Aspen Practice Exam Questions on Nutrition Support, Exams of Nursing

Download Aspen Practice Exam Questions on Nutrition Support and more Exams Nursing in PDF only on Docsity! 1 lOMoAR cPSD|37244331 ASPEN PRACTICE EXAM QUESTIONS WITH CORRECT AND ANSWERS 2024 Medicare approved indications for home parenteral nutrition include which of the following? a. supplement to enteral nutrition b. end-stage renal disease c. long-term loss of gastrointestinal function d. delayed gastric emptying - c. long-term loss of gastrointestinal function Which of the following is true concerning manganese and patients on long-term parenteral nutrition? a. manganese deficiency occurs in patients on PN for greater than 1 year b. hypermanganesemia has been reported only in patients with cholestasis c. manganese in commercial trace element preparations may result in hypermanganesemia d. the best indicator of manganese status is serum manganese - c. manganese in commercial trace element preparations may result in hypermanganesemia Which of the following are most likely to result in malnutrition of mild to moderate inflammatory response? a. anorexia nervosa b. cancer c. closed head injury d. sepsis - b. cancer In patients with severe acute pancreatitis enteral nutrition has been documented to provide the following benefits over parenteral nutrition EXCEPT: a. decreased infection rate b. decreased hospital length of stay c. decreased pain d. decreased mortality - c. decreased pain Indirect calorimetry calculates: a. total energy expenditure b. nitrogen balance c. heat released from the subject d. resting energy expenditure - d. resting energy expenditure A seven month-old infant fed reconstituted infant formula and other age-appropriate complementary foods may be at risk of over-supplementation with which of the following? a. Vitamin A 2 b. Fluoride c. Vitamin E d. Iron - b. Fluoride Zinc supplementation should be considered for patients: a. with chronic wounds b. with unexplained skin rashes and alopecia c. who are elderly d. who have below normal zinc levels - b. with unexplained skin rashes and alopecia A long term parenteral nutrition patient begins to experience Parkinson-like symptoms. Which trace element toxicity is most likely to present with these symptoms? a. manganese b. copper c. zinc d. selenium - a. manganese How much fluid per day is required to maintain fluid balance in an average healthy adult? a. 10-21 ml/kg/day b. 25-35 ml/kg/day c. 45-55 ml/kg/day d. 60-70 ml/kg/day - b. 25-35 ml/kg/day In the first 1-3 months after a bone marrow transplant the nutritional needs of a patient are best met with: a. 20-25 kcal/kg daily with >/=1.5 g protein per kg body weight b. 20-25 kcal/kg daily with 80% of total calories from carbohydrate c. 30-35 kcal/kg daily with >/=1.5 g protein per kg body weight d. 30-35 kcal/kg daily with 80% of total calories from carbohydrate - c. 30-35 kcal/kg daily with >/=1.5 g protein per kg body weight A patient has an advanced directive stating a desire to forego medical technology, including nutrition and hydration, in order to prolong life. The patient is now in an irreversible vegetative state. In deciding whether to continue nutrition and hydration by medical means, the patient's surrogate decision-maker must: a. consult with a lawyer regarding physician orders for life-sustaining treatment b. have a psychiatric evaluation in order to be declared competent to make decisions in the patient's care c. honor the patient's expressed wish to withdraw nutrition and hydration by medical means d. decide, based upon own values, whether or not to withdraw the patient's nutrition and hydration by medical means - c. honor the patient's expressed wish to withdraw nutrition and hydration by medical means 5 c. fibrosing colonopathy d. cystic fibrosis related diabetes - d. fibrosing colonopathy A patient receiving PN has high ileostomy output. Which of the following changes to the PN prescription is most appropriate to recommend? a. increase sodium and increase fluid volume b. decrease water and decrease sodium c. increase sodium and decrease protein d. decrease sodium and increase fluid volume - a. increase sodium and increase fluid volume Which of the following patients is at lowest risk of pulmonary injury from small bore feeding tube misplacement? a. a patient status post stroke on the inpatient medical unit b. a patient who is alert and cooperative c. a patient with head and neck trauma admitted to the ICU d. a patient status post Roux-en-Y gastric bypass - b. a patient who is alert and cooperative Copper toxicity is associated with: a. liver disease b. kidney disease requiring hemodialysis c. aggressive zinc supplementation d. lung disease - a. liver disease A patient with acute kidney injury (AKI) who requires parenteral nutrition support would most likely benefit from a solution containing which of the following? a. essential amino acids only b. essential amino acids with arginine only c. essential amino acids and nonessential amino acids d. essential amino acids and branched-chain amino acids - c. essential amino acids and nonessential amino acids Which of the following is NOT a common clinical symptom of celiac disease in childhood? a. failure to thrive b. constipation c. precocious puberty d. anemia - c. precocious puberty The presence of which of the following facilitates the absorption of sodium in the lumen of the small intestine? a. glucose b. potassium c. vitamin D d. protein - a. glucose 6 A 72-year old female with impaired renal function was prescribed sulfamethoxazole/trimethoprim for a urinary tract infection. What electrolyte disorder is MOST likely to occur? a. hypermagnesemia b. hyperkalemia c. hypercalcemia d. hyperphosphatemia - b. hyperkalemia An 80 year old man, living alone at home, has experienced a 15 lb unintentional weight loss over the last year and a half. The clinician assessing his nutrition status finds that he has inadequate intake. Which of the following is LEAST likely to contribute to his weight loss? a. decreased taste sensation b. social isolation c. a liberalized diet d. polypharmacy - c. a liberalized diet Which of the following tools includes the assessment of a long-term care resident's ability to maintain adequate nutrition and hydration and is mandated by the Center for Medicare and Medicaid (CMS) for certified long-term care facilities? a. minimum data sets (MDS) b. resident assessment protocols (RAP) c. utilization guidelines d. trigger legend - a. minimum data sets (MDS) Iron is primarily absorbed in the: a. stomach b. colon c. ileum d. jejunum - d. jejunum Use of a semi-elemental or elemental formula in place of a polymeric formula should be considered with: a. initiation of enteral nutrition b. intolerance to polymeric formula c. intestinal failure d. pancreatitis - b. intolerance to polymeric formula The FDA currently recommends that daily intake of parenteral aluminum not exceed what amount? a. 2 mcg/kg/day b. 5 mcg/kg/day c. 7 mcg/kg/day d. 10 mcg/kg/day - b. 5 mcg/kg/day 7 ERAS (Enhanced Recovery After Surgery) is a care program that has been shown to improve outcomes after major surgery. The key mechanism behind the ERAS effectiveness is: a. comprehensive preoperative nutrition counseling b. decrease the stress of surgery and support recovery c. decreased NPO duration and optimized nutrition before/after surgery d. the multi-professional and multidisciplinary approach - b. decrease the stress of surgery and support recovery A 24-year old woman is in the 10th week of her pregnancy. She has persistent nausea and vomiting for the past 6 weeks that has been associated with a 10% weight loss. Her nausea and vomiting is refractory to a 48 hour trial of anti-emetics and IV fluids. The decision to provide nutrition support is made to minimize further deterioration of the mother's nutritional status and possible negative effects on the fetus. What is the most appropriate initial nutrition therapy to implement? a. EN with isotonic formula via Nasogastric tube b. EN with isotonic formula via Gastrostomy tube c. EN with polymeric formula via Nasogastric tube d. EN with polymeric formula via Gastrostomy tube - c. EN with polymeric formula via Nasogastric tube The FDA-approved lipid injectable emulsion (ILE) that contains four oils differs from soybean oil-based fat emulsion in that it: a. contains egg yolk phospholipid as an emulsifying agent b. may be infused via peripheral or central intravenous line c. also contains MCT oil, olive oil, and fish oil d. provides essential fatty acids (EFAs) - c. also contains MCT oil, olive oil, and fish oil Which of the following can result in an invalid indirect calorimetry (IC) measurement? a. ascites b. chest tube leak c. hemodynamic stability d. inspired oxygen (FiO2) less than 20% - b. chest tube leak Which of the following is true regarding the concept of quality of life in home parenteral nutrition patients? a. most patients believe that the HPN access catheter has little effect on their self- image or self-esteem b. patients with chronic bowel disease seem to cope less effectively than patients with acute gastrointestinal trauma c. social isolation is not an issue since most infusions are cycled overnight d. adjusting to HPN is easier for patients who structure HPN around their specific lifestyles - d. adjusting to HPN is easier for patients who structure HPN around their specific lifestyles 10 b. inhibiting the growth of colonic bacteria c. reducing incidence of constipation d. removing water from the colon - a. increasing stool weight and bulk Which of the following medications has NOT been shown to lead to diarrhea in a patient receiving enteral nutrition? a. sorbitol-containing preparations b. Alpha-2 adrenergic agonists c. antibiotics d. magnesium-containing preparations - b. Alpha-2 adrenergic preparations Which protein transports oxygen from the lungs to other parts of the body? a. albumin b. hemoglobin c. lipoprotein d. retinol-binding protein - b. hemoglobin Which of the following best describes a lipid injectable emulsion (ILE) produced by the transesterification of fatty acids to form a composite triglyceride molecule? a. single oil b. multi-oil c. structured d. physical mixture - c. structured Which of the following is a clinical characteristic of acute disease or injury related severe malnutrition? a. moderate depletion of fat b. mild fluid accumulation c. mild depletion of muscle mass d. 10% weight loss in 6 months - a. moderate depletion of fat The initial daily protein requirements for a critically ill trauma patient weighting 70 kg and having a BMI of 23.4 are a. 55-70 grams b. 70-105 grams c. 105-140 grams d. 140-175 grams - c. 105-140 grams Which of the following is the MOST practical approach for managing micronutrients in long-term parenteral nutrition patients? a. obtain serum values for all vitamins and trace elements yearly b. perform a micronutrient assessment every 6 months c. provide micronutrients only when laboratory values indicate abnormal levels d. a nutrition focused physical assessment should be performed annually to determine micronutrient deficiencies - b. perform a micronutrient assessment every 6 months 11 Which of the following are examples of conditionally essential amino acids? a. leucine and isoleucine b. phenylalanine and valine c. glutamine and arginine d. histidine and glutamine - c. glutamine and arginine Which of the following is an example of a short chain fatty acid? a. lauric acid b. stearic acid c. oleic acid d. butyric acid - d. butyric acid A long-term PN patient presents with involuntary movements, tremor, and rigidity. Which of the following etiologies may explain these symptoms? a. manganese deficiency b. manganese toxicity c. selenium deficiency d. selenium toxicity - b. manganese toxicity What vitamin absorption is most likely to be impaired with chronic use of proton pump inhibitor therapy? a. vitamin B3 b. vitamin B1 c. vitamin B6 d. vitamin B12 - d. vitamin B12 Following initial certification of parenteral nutrition by Medicare, after what length of time is recertification required? a. 6 months b. 1 year c. 1 month d. never - a. 6 months Which oils are included in commercial enteral formulas to provide a good source of linoleic and alpha-linolenic acids? a. corn, olive, safflower, and canola oils b. corn, soybean, safflower, and canola oils c. coconut, olive, palm, and canola oils d. coconut, soybean, safflower, and canola oils - b. corn, soybean, safflower, and canola oils According to ASPEN PN Safety Consensus Recommendations, which of the following best describes safe PN compounding? a. The preparation with automated compounding devices ensures an error free process b. All healthcare providers should have the ability to override soft and hard limit alerts from ACDs 12 c. Manual compounding of PN is appropriate when volumes of a PN component to be mixed are less than the ACD can accurately deliver d. The preparation of compounded sterile preparations for all patient populations should be done at the same time - c. manual compounding of PN is appropriate when volumes of a PN component to be mixed are less than the ACD can accurately deliver A patient is receiving enteral nutrition during her second trimester of pregnancy. Nutritional assessment data reflect an average maternal weight gain of 0.42 lbs per week, normal fetal growth, an albumin of 2,0 gm/dl, and a nitrogen balance of +2 grams/day. Based on the data provided, which of the following parameters is not useful in assessing the efficacy of enteral nutrition in pregnancy? a. maternal weight gain b. fetal growth c. serum albumin d. nitrogen balance - c. serum albumin Which of the following is true regarding infectious complications associated with enteral feedings? a. bacterial contamination may originate from the patient's throat, lung, and stomach b. exceeding manufacture hang-time guidelines is not a risk for bacterial growth contamination c. open systems have less exogenous bacterial contamination d. the enteral tube site should be routinely cultured - a. bacterial contamination may originate from the patient's throat, lung, and stomach When initiating a PN regimen that contains regular insulin, how often should capillary blood glucose levels be monitored? a. every 6 hours b. every 8 hours c. every 12 hours d. every 24 hours - a. every 6 hours Which of the following is a conditionally essential amino acid that is also a primary fuel source of enterocytes? a. tryptophan b. proline c. glutamine d. arginine - c. gluatmine Which of the following is true of essential fatty acid deficiency in patients with cystic fibrosis? a. routine supplementation of omega-3 fatty acids is essential in the management of CF b. EFAD usually does not manifest in CF patients until the second decade c. CF patients without pancreatic insufficiency rarely develop EFAD d. EFA profiles have been shown to improve in CF patients after lung transplantation - d. EFA profiles have been shown to improve in CF patients after lung transplantation 15 When using cyclic parenteral nutrition (PN) solutions for nonstressed patients, age may be an important factor in monitoring for complications because older adults have a. higher rates of insulin resistance and hyperglycemia b. lower fat oxidation c. higher fluid requirements d. lower concentrations of free fatty acids - a. higher rates of insulin resistance and hyperglycemia Which of the following is common in both acute illness or injury related and social or environmental related malnutrition? a. ketosis b. hypoglycemia c. lipolysis d. hypermetabolism - c. lipolysis All of the following are potential causes of hyperglycemia in a patient receiving PN EXCEPT a. carbohydrate administration >5 mg/kg/min b. obesity c. sepsis d. renal failure - d. renal failure Which of the following types of fistulas will result in the greatest degree of nutritional loss? a. distal low output b. distal high output c. proximal low output d. proximal high output - d. proximal high output A patient receiving chronic PN therapy develops an intraluminal clot in his/her central venous access device. What is the most appropriate pharmacological intervention to clear this access device? a. heparin 100 units/ml b. alteplase 2 mg/2ml c. argatroban 350 mcg/kg d. streptokinase 10,000 units - b. alteplase 2 mg/2ml Which of the following is the best way to determine chromium deficiency? a. serum chromium levels b. urinary chromium levels c. there is no known reliable indicator of chromium status d. serum glucose to insulin ratio - c. there is no known reliable indicator of chromium status Non-nutritive sucking should be used in the enterally fed neonate less than 32 weeks corrected gestational age to promote 16 a. mother/child bonding b. weight gain c. correct development of facial and jaw muscles d. oral feeding when developmentally appropriate - d. oral feeding when developmentally appropriate What is the most important intervention to reduce the risk of pulmonary aspiration during gastric tube feeding? a. elevate the head of bed 30 to 45 degrees b. provide mouth care every 2 to 4 hours c. turn the tube feeding off when repositioning the patient d. hold tube feedings for a gastric residual >200 ml - a. elevate the head of bed 30 to 45 degrees Cycling parenteral nutrition is recommended in a. patients receiving short term parenteral nutrition b. patients at risk for liver dysfunction c. patients at risk for parenteral nutrition-associated hyperglycemia d. patients who are bed bound - b. patients at risk for liver dysfunction The routine use of preoperative parenteral nutrition (PN) is indicated for patients with non-functioning GI tract who are a. normally nourished b. mildly to moderately malnourished c. mildly malnourished with secondary co-morbidities d. severely malnourished - d. severely malnourished A 60-year old female is admitted with a stroke and fails a swallowing evaluation. A nasogastric tube is placed, and the physician requests an isotonic formula. Which of the following caloric densities of enteral formula is isotonic? a. 1.0 kcal/ml b. 1.2 kcal/ml c. 1.5 kcal/ml d. 2.0 kcal/ml - a. 1.0 kcal/ml Ursodiol facilitates absorption of a. carbohydrate b. protein c. fat d. vitamin K - c. fat Your patient is receiving the following PN order. 2400 ml with 300 grams of dextrose, 90 grams of protein in addition to 225 ml 20% ILE. How many calories and grams of fat is your patient receiving? a. 1830 kcal, 40 grams fat b. 2010 kcal, 40 grams fat 17 c. 1830 kcal, 45 grams fat d. 1470 kcal, 45 grams fat - c. 1830 kcal, 45 grams fat Upon initiation of home parenteral nutrition (HPN), initial laboratory data should be obtained a. within 48 hours after initiation b. prior to initiation c. the day of initiation d. within 1 week of initiation - b. prior to initiation Which of the following diagnoses would meet Medicare Part B coverage criteria to qualify a beneficiary for home enteral nutrition? a. dysphagia b. aspiration pneumonia c. anorexia d. malnutrition - a. dysphagia Lactic acidosis can be a result of which vitamin deficiency? a. folic acid b. vitamin E c. thiamin d. vitamin D - c. thiamin Which intervention assists with maintaining feeding tube patency in the adult patient? a. administer medications through feeding tube with 5 ml water b. use a 20 ml or smaller syringe to flush small bore feeding tubes c. flush feeding tube with 30 ml of water every 4 hours during continuous feeding d. change feeding tube every 72 hours - c. flush feeding tube with 30 ml of water every 4 hours during continuous feeding