module4

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jksrd
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module4
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2012-03-11 17:19:26
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module4
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  1. Question: 1
    Once the enteral formula is opened, how long may it be stored in a refrigerator?

    1: Up to 24 hours
    2: Up to 36 hours
    3: Up to 48 hours
    4: Up to 72 hours
    3: Up to 48 hours
  2. Question: 2
    Which of the following is not an accepted means for estimating daily fluid requirements in enterally-fed adult patients?

    1: 0.5 mL/kg/min
    2: 35 mL/kg/day
    3: 1500 mL/m
    2/24 hrs
    4: 1 mL/kcal consumed
    1: 0.5 mL/kg/min
  3. Question: 3
    A 51.5 kg afebrile 55-year-old female with dysphagia is started on a standard 1.0 kcal/mL enteral formula with 85% water at 180 mL/hr over 10 hours nightly. Which of the following water flush regimens would best meet her daily estimated fluid requirements?

    1: 0 mL
    2: 60 mL every 8 hours
    3: 90 mL every 8 hours
    4: 120 mL every 8 hours
    3: 90 mL every 8 hours
  4. Question: 4
    In studies comparing EN to PN in patients with severe acute pancreatitis, which of the following potential benefits of EN over PN has not been documented?

    1: Decrease hospitalization length
    2: Decrease mortality
    3: Decrease trend of organ failure
    4: Decrease infection rate


    • 2: Decrease mortality
  5. Question: 5
    Which of the following is NOT a perceived benefit of early enteral feeding in critically ill patients?

    1: Prevents the occurrence of translocation of gut bacteria
    2: Reduces atrophy of intestinal villae
    3: Fewer infectious complications than PN-fed patients
    4: Increases intestinal permeability


    4: Increases intestinal permeability
  6. Question: 6
    Which of the following parameters is not useful in assessing the efficacy of enteral nutrition in pregnancy?

    1: Maternal dry weight gain
    2: Fetal growth
    3: Urinalysis
    4: Nitrogen balance


    3: Urinalysis
  7. Question: 7
    Evidence exists to show which of the following enteral formulas to be most efficacious in a patient with diabetic gastroparesis?

    1: Concentrated
    2: Glutamine-supplemented
    3: Hydrolyzed
    4: Low fat


    4: Low fat
  8. Question: 8
    Lactose is a common ingredient in which type of enteral formula?

    1: Semi-elemental formula
    2: Standard adult formula
    3: Standard infant formula
    4: Elemental formula
    3: Standard infant formula
  9. Question: 9
    Which of the following patient populations would most likely have difficulty tolerating a polymeric enteral formula?

    1: Crohn's disease
    2: Intestinal lymphangiectasia
    3: Gastroparesis
    4: Celiac disease


    2: Intestinal lymphangiectasia
  10. Question: 10
    In patients with pancreatitis, which of the following parameters would be LEAST important in predicting tolerance of enteral feedings?

    1: Disease severity
    2: Duration of NPO
    3: Abdominal pain
    4: Triglyceride level


    4: Triglyceride level
  11. Question: 11
    Which of the following best describes the rationale for initiating specialized nutrition support?

    1: It may be implemented in patients who cannot, should not, or will not eat adequately
    2: It may be implemented in patients who are well nourished with an intact GI tract
    3: It should be implemented on an emergency basis, regardless of patient's hemodynamic status
    4: It is commonly used to treat specific disease manifestations


    1: It may be implemented in patients who cannot, should not, or will not eat adequately
  12. Question: 12
    Tube feedings can be effectively used in which of the following conditions?

    1: Intractable nausea and vomiting
    2: High output proximal fistula
    3: Open peritoneal cavity
    4: Short bowel syndrome (<50cm) without colon


    3: Open peritoneal cavity
  13. Question: 13
    Which of the following is an indication to surgically place a jejunostomy feeding tube?

    1: Hyperemesis gravidarum
    2: Dysphagia
    3: Gastroesophageal reflux
    4: Diabetic gastroparesis


    4: Diabetic gastroparesis
  14. Question: 14
    Which of the following is the most invasive method used to assist in placement of a nasoenteric feeding tube?

    1: Corkscrew method
    2: Direct fluoroscopic guidance
    3: Endoscopic assistance
    4: Pharmacologic stimulation


    3: Endoscopic assistance
  15. Question: 15
    How long should T-fasteners be left in place after placing a gastrostomy or jejunostomy feeding tube laparoscopically or radiologically?

    1: 4-5 days
    2: 10-14 days
    3: 21-24 days
    4: 28-31 days
    2: 10-14 days
  16. Question: 16
    Which of the following is most characteristic of a skin-level device or a button for enteral feeding?

    1: Can only be used with gastrostomies
    2: Does not contain an antireflux valve
    3: Can be capped at skin level when not in use
    4: Can only be placed in the operating room


    3: Can be capped at skin level when not in use
  17. Question: 17
    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 obvious gastric contents
    4: Air sufflation and auscultation over the gastric bubble
    1: Radiographic confirmation
  18. Question: 18
    Which of the following is a CONTRAINDICATION to a percutaneous endoscopic jejunostomy tube?

    1: Gastroparesis
    2: Partial gastrectomy
    3: Refractory celiac disease
    4: End-jejunostomy
    4: End-jejunostomy
  19. Question: 19
    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: Increased rate of ventilator-associated pneumonia


    2: Increased nutrient delivery
  20. Question: 20
    Which of the following surgically placed feeding tubes can result in a thoracic duct injury?

    1: Witzel gastrostomy
    2: Stamm gastrostomy
    3: Cervical esophagostomy
    4: Needle catheter jejunostomy
    • 3: Cervical esophagostomy
  21. Question: 21
    During placement of a nasogastric feeding tube in an alert patient, which of the following is an appropriate step to avoid inadvertent tube placement into the airway?

    1: Administer IV metoclopramide.
    2: Keep patient NPO during insertion.
    3: Position patient with head bent forward, chin toward the chest.
    4: Measure distance from the tip of the patient's nose to the earlobe and mark on tube with tape.
    3: Position patient with head bent forward, chin toward the chest.
  22. Question: 22
    Which of the following methods is usually the most successful in the transpyloric placement of a nasoenteric feeding tube?

    1: pH sensor tubes
    2: Metoclopramide
    3: Fluoroscopic placement
    4: Weighted tube at bedside


    3: Fluoroscopic placement
  23. Question: 23
    Which of the following is least likely to be problematic for placement of a percutaneous endoscopic gastrostomy (PEG) tube in a patient with liver disease?

    1: Ascites
    2: Coagulopathy
    3: Gastric varices
    4: Hepatitis B


    4: Hepatitis B
  24. Question: 24
    Which of the following is an advantage of a gastrostomy-placed feeding tube compared to a nasogastric feeding tube?

    1: Reduced incidence of aspiration
    2: Less nasal irritation
    3: More successful delivery of calories
    4: Reduced incidence of gastric perforation
    2: Less nasal irritation
  25. Question: 25
    Which of the following is a CONTRAINDICATION to percutaneous endoscopic gastrostomy tube placement?

    1: Ascites
    2: Partial gastrectomy
    3: Obesity
    4: Stroke


    1: Ascites
  26. Question: 26
    Which of the following is NOT pre-procedure care of a patient undergoing placement of a percutaneous endoscopic gastrostomy tube?

    1: Obtaining informed consent
    2: Obtaining an abdominal X ray
    3: Administering an antibiotic on call
    4: Confirming normal INR


    2: Obtaining an abdominal X ray
  27. Question: 27
    Which of the following is the preferred method of feeding tube placement when post pyloric feeding is required for less than 4 weeks?

    1: Laparoscopic
    2: Open surgical
    3: Nasal jejunal tube
    4: Percutaneous endoscopic jejunostomy


    3: Nasal jejunal tube
  28. Question: 28
    What is the primary advantage of a direct percutaneous endoscopic placed jejunal tube versus a percutaneous endoscopic transgastric-placed jejunal tube?

    1: Easier to place
    2: Reduced incidence of bleeding
    3: Reduced incidence of migration
    4: Reduced incidence of gastric outlet obstruction


    3: Reduced incidence of migration
  29. Question: 29
    Which of the following types 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
    1: High fat
  30. Question: 30
    Hospital-prepared enteral nutrition formulas should be stored at what temperature?

    1: 4° C (39.2° F)
    2: 6° C (42.8° F)
    3: 8° C (46.4° F)
    4: 10° C (50.0° F)


    1: 4° C (39.2° F)
  31. Question: 31
    An isotonic formula has an osmolality of

    1: 150 mOsm/kg.
    2: 300 mOsm/kg.
    3: 450 mOsm/kg.
    4: 600 mOsm/kg.
    2: 300 mOsm/kg.
  32. Question: 32
    Which of the following best describes the initiation of a hypertonic formula for gastric feeding?

    1: Formula can safely be initiated at full strength at a low rate
    2: Formula should be diluted to an isotonic formula and initiated at goal rate
    3: Formula should be co-administered with an anti-diarrheal agent
    4: Formula should be switched to an isotonic formula at a low rate
    1: Formula can safely be initiated at full strength at a low rate
  33. Question: 33
    Which of the following medications has NOT been shown to lead to diarrhea in a patient receiving enteral nutrition?

    1: Sorbitol elixirs
    2: Alpha-2 adrenergic agonists
    3: Antibiotics
    4: Magnesium-containing preparations
    2: Alpha-2 adrenergic agonists
  34. Question: 34
    Tube feeding with a standard enteral formula is often held before and after administration of all the following medications EXCEPT

    1: Theophylline
    2: Nitroglycerin
    3: Ciprofloxacin
    4: Phenytoin


    2: Nitroglycerin
  35. Question: 35
    Which of the following alterations to the enteral formula most often reduces the risk for physical interaction between the formula and medications?

    1: Switch to a free amino acid enteral formula
    2: Add fiber to the enteral formula
    3: Reduce fat content of the enteral formula
    4: Increase total free water in the enteral formula


    • 1: Switch to a free amino acid enteral formula
  36. Question: 36
    Drugs in microencapsulated bead, enteric-coated granule or pellet form are most effectively administered through feeding tubes when mixed with

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


    1: orange juice.
  37. Question: 37
    Which of the following feeding formulas is most likely to be contaminated?

    1: Pasteurized
    2: Blenderized
    3: Ready to feed
    4: Ready to hang


    2: Blenderized
  38. Question: 38
    Which of the following best describes the absorption of small peptides and free amino acids contained in hydrolyzed enteral formulas?

    1: The majority of small peptides and amino acids are absorbed through active transport across the gastric mucosa
    2: Free amino acid absorption occurs more rapidly than an equivalent mixture of small peptides
    3: Small peptide formulations have a higher osmolality and thereby less efficient absorption than free amino acid formulas
    4: Although absorption may differ, there are no established clinical advantages to the use of small peptide over free amino acid formulas or vice-versa.


    4: Although absorption may differ, there are no established clinical advantages to the use of small peptide over free amino acid formulas or vice-versa.
  39. Question: 39
    The use of enteral formulas with intact protein has been shown to be as effective as use of free amino acid-based formulas in promoting remission of

    1: Crohn's disease.
    2: gastrointestinal cancer.
    3: pancreatitis.
    4: hepatic encephalopathy.
    1: Crohn's disease.
  40. Question: 40
    Which of the following patients is most likely to benefit from immunonutrition?

    1: Septic trauma patient
    2: Trauma patient with isolated orthopedic injuries
    3: Medical intensive care unit patient
    4: Trauma patient with abdominal and torso injuries


    • 4: Trauma patient with abdominal and torso injuries
  41. Question: 41
    Which of the following would be the most appropriate tube feeding formula for a patient with extensive second and third degree burns?

    1: High fat
    2: High nitrogen
    3: Concentrated
    4: High fiber


    2: High nitrogen
  42. Question: 42
    Length of stay and postoperative infection rates have been shown to DECREASE in surgical patients receiving tube-feeding formulas enriched with

    1: arginine.
    2: nucleotides.
    3: ascorbic acid.
    4: branched-chain amino acids.


    1: arginine.
  43. Question: 43
    The enteral formula for individuals with pulmonary disease requiring mechanical ventilation should always be

    1: based on individual tolerance and needs.
    2: low fat, high carbohydrate.
    3: fluid concentrated, low fat.
    4: high fat, low carbohydrate.


    • 1: based on individual tolerance and needs.
  44. Question: 44
    Modular products are added to the tube-feeding regimen to

    1: prevent bacteria translocation.
    2: increase the respiratory quotient.
    3: increase calorie and protein content.
    4: alter the ratio of vitamins to minerals.
    3: increase calorie and protein content.
  45. Question: 45
    Early commencement of enteral feeding has been suggested to benefit ICU patients, reducing infectious complications, length of hospital stay and even possibly reducing mortality. Which group of patients might be at significant risk from early enteral feeding?

    1: Post surgical patients whose surgery involved the gastrointestinal tract
    2: Post surgical patients who have experienced a significant blood loss during surgery and who have a poor urine output postoperatively
    3: Trauma patients with head trauma that may include a fractured base of skull
    4: Patients admitted with acute pancreatitis


    3: Trauma patients with head trauma that may include a fractured base of skull
  46. Question: 46
    A patient with acute respiratory distress syndrome may benefit from a feeding formula containing supplemental

    1: arginine.
    2: glutamine.
    3: nucleic acids.
    4: omega 3 fatty acids.


    4: omega 3 fatty acids.
  47. Question: 47
    The use of tube feeding formulas enriched with branched-chain amino acids is best used for patients with

    1: cirrhosis.
    2: hepatic failure.
    3: liver transplantation.
    4: intractable encephalopathy.
    4: intractable encephalopathy.
  48. Question: 48
    Percutaneous endoscopic gastrostomy (PEG) placement in esophageal cancer patients prior to surgery may place the patient at risk for all of the following, EXCEPT:

    1: Constipation
    2: Delayed gastric emptying
    3: Leakage at PEG site
    4: Impaired wound healing
    1: Constipation
  49. Question: 49
    Which of the following is the best method to place a gastrostomy feeding tube in a patient with head and neck cancer?

    1: Radiologically
    2: Laparoscopically
    3: Surgical laparotomy
    4: Percutaneous endoscopically
    1: Radiologically
  50. Question: 50
    Enteral nutrition may be contraindicated in the early post-transplant period in adult patients with hematopoietic cell transplants because of

    1: increased incidence of sinusitis with enteral feedings.
    2: lack of benefit from enteral feedings in allogeneic patients.
    3: gastrointestinal toxicities related to the conditioning regimen.
    4: improved survival seen in autologous patients receiving parenteral nutrition.


    3: gastrointestinal toxicities related to the conditioning regimen.
  51. Question: 51
    In a patient with fat malabsorption, an enteral product containing which of the following can provide a concentrated source of energy?

    1: Medium chain triglyceride oil
    2: Free amino acids
    3: Fructooligosaccharides
    4: Long chain triglycerides


    1: Medium chain triglyceride oil

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