ASPEN Self-Study CNSC with questions and effective
answers
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 - CORRECT ANSWERS-4. MCT oil, glucose, fiber and protein
Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino acids are
examples of what? - CORRECT ANSWERS-Modular products
Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing infectious
complications, length of hospital stay and even possibly reducing mortality. Which group of patients
might be at significant risk from early enteral feeding?
1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic saline
4. Patients admitted to the hospital with acute on chronic pancreatitis - CORRECT ANSWERS-2. Patients
with increasing vasopressor support
What is the risk of feeding a patient before hemodynamic stability has been achieved? - CORRECT
ANSWERS-May increase the risk of intestinal ischemia as blood perfusion of the gut may be
compromised in a patient who is still requiring high doses of vasopressor drugs to maintain blood
pressure
,When should EN be initiated in the hemodynamically unstable patient? - CORRECT ANSWERS-EN should
be delayed until fluid resuscitation is complete
A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding formula
containing supplemental
1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids - CORRECT ANSWERS-4. omega-3 fatty acids
Define ARDS. - CORRECT ANSWERS-Acute respiratory distress syndrome - inflammatory response
leading to diffuse alveolar damage and lung capillary endothelial injury.
Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS? - CORRECT ANSWERS-
Inflammatory mediators, including prostaglandins and leukotrienes derived from arachidonic acid
metabolism have been implicated in both ALI and ARDS. Formulas containing omega-3 fatty acids may
down regulate the inflammatory response through the production of less inflammatory prostaglnadins
and leukotrienes
What is the evidence for use of omega-3 fatty acids in ARDS and ALI? - CORRECT ANSWERS-Based on 3
level 1 studies the Guidelines for the Provision and Assessment of Nutrition Support Therapy in the
Adult Critically Ill Patient in 2009 recommended patients with ARDS and severe ALI be placed on an
enteral formulation characterized by an anti-inflammatory lipid profile. Subsequent to the publication of
those guidelines and recommendations have been studies published in 2011 showing that enteral
supplementation of omega-3 fatty acids did not result in improved biomarkers of inflammation or
clinical outcomes
The use of enteral nutrition formulas enriched with BCAAs is best used for patients with:
1. cirrhosis
,2. hepatic failure
3. liver transplantation
4. refractory encephalopathy - CORRECT ANSWERS-4. refractory encephalopathy
What is the theory behind use of BCAAs in hepatic encephalopathy? - CORRECT ANSWERS-There is
believed to be an increased ratio of aromatic amino acids to BCAAs in patients experiencing hepatic
encephalopathy. The decrease in BCAA is suspected to be due to an increased breakdown in BCAA from
skeletal muscles and utilization. The increased levels of AAA generate false neurotransmitters, resulting
in hepatic encephalopathy symptoms.
What is the evidence for BCAA enriched amino acid enteral formulas? - CORRECT ANSWERS-Published
randomized trials have shown mixed results in patients with hepatic failure receiving these specialized
formulas. Due to the lack of evidence supporting their use and the increased cost of such products it has
been suggested that the use of these hepatic fomulas be limited to patients with encephalopathy
refractory to standard medical therapy (lactulose, non-absorbed antibiotics)
Enteral nutrition 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 PN - CORRECT ANSWERS-3. Gastrointestinal
toxicities related to the conditioning regimen
Why is EN contraindicated in the early post-transplant period in adult patients with hematopoietic cell
transplants? - CORRECT ANSWERS-GI toxicities such as nausea, vomiting, delayed gastric emptying and
diarrhea seen in the first 2-3 weeks post-stem cell transplant may preclude EN. GI toxicity is most often
related to chemotherapy and total body irradiatin, however GI toxicity may also result from other
medications or early acute graft-versus-host disease in this patient population.
, Which nutrition therapy is preferred in early post-transplant hematopoietic cell transplant patients
(adult)? - CORRECT ANSWERS-Currently there is insufficient data to establish benefits of enteral
nutrition over parenteral nutrition with hematopoietic cell transplants. In one study, parenteral
nutrition was found to increase survival in allogeneic patients
Which of the following medications would be appropriate to crush and deliver via an enteral feeding
tube?
1. Nifedipine XL
2. Metoprolol immediate release
3. Enteric coated aspirin
4. Diltiazem CD - CORRECT ANSWERS-2. Metoprolol immediate release
What type of tablets should be crushed for administration via an enteral feeding tube? - CORRECT
ANSWERS-Only immediate release tablets should be crushed fro administration via an enteral feeding
tube.
Why are enteric coated and film coated tablets not crushed for administration via an EN feeding tube? -
CORRECT ANSWERS-Enteric coated or film coated tablets do not crush well and tend to clump and
increase the risk of clogging the tube.
Why are modified release dosage forms of drugs inappropriate to crush and give via EN feeding tubes? -
CORRECT ANSWERS-Modified release dosage forms (often designated with abbreviations such as XL, XR,
SR, CD etc.) are inappropriate to crush and give via EN feeding tube because crushing these dosage
forms destroys their modified releasing properties. This may lead to an excessive dose of the drug being
released at one time (instead of slowly over a longer period of time), which can lead to adverse effects
and has even been reported as a cause of death
Which of the following describes an optimal method of preparing and administering medications via an
enteral feeding tube?
answers
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 - CORRECT ANSWERS-4. MCT oil, glucose, fiber and protein
Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino acids are
examples of what? - CORRECT ANSWERS-Modular products
Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing infectious
complications, length of hospital stay and even possibly reducing mortality. Which group of patients
might be at significant risk from early enteral feeding?
1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic saline
4. Patients admitted to the hospital with acute on chronic pancreatitis - CORRECT ANSWERS-2. Patients
with increasing vasopressor support
What is the risk of feeding a patient before hemodynamic stability has been achieved? - CORRECT
ANSWERS-May increase the risk of intestinal ischemia as blood perfusion of the gut may be
compromised in a patient who is still requiring high doses of vasopressor drugs to maintain blood
pressure
,When should EN be initiated in the hemodynamically unstable patient? - CORRECT ANSWERS-EN should
be delayed until fluid resuscitation is complete
A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding formula
containing supplemental
1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids - CORRECT ANSWERS-4. omega-3 fatty acids
Define ARDS. - CORRECT ANSWERS-Acute respiratory distress syndrome - inflammatory response
leading to diffuse alveolar damage and lung capillary endothelial injury.
Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS? - CORRECT ANSWERS-
Inflammatory mediators, including prostaglandins and leukotrienes derived from arachidonic acid
metabolism have been implicated in both ALI and ARDS. Formulas containing omega-3 fatty acids may
down regulate the inflammatory response through the production of less inflammatory prostaglnadins
and leukotrienes
What is the evidence for use of omega-3 fatty acids in ARDS and ALI? - CORRECT ANSWERS-Based on 3
level 1 studies the Guidelines for the Provision and Assessment of Nutrition Support Therapy in the
Adult Critically Ill Patient in 2009 recommended patients with ARDS and severe ALI be placed on an
enteral formulation characterized by an anti-inflammatory lipid profile. Subsequent to the publication of
those guidelines and recommendations have been studies published in 2011 showing that enteral
supplementation of omega-3 fatty acids did not result in improved biomarkers of inflammation or
clinical outcomes
The use of enteral nutrition formulas enriched with BCAAs is best used for patients with:
1. cirrhosis
,2. hepatic failure
3. liver transplantation
4. refractory encephalopathy - CORRECT ANSWERS-4. refractory encephalopathy
What is the theory behind use of BCAAs in hepatic encephalopathy? - CORRECT ANSWERS-There is
believed to be an increased ratio of aromatic amino acids to BCAAs in patients experiencing hepatic
encephalopathy. The decrease in BCAA is suspected to be due to an increased breakdown in BCAA from
skeletal muscles and utilization. The increased levels of AAA generate false neurotransmitters, resulting
in hepatic encephalopathy symptoms.
What is the evidence for BCAA enriched amino acid enteral formulas? - CORRECT ANSWERS-Published
randomized trials have shown mixed results in patients with hepatic failure receiving these specialized
formulas. Due to the lack of evidence supporting their use and the increased cost of such products it has
been suggested that the use of these hepatic fomulas be limited to patients with encephalopathy
refractory to standard medical therapy (lactulose, non-absorbed antibiotics)
Enteral nutrition 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 PN - CORRECT ANSWERS-3. Gastrointestinal
toxicities related to the conditioning regimen
Why is EN contraindicated in the early post-transplant period in adult patients with hematopoietic cell
transplants? - CORRECT ANSWERS-GI toxicities such as nausea, vomiting, delayed gastric emptying and
diarrhea seen in the first 2-3 weeks post-stem cell transplant may preclude EN. GI toxicity is most often
related to chemotherapy and total body irradiatin, however GI toxicity may also result from other
medications or early acute graft-versus-host disease in this patient population.
, Which nutrition therapy is preferred in early post-transplant hematopoietic cell transplant patients
(adult)? - CORRECT ANSWERS-Currently there is insufficient data to establish benefits of enteral
nutrition over parenteral nutrition with hematopoietic cell transplants. In one study, parenteral
nutrition was found to increase survival in allogeneic patients
Which of the following medications would be appropriate to crush and deliver via an enteral feeding
tube?
1. Nifedipine XL
2. Metoprolol immediate release
3. Enteric coated aspirin
4. Diltiazem CD - CORRECT ANSWERS-2. Metoprolol immediate release
What type of tablets should be crushed for administration via an enteral feeding tube? - CORRECT
ANSWERS-Only immediate release tablets should be crushed fro administration via an enteral feeding
tube.
Why are enteric coated and film coated tablets not crushed for administration via an EN feeding tube? -
CORRECT ANSWERS-Enteric coated or film coated tablets do not crush well and tend to clump and
increase the risk of clogging the tube.
Why are modified release dosage forms of drugs inappropriate to crush and give via EN feeding tubes? -
CORRECT ANSWERS-Modified release dosage forms (often designated with abbreviations such as XL, XR,
SR, CD etc.) are inappropriate to crush and give via EN feeding tube because crushing these dosage
forms destroys their modified releasing properties. This may lead to an excessive dose of the drug being
released at one time (instead of slowly over a longer period of time), which can lead to adverse effects
and has even been reported as a cause of death
Which of the following describes an optimal method of preparing and administering medications via an
enteral feeding tube?
