OM

Question 1

The Joint Commission recommends nutrition screening be completed within ___ hours

Answer 1

24

Question 2

According to the 2017 ASPEN clinical guidelines, recommended minimum protein requirement for critically ill children is ___ g/kg/day, whilst for the neonatal population this can be as high as ___ g/kg/day.

Answer 2

1.5, 3

ECMO = 3g

Question 3

What type of feeding tube would be appropriate for someone with a facial fracture?

Answer 3

Nasal insertion of enteral tubes is contra-indicated in an infant, child or young person with a basal skull fracture, maxillo facial abnormalities, or nasopharyngeal abnormalities.

Question 4

What electrolyte abnormality is associated with sucrafalate?

Answer 4

Hypophosphatemia (phos binding properties. Note sucrafalate is also an aluminum containing agent.

Question 5

___ is the only FDA approved drug for SBS patients on home TPN, improves gastric emptying and intestinal transit, decreases gastric and bowel secretions in SBS → may reduce PN use

Answer 5

Gattex (teduglutide)

Question 6

What type of central line is associated with pneumothorax?

Answer 6

Tunneled line

Question 7

A ___ is a patient safety event of an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.

Answer 7

Sentinel event

Examples of sentinel events include medication errors, wrong site surgery, restraint-related deaths, blood transfusion errors, and operative or postoperative complications.

Question 8

The Joint Commission’s sentinel event policy is designed to help organizations ___ sentinel events and take action to ___ their recurrence.

Answer 8

Identify, prevent

Question 9

What is the primary fuel for enterocytes?

Answer 9

Glutamine

Question 10

SCFAs such as ___,___ and ___ serve as fuel for the colonocytes.

Answer 10

Acetate, butyrate, and propionate

Question 11

Digoxin toxicity can be exacerbated by what electrolyte abnormalities?

Answer 11

Hypokalemia, hypomagnesemia (which increase the heart’s sensitivity to digoxin)

Question 12

Digoxin primarily affects ___ levels by indirectly increasing intracellular ___ in cardiac muscle cells

Answer 12

Calcium, calcium

Question 13

What is ursodiol? What patients may benefit from this medication?

Answer 13

Form of bile acid that helps improve fat absorption, those with PNALD may benefit

Question 14

Indirect calorimetry is a respiratory measurement that under proper conditions is equivalent to metabolism, any factor that violates these conditions is a contraindication to IC.

Name the 6 major contraindications to IC.

Answer 14

1. Air leaks
2. Extracorporeal membrane oxygenation (ECMO)
3. HD
4. FiO2 >60%
5. Supplemental oxygen
6. Anxiety/claustrophobia

Question 15

Use of ___-barrier precautions during catheter insertion (mask, cap, sterile gloves, long-sleeve gowns, and sheet drapes) reduces the incidence of catheter-related infections more than the use of only sterile gloves and drapes alone.

Answer 15

Maximal

Question 16

Skin preparation with ___ during catheter insertion results in lower incidence of microbial colonization than povidone-iodine.

Answer 16

Chlorhexidine

Question 17

Prophylactic use of ___ at the catheter exit site encourages the development of resistant flora and should be avoided.

Answer 17

Antibiotic ointment

Question 18

___ during catheter insertion has not been demonstrated to reduce the incidence of catheter-associated sepsis.

Answer 18

Antibiotic prophylaxis

Question 19

Ethanol locks can be used in ___ based catheters

Answer 19

Silicon (more durable than polyurethane)

CVADs made of polyurethane material have ruptured and split when ethanol lock solutions were used for intraluminal locking. However, ethanol can be safely instilled into a silicone catheter

Question 20

Most NG tubes are made of what?

Answer 20

Polyurethane

Question 21

Most permanent feeding tubes are made of what?

Answer 21

Silicon

Question 22

___ lock solutions include ethanol, taurolidine, citrate, 26% sodium chloride, and EDTA. Ethanol locking solutions exhibit bactericidal and fungicidal properties and have been shown to eradicate organisms in ___ to prophylactically prevent and treat CRBSI

Answer 22

Antiseptic, biofilm

Question 23

Antibiotic lock therapy solutions contain ___ concentrations of antibiotics, which are chosen based on the infecting organism. The emergence of antimicrobial-resistant bacterial strains is a concern with the use of antibiotic lock therapy. Because biofilm that forms naturally can be difficult to penetrate with antibiotic lock therapy, even ___ concentrations of ongoing antibiotics are needed

Answer 23

Higher, higher

Question 24

An example of a solution used in an antiseptic lock is ___.

___ are difficult to penetrate with antibiotic locks, which is why you need the antiseptic.

Answer 24

70% ethanol

Biofilms

Question 25

An RQ <0.7 or >1.0 may result from ___ or ___.

Answer 25

Hypoventilation or hyperventilation

Question 26

An RQ of 0.71 is traditionally interpreted as primarily ___ oxidation.

Answer 26

Fat

Question 27

An RQ of 0.82 is traditionally interpreted as primarily ___ oxidation.

Answer 27

Protein

Question 28

An RQ of 0.85 is traditionally interpreted as primarily ___.

Answer 28

Mixed substrate utilization

Question 29

An RQ of 1.0 is traditionally interpreted as primarily ___ oxidation.

Answer 29

Carbohydrate

Question 30

Hospital prepared formula needs to be kept in the fridge at ___* C (___*F)

Answer 30

4C, 39F In order to o keep below temperature danger zone (41-135*F)

Question 31

Powered/reconstituted should only be kept in the fridge for ___ hours.

Answer 31

<24

Question 32

TPN needs to be held at room temperature of ___*C (___*F). How long is it shelf stable at this temperature?

Answer 32

25C (77F) 30 hours

Question 33

TPN needs to be refrigerated at ___*C (___*F). How long is it OK to keep at this temperature?

Answer 33

5C (41*F) 9 days

Question 34

Home prepared/blenderized formulas: must be discarded after ___ hours

Answer 34

24

Question 35

Cold storage of TPN decreases ___ risk

Answer 35

Precipitation

Question 36

The maximum hang time for human milk is ___ hours

Answer 36

4 hours

Question 37

At home, open systems have a max hang time of ___ hours

Answer 37

12 hours (unlike max 8 hours in the hospital)

Question 38

At home, closed systems have a max hang time of ___ hours

Answer 38

24-48 hours

Question 39

At home, prepared/re-constituted/blenderized formulas have a max hang time of ___ hours

Answer 39

4

Question 40

The maximum hang time for open systems in the hospital is ___ hours (if powered/reconstituted) and ___ hours if canned/bottled

Answer 40

4 hours 8 hours

Question 41

In the hospital, blenderized formulas can hang for ___ hours

Answer 41

2-8 hours (depending on if commercial or homemade)

Question 42

Feeding administration set should be changed every ___ hours in open systems (except breast milk, every ___ hours)

Answer 42

24, 4

Question 43

Only ___ hour supply should be poured into open administration set

Answer 43

8-12

Question 44

What is catheter-related phlebitis?

Answer 44

Characterized by inflammation of the vessel wall as well as erythema and pain near the catheter insertion site or along the affected vein

Question 45

Conventional therapy for an occluded CVAD due to an intraluminal clot or fibrin sheath is local ___ therapy with a low dose agent in a single or repeated bolus. ___is the only FDA-approved thrombolytic agent for CVAD occlusions.

Answer 45

Thrombolytic Cathflow (Alteplase)

Question 46

Fibrin sheaths often occur on the ___ catheter ___ and work as a ___ valve allowing medications and nutrition to be infused but making aspiration of blood difficult.

Answer 46

Distal, tip One-way

Question 47

A fibrin sheath (or fibrin sleeve) is a thrombotic catheter occlusion and develops when ___ adheres to the ___ of the catheter.

Answer 47

Fibrin, external surfaces

Question 48

What is the difference between a fibrin sheath and fibrin flap?

Answer 48

A fibrin sheath Surrounds catheter body and forms a tube-like encasement. A fibrin flap is more around the tip of the catheter and is a flap/strand around the tip

Question 49

What type of occlusion is characterized by fibrin on the CVC tip that allows infusion, not withdrawal?

Answer 49

Fibrin tail/flap:

Question 50

Fibrin sleeve formation is seen as a common complication of ___ devices.

Answer 50

Silicone

Question 51

Choline is required for ___transport and metabolism. Low plasma choline levels in patients on long-term PN have been associated with elevated ___ concentrations

Answer 51

lipid, liver aminotransferase concentrations. Investigations reported that steatosis resolved following choline supplementation. Currently PN admixtures do not contain choline. Further studies to evaluate choline supplementation to prevent and treat PN associated liver disease are needed.

Question 52

Protein needs for CVVH

Answer 52

1.5-1.8

Question 53

What is an "odds ratio"

Answer 53

An odds ratio (OR) is a statistical measure that expresses the likelihood of an event occurring in one group versus another group. It is calculated by dividing the odds of the event occurring in the first group by the odds of the event occurring in the second group. OR = 1 = no difference OR = <1 = decrease in odds of meeting outcome in treatment vs control group OR = >1 = increase in odds of meeting outcome in treatment vs control

Question 54

What is the "p-value"

Answer 54

A p-value measures the probability of obtaining the observed results, assuming that the null hypothesis is true. The lower the p-value, the greater the statistical significance of the observed difference. A p-value of 0.05 or lower is generally considered statistically significant.

Question 55

Randomized control trial

Answer 55

Prospective study, can obtain relative risk, incident rate

Question 56

Cohort Study

Answer 56

Prospective, observational study, obtain relative risk, not randomized, just assess impact of exposure (E)/risk factor (RF) on disease outcome

Question 57

Case-Control Study

Answer 57

Retrospective, observational, obtain Odds Ratio, look back in time based on who has disease now

Question 58

Cross-sectional study

Answer 58

Association, observational study with simultaneous data collection all at one point in time, shows correlation not causation to give prevalence estimates

Question 59

What would be the best study design for: A new drug or therapy (ex: effectiveness of vitamin supplement on UTI incidence?)

Answer 59

Randomized, double blinded, placebo controlled study

Question 60

What would be the best study design for: The best diagnosis or screening tool (ex: CT vs. ultrasound to determine muscle loss?)

Answer 60

cross sectional survey comparing new with established standard

Question 61

What would be the best study design for: Determining causation/association (ex: malnutrition dx impact on inpatient falls?)

Answer 61

cohort or case controlled, possibly case reports

Question 62

What would be the best study design for: Determining prognosis (ex: diet changes leading to initial and sustained wt loss over time?)

Answer 62

longitudinal cohort study

Question 63

Adequate Power (standard 0.8-80% power)

Answer 63

Capacity of the study to detect a difference/relationship that exists in a population

Question 64

Relative Risk/Risk Ratio

Answer 64

Ratio of two probabilities, if >1 indicates will achieve outcome

Question 65

Effect Size

Answer 65

Indicates practical importance of outcome, the larger the effect size the more impact on the population

Question 66

Type 1, 2, 3 and 4 errors

Answer 66

Type 1 Error = rejecting the null hypothesis when it’s actually true (false positive). Ex: When conclusion is that a difference exists when it doesn’t (e.g., tell man they’re pregnant) Type 2 Error = failing to reject the null hypothesis when it’s actually false (false negative). Ex: When conclude no difference exists when there actually is one (e.g., tell pregnant woman they’re not pregnant) Type 3 Error = reject null hypothesis correctly but for the wrong reason Type 4 Error = specific type of type 3 error, when reject null hypothesis correctly by misinterpreting the results