ASPEN Practice Test Flashcards by Julia T

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 

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What trace element should be monitored in a child with chronic diarrhea?

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

2: Zinc 

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Enteral nutrition (EN) 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. 

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A patient arrives in your clinic complaining of intermittent catheter malfunction. You identify that the catheter malfunction is relieved by raising the patient’s arm where the catheter is located. Which condition should be suspected?

1: Fibrin sheath
 2: Pinch-off syndrome
 3: Superior vena cava syndrome 
4: Catheter migration

 2: Pinch-off syndrome

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Absorption of large polypeptides, oligopeptides and free amino acids takes place in the

1: small intestine. 
2: stomach. 
3: large intestine. 
4: mouth.

1: small intestine. 

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Which of the following is a risk factor for the development of PN-associated liver complications in PN-dependent patients?

1: Short bowel syndrome 
2: Cyclic infusion of PN 
3: Supplemental trophic enteral feeding
 4: Medication therapy with ursodiol

1: Short bowel syndrome 

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Following initial certification of parenteral nutrition by Medicare, after what length of time is recertification required?

1: 6 months 
2: 1 year
3: 1 month 
4: Never

1: 6 months 

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A patient receiving PN is afebrile, has negative blood cultures, but presents with redness and purulence at the catheter exit site. How is this exit site infection best managed?

1: Remove central venous catheter (CVC) 
2: Exchange catheter over a guidewire 
3: Initiate systemic antimicrobial therapy
4: Apply topical antibiotic ointment

3: Initiate systemic antimicrobial therapy

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Which of the following compromises the reliability of urinary urea nitrogen to calculate nitrogen balance?

1: protein intake 2.5 L
 4: fecal nitrogen >1g

2: creatinine clearance

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Medicare reimbursement for home and community-based professional nutrition educational services provided by a registered dietitian is restricted to patients who

1: live alone. 
2: have cancer. 
3: are over the age of 65. 
4: have diabetes or renal disease.

4: have diabetes or renal disease.

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Modular products are used to enhance the nutrient profile of a feeding regimen. Which of the following combinations represents modular products?

1: Safflower oil, protein, glucose, and selenium 
2: Glucose, glutamine, water, and MCT oil 
3: Protein, cholecalciferol, fiber, and safflower oil 
4: MCT oil, glucose, fiber, and protein

4: MCT oil, glucose, fiber, and protein

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In which of the following patient populations is toxicity with fat soluble drugs most likely?

1: Obese elderly 
2: Sedentary elderly
 3: Malnourished elderly
 4: Physically active elderly

1: Obese elderly 

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Phosphofructokinase, a rate-limiting enzyme of glycolysis, is inhibited when ATP is abundant. Why is this inhibition important?

1: Facilitates gluconeogenesis to maintain euglycemia 
2: Allows the cell to divert glucose to be stored as glycogen
 3: Promotes catabolism
 4: Enhances the Tricarboxylic Acid (TCA) Cycle

2: Allows the cell to divert glucose to be stored as glycogen

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A patient on long-term home enteral nutrition suddenly develops nausea and vomiting. The most likely cause is

1: frequent use of sorbitol-containing medications. 
2: gastric outlet obstruction. 
3: low osmolarity formula.
 4: sudden decrease in enteral feeding rate.

2: gastric outlet obstruction. 

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A previously well-nourished patient with persistent fever is admitted to the hospital. His laboratory tests reveal: albumin, 2.1 g/dL; C-reactive protein, 12 mg/L; serum calcium of 7.2 mg/dL. Which of the following is the most likely reason of the hypoalbuminemia?

1: Caloric intake is below the recommendations 
2: Protein intake is below the recommendations 
3: Hypocalcemia 
4: Inflammatory response

4: Inflammatory response

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The use of enteral nutrition formulas enriched with branched-chain amino acids is best used for patients with

1: cirrhosis. 
2: hepatic failure. 
3: liver transplantation. 
4: refractory encephalopathy. 

4: refractory encephalopathy. 

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An enzyme deficiency commonly seen in African Americans and Native Americans is

1: lactase. 
2: maltase. 
3: amylase. 
4: sucrase.

1: lactase. 

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Which of the following is a primary cause of oozing stools in a tube fed patient?

1: Fecal impaction 
2: Fluid restriction
 3: Physical inactivity 
4: Narcotic usage

1: Fecal impaction 

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Which of the following best describes the use of artificial nutrition and hydration (ANH) in terminally ill patients?

1: Those who receive ANH have a more comfortable death 
2: Those who have dysphagia survive longer with ANH 
3: Those who receive ANH have a decrease in abnormal electrolytes 
4: Those who receive no ANH survive as long or longer than those who do

4: Those who receive no ANH survive as long or longer than those who do

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Which of the following parameters is not useful in assessing the efficacy of enteral nutrition in pregnancy?

1: Maternal weight gain 
2: Fetal growth 
3: Serum Albumin 
4: Nitrogen balance

3: Serum Albumin 

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Which of the following tests is not used to assess vitamin A status?

1: Plasma carotenoid level 
2: Serum retinol concentration 
3: Plasma transthyretin-retinol binding protein (TTR-RBP) concentration 
4: Serum retinol binding protein level

1: Plasma carotenoid level 

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Arginine supplementation should be used most cautiously in which of the following patients?

1: Trauma patients 
2: Surgical patients 
3: Septic shock patients 
4: Immunocompromised patients

3: Septic shock patients 

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When transitioning a patient from hospital to home parenteral nutrition (HPN) support, screening criteria should include which of the following?

1: Transportation needed to make it to lab draws 
2: Presence of electricity and sanitary water supply in the home
 3: Cellular telephone access 
4: A caregiver

2: Presence of electricity and sanitary water supply in the home

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Increased mortality in maintenance hemodialysis patients has been associated with

1: low baseline body fat percentage and low muscle mass. 
2: elevated albumin and decreased CRP values. 
3: increased body mass index. 
4: decreased serum cholesterol.

1: low baseline body fat percentage and low muscle mass. 

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The best approach to prevent PN-induced cholelithiasis is administration of 1: choline.  2: cholecystokinin-octapeptide (CCK-OP).  3: ursodiol.  4: oral or enteral feeding.

4: oral or enteral feeding.

Which of the following should always appear on the label of an enteral feeding product given to a patient in the hospital? 1: Product name, rate, volume, additives, caloric density,date and time the formula was prepared and hung  2: Patient identification, product name, administration method , date and time the formula was prepared and hung  3: Patient's name, product name, rate, strength, osmolality, date and time the formula was prepared and hung  4: Patient's name, room number, strength, additives, volume,date and time the formula was prepared and hung

2: Patient identification, product name, administration method , date and time the formula was prepared and hung 

In response to illness and trauma, there is an increase in which of the following hormones? 1: Cortisol, epinephrine, growth hormone, and glucagon  2: Insulin, epinephrine, estrogen, and somatostatin  3: Glucagon, gastrin, insulin-like growth factor, and renin  4: Leptin, cortisol, growth hormone, and cholecystokinin

1: Cortisol, epinephrine, growth hormone, and glucagon 

The presence of which of the following facilitates the absorption of sodium in the lumen of the small intestine? 1: Glucose  2: Potassium  3: Vitamin D  4: Protein

1: Glucose 

Which of the following are considered the lowest risk candidates for initiation of parenteral nutrition (PN) in the home setting would be 1: infants.  2: teenagers.  3: intravenous drug abusers.  4: diabetic patients.

2: teenagers. 

Serum conjugated bilirubin level is elevated in an adult patient with short bowel syndrome. The patient has been receiving a 12-hour cycle of 3-in-1 home parenteral nutrition (HPN) solution. The clinician's initial plan may include Serum conjugated bilirubin level is elevated in an adult patient with short bowel syndrome. The patient has been receiving a 12 hour cycle of 3-in-1 home parenteral nutrition (HPN) solution. The clinician’s initial plan may include 1: removal of all trace elements from HPN.  2: increasing lipid calories to prevent essential fatty acid deficiency.  3: evaluation for possible overfeeding of dextrose and/or intravenous fat emulsion.  4: addition of carnitine and choline to the HPN.

3: evaluation for possible overfeeding of dextrose and/or intravenous fat emulsion.

Which of the following therapies would be considered most appropriate in the nutritional management of chronic lung disease? 1: Use of concentrated formula  2: Use of a high fat, low carbohydrate formula  3: Use of a hydrolyzed protein formula  4: Use of an MCT oil predominant formula

1: Use of concentrated formula 

When used in assessment of critically ill children, how do predictive equations compare to indirect calorimetry? 1: No consistent comparison can be found  2: Equations typically overestimate needs  3: Equations typically underestimate needs 4: Equations correlate well with indirect calorimetry

1: No consistent comparison can be found 

Which of the following is a sign observed in PN patients with inadequate chromium intake? 1: Weight gain  2: Hypoglycemia  3: Hyperglycemia  4: Rhabdomyolysis

3: Hyperglycemia 

During extended periods of fasting (starvation), the main source of energy is from 1: protein catabolism.  2: gluconeogenesis.  3: glycolysis.  4: ketogenesis.

4: ketogenesis.

Which of the following best reflects the use of specialized nutrition support (SNS) in patients with a Do Not Resuscitate (DNR) status? 1: The DNR status is a contraindication to the provision of SNS  2: The DNR status should not preclude the initiation of SNS if the indications exist  3: The provision of SNS to a patient with a DNR status is based on individual state laws  4: SNS cannot be withheld or withdrawn in a patient with a DNR order, even if all agree that SNS is no longer meeting the desired goal

2: The DNR status should not preclude the initiation of SNS if the indications exist 

Which of the following is TRUE regarding aspiration in critically ill children? 1: The incidence of aspiration directly caused by enteral nutrition is difficult to determine due to a lack of good clinical research  2: Increased gastric residuals are directly related to increased risk for aspiration  3: Children have strong coordination of pharyngeal muscles, making aspiration less likely than in adults  4: Children have strong cough reflex which helps protect them from aspiration

1: The incidence of aspiration directly caused by enteral nutrition is difficult to determine due to a lack of good clinical research 

After placement of a central line, discovery of a pneumothorax during PN administration should be viewed as a 1: sentinel event.  2: process indicator.  3: resource indicator.  4: structural indicator.

1: sentinel event. 

In an infant with adequate energy intake, what is the MINIMUM amount of fat emulsion containing long chain fatty acids needed to prevent essential fatty acid deficiency? 1: 0.2-0.4 g/kg/day  2: 0.5-1.0 g/kg/day  3: 1.1-1.5 g/kg/day  4: 1.8-2.0 g/kg/day

2: 0.5-1.0 g/kg/day 

Which of the following best describes the addition of blue dye to enteral feedings? 1: It prevents aspiration of enteral formula  2: Its use in detection of aspiration is highly sensitive  3: It should be added only in small amounts  4: It is no longer recommended for the detection of aspiration of enteral formula

4: It is no longer recommended for the detection of aspiration of enteral formula

What is the nutritional value of the following PN order? 2400 mL with 300 grams dextrose and 90 grams protein in addition to 225 mL 20% IVFE. 1: 1830 kcal, 90 grams protein, 40 grams fat, 2625 mL 2: 2010 kcal, 90 grams protein, 40 grams fat, 2400 mL  3: 1830 kcal, 90 grams protein, 45 grams fat, 2625 mL  4: 1470 kcal, 90 grams protein, 45 grams fat, 2400 mL

3: 1830 kcal, 90 grams protein, 45 grams fat, 2625 mL 

Managed care and private insurance companies often use which established criteria/guidelines when approving coverage for home parenteral nutrition? 1: Medicare criteria  2: State-funded Medicaid program criteria  3: Oley Foundation criteria  4: A.S.P.E.N. Standards for Specialized Nutrition Support: Home Care Patients

1: Medicare criteria 

Third-party payors (insurance companies) are LEAST likely to reimburse which of the following home enteral nutrition expenses? 1: Feeding bags and tubing  2: Enteral feeding pumps  3: Enteral formula  4: IV pole and/or syringes

3: Enteral formula 

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 

Which of the following is the BEST indication for use of a soy-based infant formula? 1: Diarrhea  2: Cow's milk protein allergy  3: Galactosemia  4: Regurgitation with feeds

3: Galactosemia 

An 87-year-old woman underwent a total abdominal colectomy. Her ileostomy output is 1.5-2.0 liters per day. Supplementation of which of the following micronutrients should be considered? 1: Zinc  2: Copper  3: Vitamin E  4: Chromium

1: Zinc 

A 60-year-old female (45 kg) is receiving PN for a rectovaginal fistula. The PN formula consists of the following components: 70 grams protein, 400 grams dextrose, and 25 grams fat infused continuously in a total volume of 1.5 liters. Which one of the following complications is she at greatest risk for developing? (24-hour continuous PN infusion; Total PN Volume with electrolytes and additives is 1.5 L) 1: Hypertriglyceridemia  2: Azotemia  3: Hyperglycemia  4: Pulmonary edema

3: Hyperglycemia

An infant has a complete ileal resection with preservation of the ileocecal valve. Of the following, the primary nutrition-related concern will be 1: decreased vitamin B12 absorption.  2: water soluble vitamin malabsorption.  3: dumping syndrome.  4: protein malabsorption due to decreased cholecystokinin secretion.

1: decreased vitamin B12 absorption. 

A 40-year-old male receiving chronic PN therapy (initiated 15 years ago) secondary to massive bowel resection develops metabolic bone disease. His current 12-hour cyclic PN formula provides 5 g/kg/day dextrose, 2 g/kg/day protein and 1 g/kg/day of fat. What is the most appropriate intervention to reduce hypercalciuria? 1: Increase calcium gluconate  2: Decrease phosphorus supplementation  3: Shorten PN infusion time to 10 hours  4: Decrease amino acid content of PN solution

4: Decrease amino acid content of PN solution

The clinical presentation of refeeding syndrome includes all of the following EXCEPT 1: respiratory failure.  2: muscle weakness.  3: cardiac arrythmias.  4: dehydration

4: dehydration

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 incompetent and in an irreversible vegetative state. In deciding whether to continue nutrition and hydration by medical means, the patient's surrogate decision-maker must 1: consult with a lawyer.  2: have a psychiatric evaluation to be declared competent to make any decisions in the patient's care.  3: honor the patient's expressed wish to withdraw nutrition and hydration by medical means.  4: decide, based upon own values, to make a decision to withdraw the patient's nutrition and hydration by medical means.

3: honor the patient's expressed wish to withdraw nutrition and hydration by medical means.

Discontinuation of intravenous fat emulsion (IVFE) is recommended treatment of catheter-related bloodstream infection due to 1: coagulase-negative staphylocci.  2: staphylococcus aureus.  3: pseudomonas aeruginosa.  4: malassezia furfur.

4: malassezia furfur.

The highest prevalence and severity of weight loss is found in patients with which of the following types of cancer? 1: Lung and colon  2: Breast and ovarian  3: Prostate and testicular  4: Pancreatic and gastric

4: Pancreatic and gastric

Medicare approved indications for home parenteral nutrition (HPN) include which of the following? 1: Supplement to enteral nutrition  2: End-stage renal disease (ESRD)  3: Long-term loss of gastrointestinal function  4: Delayed gastric emptying

3: Long-term loss of gastrointestinal function 

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 

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 

What is the optimal sodium concentration of an oral rehydration solution for patients with short bowel syndrome? 1: 40 mmol/L  2: 90 mmol/L  3: 140 mmol/L  4: 190 mmol/L

 2: 90 mmol/L 

Presence of dietary fat in the distal ileum contributes to 1: increased gastric emptying 2: slowed intestinal transit  3: bacterial fermentation  4: production of short chain fatty acids

2: slowed intestinal transit 

Patients with diabetes who are receiving PN 1: should have blood glucose checked every 2 hours.  2: have an increased incidence of catheter related infections.  3: often require high protein doses.  4: often develop micronutrient deficiencies.

2: have an increased incidence of catheter related infections. 

The use of Lactobacillus GG in pediatric practice has been found to be MOST effective in 1: treating infectious diarrhea.  2: reducing the incidence of NEC.  3: prolonging time to remission in children with Crohn’s.  4: eradicating heliobacter pylori infection.

1: treating infectious diarrhea. 

Which water-soluble vitamins do not require NA+ co-transporters for absorption? 1: Vitamin C and Vitamin B6  2: Vitamin E and Vitamin D  3: Vitamin B12and Folic acid  4: B1 and Choline

 3: Vitamin B12and Folic acid 

Which of the following is a strong indication for the use of parenteral nutrition (PN)? 1: High output fistula  2: Crohn's disease  3: Pancreatitis  4: Hyperemesis gravidarum

1: High output fistula 

Supplementation with which of the following nutrients is routinely restricted during the early stages following hematopoietic stem cell transplantation (HSCT)? 1: Sodium  2: Folate  3: Iron  4: Vitamin B12

 3: Iron 

A 62-year-old female with impaired renal function was prescribed sulfamethoxazole/trimethoprim for a urinary tract infection. What electrolyte disorder is likely to occur? 1: Hypermagnesemia  2: Hyperkalemia  3: Hypercalcemia  4: Hyperphosphatemia

2: Hyperkalemia

Which can decrease the accuracy of an indirect calorimetry study? 1: mechanical ventilation with FiO2 >= 60.  2: holding routine nursing care or activities during the study.  3: measurements made in a quiet, thermoneutral environment.  4: stable nutrient intake for the previous 12 hours.

1: mechanical ventilation with FiO2 >= 60. 

Which of the following is a benefit of closed enteral feeding systems? 1: Decreased risk for microbial contamination  2: Maximum hang time of 8-12 hours  3: Packaging amenable to addition of medication or modular  4: Decreased incidence of gastric intolerance

1: Decreased risk for microbial contamination

Which of the following reduces the risk of calcium phosphate precipitation in PN? 1: Increased amino acid concentration  2: Use of calcium chloride as the calcium salt  3: Increased temperature  4: Adding calcium salt immediately after adding phosphate salt

1: Increased amino acid concentration 

When is parenteral nutrition (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: Enteral nutrition is contraindicated or unlikely to meet nutrition needs  4: Within 7-10 days after hospital admission

 3: Enteral nutrition is contraindicated or unlikely to meet nutrition needs 

The use of 0.1N hydrochloric acid is most effective for clearing catheter occlusions due to precipation of 1: calcium-phosphate.  2: tobramycin.  3: phenytoin.  4: lipid residue.

1: calcium-phosphate. 

The most effective strategy to DECREASE the risk of catheter-associated sepsis is use of 1: povidone-iodine as a skin preparation.  2: antibiotic ointment at catheter exit site.  3: antibiotic prophylaxis during catheter insertion.  4: full-barrier precautions during catheter insertion.

4: full-barrier precautions during catheter insertion.

Which of the following children is at greatest risk for iron deficiency anemia? 1: 4 month-old term infant exclusively fed human milk  2: 4 month corrected gestational age, former preemie on a transitional formula  3: 10 month-old switched from formula to whole milk  4: 17 month-old "picky eater"

 3: 10 month-old switched from formula to whole milk 

What is the fluid requirement for patients during critical illness and sepsis? 1: 15-25 mL/kg/day  2: 30-40 mL/kg/day  3: 45-55 mL/kg/day  4: 60-70 mL/kg/day

 2: 30-40 mL/kg/day 

In a preterm infant, which of the following amino acids is separately added to parenteral nutrition solutions due to solubility concerns? 1: Glycine  2: Cysteine  3: Methionine  4: Phenylalanine

2: Cysteine 

If a 68-year-old woman with encephalopathy is receiving a tube feeding due to recent gastrointestinal surgery and develops elevated ammonia levels, which of the following should be tried first? 1: Decrease in amount of protein given to 0.6 g/kg of body weight  2: Medium-chain triglyceride added to tube feeding  3: Formula enriched with branched-chain amino acids  4: Lactulose and neomycin therapy

4: Lactulose and neomycin therapy

The best method to administer psyllium soluble fiber via feeding tube is to 1: mix with formula and infuse via a gravity feeding bag  2: mix with formula and infuse with feeding pump  3: mix with water and other medications and give by syringe followed by 15 mL water flush.  4: dilute in water and give by syringe followed by 15 mL water flush.

4: dilute in water and give by syringe followed by 15 mL water flush.

During discharge education, which of the following is the BEST way for a home nutrition support provider to know if a patient and/or caregiver understands enteral tube feeding delivery? 1: Verbal description of proper techniques  2: Written explanation of proper techniques  3: Appropriate responses to questions asked  4: Return demonstration of procedure techniques

4: Return demonstration of procedure techniques

Sarcopenia, a loss of lean body mass that occurs with aging, is also associated with 1: excess growth hormone.  2: decreased cytokine activity.  3: decreased bone density.  4: decreased total body fat.

3: decreased bone density.

An elderly patient requires bowel rest for 6 weeks. Which of the following feeding delivery methods should be employed? 1: PN through a port  2: PN through a PICC line  3: Peripheral PN  4: PN through a short-term central venous catheter

 2: PN through a PICC line 

PN solutions should NOT be infused via a catheter inserted in which vein? 1: Basilic  2: Femoral  3: Subclavian  4: Internal jugular

2: Femoral 

Fibrin that builds up on the wall of blood vessels may also adhere to the catheter creating a 1: fibrin sheath.  2: fibrin tail.  3: intraluminal thrombus.  4: mural thrombus.

4: mural thrombus.

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) 

Which is considered inappropriate management of hypergranulation around the PEG site? 1: Keeping the area dry  2: Using a tube stabilizing device  3: Applying an occlusive dressing  4: Cauterization with silver nitrate

3: Applying an occlusive dressing 

Which of the following is NOT a perceived benefit of early enteral feeding in critically ill patients? 1: May prevent of translocation of gut bacteria  2: Reduces atrophy of intestinal villae  3: Fewer infectious complications than parenterally fed patients  4: Increases intestinal permeability

4: Increases intestinal permeability

A patient with chronic heart failure on high-dose furosemide is started on enteral nutrition for an inability to consume adequate oral nutrition. Despite a slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected in the cause of his symptoms? 1: Thiamin  2: Vitamin B12  3: Folate  4: Riboflavin

1: Thiamin

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

 4: Preoperatively regardless of nutrition status

Which of the following best describes the benefit of megestrol acetate in patients with cancer-associated cachexia? 1: Increase in lean muscle mass  2: Decreases the risk of thromboembolic events  3: Improves blood glucose control in diabetes mellitus  4: Improves appetite and ameliorates weight loss

4: Improves appetite and ameliorates weight loss

To meet the Medicare payor criteria for home enteral or parenteral nutrition, the patient's condition must be considered to be “of long and indefinite duration”. Which length of time below meets Medicare’s test of permanence requirement? 1: 30 days.  2: 60 days.  3: 90 days.  4: 120 days.

3: 90 days. 

RNA and DNA are hydrolyzed to form mononucleotides during the digestion of 1: nucleic acids.  2: protein.  3: fats.  4: carbohydrate.

1: nucleic acids. 

According to current Medicare guidelines, coverage for an enteral feeding pump can be justified under which of these circumstances? 1: The patient is being fed using a jejunal feeding tube  2: The patient states that bolus tube feedings interrupt his daily schedule; his preference is to infuse feedings during the night using a pump  3: The patient’s caregiver has difficulty preparing several bolus feedings each day  4: The patient would like enteral feedings to infuse quickly.

1: The patient is being fed using a jejunal feeding tube 

All of the following may be short-term complications of home parenteral nutrition EXCEPT 1: dehydration.  2: metabolic bone disease.  3: refeeding syndrome.  4: catheter malposition.

2: metabolic bone disease. 

Copper toxicity is associated with 1: liver disease.  2: kidney disease requiring hemodialysis.  3: aggressive zinc supplementation.  4: lung disease.

1: liver disease.

What is the primary fuel of the colonocytes? 1: Medium chain fatty acids  2: Glucose  3: Glutamine  4: Short chain fatty acids

4: Short chain fatty acids

Which of the following is NOT a research-based method used to restore patency to clogged feeding tubes? 1: Water flush  2: Cranberry juice flush  3: Mechanical declogging devices  4: Pancreatic enzyme mixed with sodium bicarbonate

2: Cranberry juice flush 

Which of the following strategies is a common cause for feeding tube occulsion? 1: Optimal flushing between medications  2: Administration of high protein/high fiber formula  3: Choosing liquid medication over pill  4: Frequent checking of gastric residuals

 2: Administration of high protein/high fiber formula 

Which of the following are counter-regulatory hormones responsible for the hypercatabolism observed in critically ill trauma patients? 1: Glycogen, insulin, norepinephrine  2: Glucagon, epinephrine, cortisol  3: Glycerol, serotonin, thymoglobulin  4: Glycerin, leptin, adenosine

 2: Glucagon, epinephrine, cortisol 

Up to 26% of enterally fed patients report nausea and/or vomiting. If delayed gastric emptying is suspected as the causative factor, which of the following is LEAST likely to improve the patient's symptoms? 1: Reduce or discontinue narcotic medications  2: Switch to a low fat enteral formula  3: Reduce the rate of enteral nutrition infusion  4: Use a more concentrated enteral formula

4: Use a more concentrated enteral formula

In patients with burns, providing caloric support above energy expenditure has been found to 1: decrease mortality.  2: improve wound healing.  3: decrease fat mass accumulation.  4: have no effect on lean body mass preservation.

4: have no effect on lean body mass preservation.

Cycling parenteral nutrition is recommended in 1: patients receiving short term parenteral nutrition.  2: patients at risk for liver dysfunction.  3: patients at risk for parenteral nutrition-associated hyperglycemia.  4: bed-bound patients.

2: patients at risk for liver dysfunction. 

Which of the following methods to determine energy expenditure Incorporate body surface area? 1: Harris-Benedict Equation.  2: Ireton-Jones Equation  3: Mifflin-St. Jeor Equation.  4: Swinamer Equation.

4: Swinamer Equation.

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