ASPEN CNSC FINAL PAPER COMPLETE
QUESTIONS AND ANSWERS GRADED A+
◍ Name 6 possible causes of constipation with enteral nutrition.
Answer: 1. lack of adequate hydration
2. long term fiber-free feedings
3. prolonged bedrest
4. Impaction
5. Obstruction
6. Narcotics
◍ Which of the following is the most likely cause of watery diarrhea
and bloating in the enterally fed adult patient?
1. lactose content of the enteral formula
2. sorbitol content of liquid medications
3. Sorbitol content of the enteral formula
4. Lactose content of liquid medications Answer: 2. sorbitol content
of liquid medications
◍ Do adult enteral products contain lactose? Answer: No
◍ Do liquid medications contain lactose? Answer: the lactose content
of most individual dosage forms of medication is too small to result in
significant digestive problems
,◍ Is sorbitol an ingredient in enteral formulas? Answer: No
◍ 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 Answer: 4. use a more
concentrated enteral formula
◍ 4 strategies to reduce nausea vomiting with enteral feedings?
Answer: 1. reduction or discontinuation of narcotic medications
2. use of low fat formulas
3. administering enteral formula t room temperature
4. reducing the rate and/or volume of tube feeding infusion
◍ Although the etiology of nausea and vomiting is multifactorial
what is a common source of this tubefeeding intolerance? Answer:
Delayed gastric emptying
◍ Why would concentrated enteral solutions not be recommended for
nausea/vomiting? Answer: Concentrated enteral solutions generally
contain more fat and can contribute to enteral intolerance by
,presenting a higher osmotic load to the GI tract. They also slow
gastric emptying.
◍ The initiation of enteral tube feeding should be delayed when the
patient is
1. hemodynamically unstable
2. at a decreased level of consciousness
3. without bowel sounds
4. scheduled for discharge Answer: 1. hemodynamically unstable
◍ EN should be delayed until these 3 things can be accomplished in
order to reduce the risk of intestinal ischemia? Answer: 1. patient is
fully volume resuscitated
2. hemodynamically stable
3. mesenteric perfusion has been restored
◍ Is evidence of bowel function (bowel sounds) required prior to
starting enteral nutrition? Answer: No
◍ What is the evidence for not withholding EN until patient is fully
volume resuscitated, hemodynamically stable and mesenteric
perfusion has been restored? Answer: A recent retrospective trial
indicates early EN in hemodynamically unstable patients receiving
mechanical ventilation may decrease mortality; however, due to
inherent study limitations further prospective randomized trials are
needed before guideline changes can be made
, ◍ When initiating and advancing enteral feedings in the hospitalized
patient, which of the following is most appropriate?
1. 1/2 strength formula at 25 mL/hr, advance to goal rate and strength
over 5-7 days
2. 240 mL bolus feeds of full strength hypertonic formulas every 4
hours
3. full strength formula at 10-40 mL/hour and advance by 10-20
mL/hour every 8-12 hours to goal rate
4. 1/4 strength formula at goal rate. Advance to full strength over 3-5
days Answer: 3 Full strength formula at 10-40 mL/hour and advance
by 10-20 mL/hour every 8-12 hours to goal rate
◍ What is the current recommendation for initiating enteral feedings
in adults and children? Answer: Currently, it is recommended that
feedings in adults and children be initiated with full strength formulas
at a slow rate and steadily advanced.
◍ 2 benefits of initiating enteral feedings at full strength formula at a
slow rate and steadily advancing? Answer: 1. Goal rates achieved
earlier
2. Reduces the risk for microbial contamination by minimizing the
number of times the formula is manipulated
◍ While a patient is receiving speech therapy, oral foods are provided
during the daytime hours. To meet the patient's nutritional
QUESTIONS AND ANSWERS GRADED A+
◍ Name 6 possible causes of constipation with enteral nutrition.
Answer: 1. lack of adequate hydration
2. long term fiber-free feedings
3. prolonged bedrest
4. Impaction
5. Obstruction
6. Narcotics
◍ Which of the following is the most likely cause of watery diarrhea
and bloating in the enterally fed adult patient?
1. lactose content of the enteral formula
2. sorbitol content of liquid medications
3. Sorbitol content of the enteral formula
4. Lactose content of liquid medications Answer: 2. sorbitol content
of liquid medications
◍ Do adult enteral products contain lactose? Answer: No
◍ Do liquid medications contain lactose? Answer: the lactose content
of most individual dosage forms of medication is too small to result in
significant digestive problems
,◍ Is sorbitol an ingredient in enteral formulas? Answer: No
◍ 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 Answer: 4. use a more
concentrated enteral formula
◍ 4 strategies to reduce nausea vomiting with enteral feedings?
Answer: 1. reduction or discontinuation of narcotic medications
2. use of low fat formulas
3. administering enteral formula t room temperature
4. reducing the rate and/or volume of tube feeding infusion
◍ Although the etiology of nausea and vomiting is multifactorial
what is a common source of this tubefeeding intolerance? Answer:
Delayed gastric emptying
◍ Why would concentrated enteral solutions not be recommended for
nausea/vomiting? Answer: Concentrated enteral solutions generally
contain more fat and can contribute to enteral intolerance by
,presenting a higher osmotic load to the GI tract. They also slow
gastric emptying.
◍ The initiation of enteral tube feeding should be delayed when the
patient is
1. hemodynamically unstable
2. at a decreased level of consciousness
3. without bowel sounds
4. scheduled for discharge Answer: 1. hemodynamically unstable
◍ EN should be delayed until these 3 things can be accomplished in
order to reduce the risk of intestinal ischemia? Answer: 1. patient is
fully volume resuscitated
2. hemodynamically stable
3. mesenteric perfusion has been restored
◍ Is evidence of bowel function (bowel sounds) required prior to
starting enteral nutrition? Answer: No
◍ What is the evidence for not withholding EN until patient is fully
volume resuscitated, hemodynamically stable and mesenteric
perfusion has been restored? Answer: A recent retrospective trial
indicates early EN in hemodynamically unstable patients receiving
mechanical ventilation may decrease mortality; however, due to
inherent study limitations further prospective randomized trials are
needed before guideline changes can be made
, ◍ When initiating and advancing enteral feedings in the hospitalized
patient, which of the following is most appropriate?
1. 1/2 strength formula at 25 mL/hr, advance to goal rate and strength
over 5-7 days
2. 240 mL bolus feeds of full strength hypertonic formulas every 4
hours
3. full strength formula at 10-40 mL/hour and advance by 10-20
mL/hour every 8-12 hours to goal rate
4. 1/4 strength formula at goal rate. Advance to full strength over 3-5
days Answer: 3 Full strength formula at 10-40 mL/hour and advance
by 10-20 mL/hour every 8-12 hours to goal rate
◍ What is the current recommendation for initiating enteral feedings
in adults and children? Answer: Currently, it is recommended that
feedings in adults and children be initiated with full strength formulas
at a slow rate and steadily advanced.
◍ 2 benefits of initiating enteral feedings at full strength formula at a
slow rate and steadily advancing? Answer: 1. Goal rates achieved
earlier
2. Reduces the risk for microbial contamination by minimizing the
number of times the formula is manipulated
◍ While a patient is receiving speech therapy, oral foods are provided
during the daytime hours. To meet the patient's nutritional
