Nutrition Therapy And Pathophysiology 2nd Edition by Marcia Nahikian Nelms - Test Bank

Nutrition Therapy And Pathophysiology 2nd Edition by Marcia Nahikian Nelms – Test Bank

 

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Sample Questions Are Posted Below

 

Chapter 5 – Enteral and Parenteral Nutrition Support

 

Multiple Choice

 

An.  Type      Page(s)                                                                      Note: Under Type, K = knowledge and A = application.

 

d      K             82                   1.             Which of the following is not a contraindication to enteral feeding?

1. paralytic ileus
2. nonresponsive, intractable vomiting and diarrhea
3. intestinal obstruction distal to tube
4. severe dysphagia

 

a      K             82                   2.             Which of the following is a contraindication for tube feeding?

1. hypomotility of the small intestine
2. functioning GI tract, but patient cannot meet nutritional needs
3. protein-energy malnutrition
4. severe dysphagia (difficulty swallowing)

 

a      K             83                   3.     Which type of feeding tube is the most common, least expensive, and easiest to achieve and maintain?

1. nasogastric
2. orogastric
3. nasojejunal
4. nasoduodenal

 

b      K             83                   4.     In cases of gastroparesis, which methods of support would yield the best results?

1. nasogastric
2. nasoduodenal
3. orogastric
4. oral

 

b      A             82, 83-84       5.     Your patient has had a portion of his stomach resected. The physician predicts that he will likely be on nutrition support for a long time. He has a functional GI tract. What is the best way to feed this patient?

1. TPN
2. jejunostomy
3. PEG
4. PPN

 

b      A             83-84             6.     A disadvantage of using the gastrostomy route for a tube feeding is:

1. the intestine does not have time to properly absorb the nutrients.
2. the feedings are sometimes regurgitated.
3. the feeding bypasses the stomach.
4. all of the above

 

d      K             84                   7.     If a physician places a feeding tube through the skin and into the stomach without a surgical incision and using an endoscope, it is most specifically referred to as:

1. gastrostomy.
2. nasogastric.
3. orogastric.
4. PEG.

 

b      A             86-87             8.     Which of the following tube feedings would leave the least residue in the gut?

1. a blenderized formula
2. a hydrolyzed formula
3. a polymeric formula
4. a fiber-added formula

 

b      K             87                   9.             Formulas containing di- and tripeptides are termed:

1. intact.
2. hydrolyzed.
3. crystalline.
4. modular.

 

c      K             87                   10.          Formulas containing crystalline amino acids are termed:

1. intact.
2. semi-elemental.
3. elemental.
4. modular.

 

a      K             87                   11.  Concern about the adverse side effects of long-chain fats has given rise to formulas supplemented with _____ to boost immunity.

1. omega-3 fatty acids
2. MCT oil
3. FOS
4. CHO

 

b      K             87                   12.          Which of the following is true about enteral formulas?

1. They contain SCFA.
2. They are lactose free.
3. They are composed of dipeptides.
4. The source of fat is canola oil.

 

c      K             87                   13.          What are the benefits of enteral formulas with fiber?

1. Fiber aids in the absorption of minerals.
2. Fiber helps prevent clogging of the feeding tube.
3. Fiber helps maintain normal bowel function.
4. Fiber reduces viscosity of the formula by attracting water.

 

c      A             87                   14.          Which of the following feedings is isotonic?

1. Traumacal – 425 mOsm/kg
2. Vivonex – 550 mOsm/kg
3. Isocal – 300 mOsm/kg
4. Boost – 620 mOsm/kg

 

c      A             87                   15.  You have a patient who weighs 215# and is on dialysis. This patient often presents with edema. Which of the following formulas would be best for this patient?

1. hydrolyzed
2. intact
3. nutrient dense
4. hepatic

 

d      A             87                   16.  Your patient has Crohn’s disease and presents with severe malabsorption. Which of the following formulas would be best for this patient?

1. intact
2. immune enhancing
3. lactose free
4. hydrolyzed

b      A             87                   17.  How much additional water would a patient with an energy requirement of 2400 kcal/day need if 2400 mL of a standard formula (85% water) were administered daily?

1. 235 mL/day
2. 360 mL/day
3. 480 mL/day
4. 125 mL/day

 

b      K             88                   18.  A formula feeding that is administered within the space of a few minutes is a:

1. single feeding.
2. bolus feeding.
3. complete feeding.
4. quick delivery system.

 

c      K             88                   19.  Which tube feeding administration is most useful for people who have poor tolerance to larger volumes of formula?

1. bolus
2. intermittent
3. continuous drip
4. combination

 

b      K             87, 91             20.          What is the consequence of a hyperosmolar formula?

1. excess kilocalories
2. diarrhea
3. excess fluid
4. delayed healing

 

a      A             89                   21.  An isotonic tube feeding is often started at _____ mL/h, then gradually increased by _____ mL/h every 6-8 hours as tolerated until final volume is reached.

1. 50; 20
2. 25; 50
3. 100; 50
4. 10; 10

 

a      A             89                   22.  If a patient’s enteral volume requirement is 2100 mL/day, what will the final rate be?

1. 88 mL/hr
2. 100 mL/hr
3. 50 mL/hr
4. 75 mL/hr

 

a      A             89,91              23.  If there is a concern that a client may not tolerate a tube feeding well it is wise to:

1. start the tube feeding at a very slow rate.
2. administer the tube feeding rapidly to provide as much formula as possible before complications occur.
3. start the tube feeding at half strength.
4. none of the above

 

b      K             91                   24.          The most commonly reported GI complication from enteral nutrition support is:

1. hepatic steatosis.
2. diarrhea.
3. constipation.
4. elevated LFTs.

 

d      K             91                   25.  What EN complication should the RD particularly monitor for in a patient who is sedated, has an endotracheal tube, or has swallowing problems?

1. diarrhea
2. hyperglycemia
3. a clogged tube
4. aspiration

 

c      K             91-92             26.          Complications of EN delivered into the stomach could include:

1. ulcer.
2. gastric atrophy.
3. aspiration pneumonia.
4. edema.

 

b      K             92                   27.  Which of the following would not be an effective measure of hydration status for a patient on tube feeding?

1. hydration is monitored by daily weights
2. hydration is monitored by interviews with the patient
3. hydration is monitored by BUN
4. hydration is monitored by urine specific gravity

 

a      A             92-93             28.  Your patient is a reported alcohol abuser and has been in and out of homeless shelters for 2 years. He presents to the ER with a CVA and severe dysphagia and requires a feeding tube. What complication is he at risk for developing?

1. refeeding syndrome
2. hypoglycemia
3. overhydration
4. hepatic steatosis

 

c      A             93                   29.  Your patient presents to the ER with intractable vomiting that is not responding to anti-nausea medications. How do you feed this patient?

1. nasointestinal tube
2. gastrostomy
3. PN
4. jejunostomy

 

a      K             94                   30.          The most common form of parenteral access is a(n):

1. CVC.
2. PICC.
3. PPN.
4. implantable port.

 

b      A             94                   31.  Your patient has had multiple bowel resections and is being sent home on PN. What is the best access option for this patient?

1. NDT
2. tunneled catheter
3. CVC
4. PICC

 

d      K             94                   32.  Which of the following access devices would be best for a patient requiring long-term PN who has body image concerns and would like something that can be hidden?

1. CVC
2. PICC
3. tunneled catheter
4. implantable port

 

b      K             94-95             33.          Your patient’s PN is infusing from one bag. This is called:

1. a two-in-one system.
2. a three-in-one system.
3. a closed system.
4. an open system.

 

c      K             95                   34.          Protein is added to the solution by using:

1. di- and tripeptides.
2. complete proteins.
3. amino acids.

 

b      K             96                   35.          In PN, concentrations of up to 70% are used for:

1. protein.
2. carbohydrates.
3. lipids.
4. vitamins.

 

d      K             96                   36.          The carbohydrate source used in PN is:

1. glucose.
2. intralipid.
3. disaccharides.
4. dextrose monohydrate.

 

c      K             96                   37.          The caloric value of the carbohydrate source used in PN is:

1. 4 kcal/g.
2. 9 kcal/g.
3. 3.4 kcal/g.
4. 11 kcal/g.

 

d      K             96                   38.  What type of lipid is commonly used to make the lipid used in TPN?

1. olive oil
2. egg phospholipid
3. stearic acid
4. soybean oil

 

c      K             96                   39.  Which of the following is not a side effect of excessive carbohydrate infusion via PN?

1. hyperglycemia
2. excessive CO₂ production
3. excess fluid infusion
4. hepatic steatosis

 

c      A             96                   40.  In which of the following clinical conditions might your patient benefit from a larger percentage of their kcal provided by lipid?

1. respiratory failure
2. liver failure
3. hyperglycemia
4. congestive heart failure

 

a      A             97                   41.  Which of the following is not routinely included in the parenteral solution, but may be added in some institutions?

1. medications
2. trace minerals
3. vitamins
4. electrolytes

 

d      K             93                   42.          Which of the following is true about PPN?

1. The formula is generally sufficient in protein and kilocalories.
2. It is administered through a central line.
3. It is indicated for long-term support.
4. The formula is dilute so it does not irritate veins.

 

b      K             101                 43.  What lab value would you monitor to evaluate the tolerance to IV lipid?

1. albumin
2. triglycerides
3. glucose
4. creatinine

 

d      K             101                 44.          A common GI complication of PN when the bowel is at complete rest is:

1. diarrhea.
2. decreased LFTs.
3. hepatic steatosis.
4. cholestasis.

 

Case Study Multiple Choice

 

You have an 80 yo M patient that has end-stage Alzheimer’s disease and has recently been diagnosed with severe dysphagia. This patient is getting ready for discharge from the hospital. His height is 5’ 9’’ and he weighs 162# with no recent changes in weight.

 

c      A             82-84             45.          How would you feed this patient?

1. nasogastric tube
2. nasointestinal tube
3. PEG
4. PN

 

b      A             89                   46.  How many kcalories per kilogram of body weight would you use to estimate his caloric needs?

1. 20
2. 25
3. 35
4. 15

 

b      A             90                   47.          How many grams of protein per kilogram of body weight does he need?

1. 0.8
2. 1.0
3. 1.4
4. 1.6

 

c      A             90                   48.          How many milliliters of fluid per kilogram of body weight does he need?

1. 20
2. 25
3. 30
4. 40

 

a      A             88                   49.  After selecting the formula that would best fit his nutrient needs, you determine that he needs ~ 1500 mL of formula per day. Which of the following is the most appropriate schedule for him?

1. 375 mL four times daily
2. 100 mL eight times daily
3. 35 mL per hour over 24 hours
4. 75 mL per hour from 8 p.m. to 8 a.m. daily

 

b      A             91-93             50.  What is the most important parameter for the RD to follow up on with this patient on the second day?

1. refeeding syndrome
2. gastrointestinal tolerance
3. dehydration
4. tube dislodgement

 

 

Matching

 

An.	Page(s)
m	81	1.     aspiration	a.     administration of formula 10-24 hours daily using a pump to control the feeding rate b.     nil per os, which is Latin meaning “nothing by mouth” c.     rapid administration of 250-500 mL of formula several times daily d.     a procedure used by a physician to insert a feeding tube through the skin and into the stomach using an endoscope e.     number of water-attracting particles per weight of water in kilograms (expressed as mOsm/kg) f.     having a higher osmolality than body fluids (>300 mOsm/kg) g.     thickness of a liquid h.     epithelial cell of the large intestine or colon i.      water loving, or attracting water j.      number of millimoles of liquid or solid in a liter of solution k.     having the same osmolality as body fluids (approximately 300 mOsm/kg) l.      wire guide within the enteral tube that assists with insertion m.   inspiration of foreign matter into the lung n.     an opening into the stomach that requires a surgical procedure o.     metabolic alterations that may occur during nutritional repletion of starved patients
c	81	2.     bolus feedings
h	81	3.     colonocyte
a	81	4.     continuous feedings
i	81	5.     hydrophilic
f	87	6.     hyperosmolar
k	87	7.     iso-osmolar
b	81	8.     NPO
e	81	9.     osmolality
j	81	10.  osmolarity
d	81	11.  PEG
o	81	12.  refeeding syndrome
l	81	13.  stylet
n	81	14.  surgical gastrostomy
g	81	15.  viscosity

 

 

Discussion

 

Page(s)

83-5,88-9      1.     Discuss the methods of delivering a tube feeding. Give examples of when you would use each and list their benefits.

 

86-87             2.     List and briefly explain at least four considerations in selecting the appropriate formula for a client.

 

89-90             3.     Give an example of an appropriately written tube feeding prescription.

 

91-93,101     4.     What are some of the common complications of both enteral and parenteral nutrition support? Discuss interventions.

 

92-93             5.     Discuss the etiology of refeeding syndrome. For which patients would this be a concern?

 

93                   6.     Name at least two considerations in making the decision between peripheral and central parenteral nutrition.

 

97,99-100     7.     Your patient is hospitalized and requires nutrition support via TPN. You have estimated his daily needs to be: 2000 kcal, 80 grams protein, 2000 mL fluid. Calculate a sample regimen of TPN including the percentages from each macronutrient.

 

 

Application

 

Page(s)

 

Information for application questions 1-4: Your client, a 52-year-old male, was admitted after a motor vehicle accident. He suffered several fractures: s/p fracture of clavicle, several ribs, R arm, and femur.

He has a closed head injury and fractured mandible. The orthopedic surgeon placed a gastrostomy feeding tube after his surgery for stabilization of his fractures in anticipation that he will be unable to meet his nutritional needs by mouth.

Ht: 5’8”                 Wt: 155#

Mifflin-St. Jeor: 10 × weight (kg) + 6.25 × height (cm) – 5 × age (y) + 5

 

89-90             1.     Estimate energy, protein, and fluid requirements. Use an activity factor of 1.2 and an injury factor of 1.3.

 

86-7,90          2.     Determine the formula of choice from among the following:

Polymeric (Osmolite 1.06 kcal/mL; 0.34 g protein/mL)

Hydrolyzed (Perative 1.3 kcal/mL; 0.066 g protein/mL)

High-nitrogen (Impact 1 kcal/mL; 0.056 g protein/mL)

 

89-90             3.     Determine the prescription for this patient; include total volume; goal rate; initiation and progression; and free water.

 

91-93             4.     Name three indices to monitor tolerance to feeding and adequacy of the prescription.

 

Information for application questions 5-8: Consider the following solution:

D₁₅ 4.25% CAA with 25 grams of 10% lipid                 Total volume: 3.5 liters

 

96,99-100     5.     What are the kcal from carbohydrate?

 

95-6,99-100  6.     How many grams of amino acids are provided?

 

96,99-100     7.     What is the caloric value of the lipid per liter of solution? How much in total volume?

 

95-100           8.     What are the total non-protein calories provided by the solution?

 

 

Figure Identification

 

Instructions: Complete the flowchart diagram for selecting a formula.

 

 

 

 

Answer key:

1.             Standard 2.             Hydrolyzed 3.             malabsorption 4.             Lactose 5.             Fiber-enriched

6.             Standard 7.             blenderized 8.             energy 9.             protein 10.          Carbohydrate

11.          Fluid and sodium 12.          Renal 13.          hepatic