum cholesterol level < 100 mg/dL
    4: A triene to tetraene ratio greater than 0.4


    4: A triene to tetraene ratio greater than 0.4
  43. Question: 44
    Concurrent infusion of IVFE and propofol would most likely cause

    1: hyperglycemia.
    2: hypertriglyceridemia.
    3: azotemia.
    4: hypernatremia.
    2: hypertriglyceridemia.
  44. Question: 45
    Which component of PN most likely impacts a patient receiving warfarin for anticoagulation?

    1: Standard amino acids and electrolytes
    2: Dextrose and trace elements
    3: Intravenous fat emulsion (IVFE) and vitamins
    4: Branched-chain amino acids and electrolytes


    3: Intravenous fat emulsion (IVFE) and vitamins
  45. Question: 46
    When initiating a PN regimen that contains regular insulin, how often should capillary blood glucose levels be monitored?

    1: Every 6 hours
    2: Every 8 hours
    3: Every 12 hours
    4: Every 24 hours


    1: Every 6 hours
  46. Question: 47
    A patient is receiving 120 mL/hr of a cyclic PN solution containing 50 units of regular insulin. How should the PN solution be tapered off?

    1: Cut the rate in one quarter for the last two hours prior to discontinuation
    2: Cut the rate in one quarter for the last four hours prior to discontinuation
    3: Cut the rate in half for the last two hours prior to discontinuation
    4: Cut the rate in half for the last four hours prior to discontinuation
    3: Cut the rate in half for the last two hours prior to discontinuation
  47. Question: 48
    In adult parenteral nutrition patients, intravenous fat emulsion (IVFE) use should be limited to the provision of essential fatty acids only when serum triglyceride levels rise above

    1: 400 mg/dL.
    2: 300 mg/dL.
    3: 200 mg/dL.
    4: 100 mg/dL.


    1: 400 mg/dL.
  48. Question: 49
    Long term use of which parenteral nutrition (PN) product would most likely contribute to aluminum accumulation in a person requiring chronic parenteral nutrition?

    1: Vitamin K
    2: Potassium phosphate
    3: 10% intravenous fat emulsion
    4: Parenteral amino acids


    2: Potassium phosphate
  49. Question: 50
    Commonly reported advantages to cycling parenteral nutrition include all except

    1: more rapid restoration of serum albumin levels.
    2: prevention of parenteral nutrition-induced fatty infiltration of the liver.
    3: prevention of parenteral nutrition-associated hyperglycemia.
    4: higher level of social activity and interaction in parenteral nutrition-dependent patients
    3: prevention of parenteral nutrition-associated hyperglycemia.

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