PN FINAL TEST 2026 QUESTIONS WITH
CORRECT ANSWERS GRADED A+
◍ ey electrolytes & vitamin to monitor in refeeding syndrome..
Answer: Phosphorus (most critical), potassium, magnesium, thiamin (B1) —
monitor & replete before/with feeding; start low & advance slowly to
prevent hemolysis, cardiac/respiratory failure, and Wernicke's.
◍ Who is at highest risk for refeeding syndrome?.
Answer: Severely malnourished, NPO >7 days, chronic alcoholism,
anorexia, prolonged poor intake, or prolonged IV fluids w/o nutrients.
◍ The Specific Gravity of Urine.
Answer: 1.010 - 1.030
◍ What are clinical signs of refeeding syndrome?.
Answer: Hypophosphatemia: weakness, impaired breathing,
deathHypomagnesemia: tremors, twitching, arrhythmias,
paralysisHypokalemia: cardiac abnormalitiesThiamin deficiency:
Wernicke's encephalopathy (confusion, ataxia, vision problems, amnesia)
◍ When is PN contraindicated?.
Answer: When GI tract is functional and usable, or risks outweigh benefits
(infection, overfeeding).
◍ Typical EN protein contribution?.
Answer: 10-25% kcal (standard); up to 25% for high-protein formulas.
◍ What are protein sources in PN?.
Answer: Crystalline amino acids (3-20% solutions); 0.8-2.0 g/kg/day
depending on condition.
◍ What are clinical consequences?.
Answer: Hypophosphatemia, hypomagnesemia, hypokalemia,
, cardiac/respiratory failure, Wernicke's encephalopathy.
◍ DNR (do not resuscitate).
Answer: requires a written physician's order in the medical record; no
extraordinary care given in the event of the client's death. Extraordinary care
after cardiac or pulmonary cessation; cardiopulmonary resuscitation (CPR),
medications, ventilators, defibrillation.
◍ Why is phosphorus critical in refeeding syndrome?.
Answer: It's needed for ATP and oxygen delivery; depletion leads to
hemolysis, respiratory failure, and cardiac dysfunction
◍ The normal levels of Hemotocrit.
Answer: Male 42-50%Female 40-48%
◍ What medications can be added to PN?.
Answer: Insulin, heparin, corticosteroids, H₂ blockers, metoclopramide, and
others compatible with solution.
◍ Describe gastrostomy feeding..
Answer: Tube into stomach (surgical); long-term; allows bolus feeds;
infection risk at site.
◍ What are the main access routes for EN?.
Answer: Nasoenteric/orogastric for short-term (<6 wks),
gastrostomy/jejunostomy/PEG for long-term.
◍ Love and Belonging.
Answer: Maintain support systemsProtect from isolation
◍ What are special EN protein formulas used for?.
Answer: Hydrolyzed or peptide-based formulas for malabsorption, enzyme
deficiency, or short bowel syndrome.
◍ What is the osmolarity limit for peripheral PN (PPN)?.
Answer: <900 mOsm/L; if higher, must use central line at or near right
atrium.
◍ List disadvantages of P
, N. .
Answer: Infection risk (catheter-related)Metabolic complications
(hyperglycemia, refeeding, liver dysfunction)Expensive, requires central
access
◍ General energy needs for EN/PN?.
Answer: 25-30 kcal/kg/day (12-25 kcal/kg for ICU); ASPEN: ≤70% of
needs if BMI >30.
◍ How to prevent dehydration in EN?.
Answer: Provide ~1 mL/kcal water; monitor skin turgor, mucosa, BUN/Cr,
urine gravity.
◍ What factors increase infection risk in PN?.
Answer: Contaminated solutionsPoor catheter careMore catheter
lumensHigh dextrose or energy delivery
◍ List advantages of E
N. .
Answer: Cost-effectiveMaintains gut integrity and immune function
(lymphoid tissue)Reduces bacterial translocationEasier to manage than PN
◍ Phenytoin (Dilantin).
Answer: 10-20 mcg/mL
◍ What EN formula adjustments are made for renal disease?.
Answer: High protein, low phosphorus, potassium, sodium, energy-dense
(for fluid restriction).
◍ Define Parenteral Nutrition (PN)..
Answer: Delivery of nutrients directly into the bloodstream via IV,
bypassing the GI tract.
◍ What are immune-enhancing formulas and when are they used?.
Answer: Contain antioxidants, omega-3s, glutamine, arginine; used in TBI
and postoperative patients.
◍ Think ABCs..
CORRECT ANSWERS GRADED A+
◍ ey electrolytes & vitamin to monitor in refeeding syndrome..
Answer: Phosphorus (most critical), potassium, magnesium, thiamin (B1) —
monitor & replete before/with feeding; start low & advance slowly to
prevent hemolysis, cardiac/respiratory failure, and Wernicke's.
◍ Who is at highest risk for refeeding syndrome?.
Answer: Severely malnourished, NPO >7 days, chronic alcoholism,
anorexia, prolonged poor intake, or prolonged IV fluids w/o nutrients.
◍ The Specific Gravity of Urine.
Answer: 1.010 - 1.030
◍ What are clinical signs of refeeding syndrome?.
Answer: Hypophosphatemia: weakness, impaired breathing,
deathHypomagnesemia: tremors, twitching, arrhythmias,
paralysisHypokalemia: cardiac abnormalitiesThiamin deficiency:
Wernicke's encephalopathy (confusion, ataxia, vision problems, amnesia)
◍ When is PN contraindicated?.
Answer: When GI tract is functional and usable, or risks outweigh benefits
(infection, overfeeding).
◍ Typical EN protein contribution?.
Answer: 10-25% kcal (standard); up to 25% for high-protein formulas.
◍ What are protein sources in PN?.
Answer: Crystalline amino acids (3-20% solutions); 0.8-2.0 g/kg/day
depending on condition.
◍ What are clinical consequences?.
Answer: Hypophosphatemia, hypomagnesemia, hypokalemia,
, cardiac/respiratory failure, Wernicke's encephalopathy.
◍ DNR (do not resuscitate).
Answer: requires a written physician's order in the medical record; no
extraordinary care given in the event of the client's death. Extraordinary care
after cardiac or pulmonary cessation; cardiopulmonary resuscitation (CPR),
medications, ventilators, defibrillation.
◍ Why is phosphorus critical in refeeding syndrome?.
Answer: It's needed for ATP and oxygen delivery; depletion leads to
hemolysis, respiratory failure, and cardiac dysfunction
◍ The normal levels of Hemotocrit.
Answer: Male 42-50%Female 40-48%
◍ What medications can be added to PN?.
Answer: Insulin, heparin, corticosteroids, H₂ blockers, metoclopramide, and
others compatible with solution.
◍ Describe gastrostomy feeding..
Answer: Tube into stomach (surgical); long-term; allows bolus feeds;
infection risk at site.
◍ What are the main access routes for EN?.
Answer: Nasoenteric/orogastric for short-term (<6 wks),
gastrostomy/jejunostomy/PEG for long-term.
◍ Love and Belonging.
Answer: Maintain support systemsProtect from isolation
◍ What are special EN protein formulas used for?.
Answer: Hydrolyzed or peptide-based formulas for malabsorption, enzyme
deficiency, or short bowel syndrome.
◍ What is the osmolarity limit for peripheral PN (PPN)?.
Answer: <900 mOsm/L; if higher, must use central line at or near right
atrium.
◍ List disadvantages of P
, N. .
Answer: Infection risk (catheter-related)Metabolic complications
(hyperglycemia, refeeding, liver dysfunction)Expensive, requires central
access
◍ General energy needs for EN/PN?.
Answer: 25-30 kcal/kg/day (12-25 kcal/kg for ICU); ASPEN: ≤70% of
needs if BMI >30.
◍ How to prevent dehydration in EN?.
Answer: Provide ~1 mL/kcal water; monitor skin turgor, mucosa, BUN/Cr,
urine gravity.
◍ What factors increase infection risk in PN?.
Answer: Contaminated solutionsPoor catheter careMore catheter
lumensHigh dextrose or energy delivery
◍ List advantages of E
N. .
Answer: Cost-effectiveMaintains gut integrity and immune function
(lymphoid tissue)Reduces bacterial translocationEasier to manage than PN
◍ Phenytoin (Dilantin).
Answer: 10-20 mcg/mL
◍ What EN formula adjustments are made for renal disease?.
Answer: High protein, low phosphorus, potassium, sodium, energy-dense
(for fluid restriction).
◍ Define Parenteral Nutrition (PN)..
Answer: Delivery of nutrients directly into the bloodstream via IV,
bypassing the GI tract.
◍ What are immune-enhancing formulas and when are they used?.
Answer: Contain antioxidants, omega-3s, glutamine, arginine; used in TBI
and postoperative patients.
◍ Think ABCs..
