ASPEN Final Competency Certification Study
Guide Exam Questions with Certified for
Accuracy Answers 2024/2025
What is the ASPEN Clinical Guideline for osmolarity in peripheral parenteral nutrition? -
correct answer ASPEN Clinical Guidelines suggest that PN with an osmolarity of up to
900 mOsm/L can be safely infused peripherally.
What can occur if hypertonic parenteral solutions exceeding 900 mOsm/L are infused
through a peripheral catheter? - correct answer May result in phlebitis
What is required for PN solutions with an osmolarity > 900 mOsm/L? - correct answer
Central access
What concentrations of dextrose are most often used for peripheral administration? -
correct answer The lower concentrated dextrose solutions (5, 10%) and amino acid
solutions (3%)
What is the osmolarity of 10% dextrose solution? - correct answer 500 mOsm/L
What is the osmolarity of a 3% amino acid solution? - correct answer 300 mOsm/L
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 - correct answer 1.
Increased amino acid concentration
How does increasing the amino acid concentration in PN reduce the risk of calcium
phosphate precipitation? - correct answer Increased concentration of amino acids
,reduces the risk of calcium phosphate precipitation by forming soluble complexes with
calcium, thereby reducing the free calcium ions available to form insoluble dibasic
calcium phosphate precipitates. Additionally, higher concentrations of amino acids may
lower the pH of the PN formulation, which also improves calcium phosphate solubility.
How do the different forms of calcium (calcium chloride vs. calcium gluconate) impact
calcium phosphate precipitation? - correct answer Calcium chloride dissociated more
readily than calcium gluconate, increasing the free calcium ions available to bind with
phosphate ions when using calcium chloride
How does temperature impact calcium phosphate precipitation? - correct answer
Increasing temperature increases the dissociation of calcium salts. Storage under
refrigeration reduces risk of calcium phosphate precipitation.
How should calcium and phosphate be added to PN to help reduce calcium phosphate
precipitation? - correct answer When compounding PN, it is recommended to add the
phosphate first and then add the calcium near the end of compounding to utilize the
maximum volume of the PN formulation to dilute the salts. Adding the calcium and
phosphate salts back-to-back causes locally high concentrations of these salts prior to
adequate mixing
Which parenteral amino acid (AA) formulation should be used in a hospitalized adult
patient with acute kidney injury (AKI) requiring parenteral nutrition support?
1. Standard AA formulation
2. Branched chain AA formulation
3. Essential AA formulation
4. Renal specialty AA formulation - correct answer 1. Standard AA formulation
Why is standard AA formulation recommended for parenteral nutrition support in
patients with AKI? - correct answer The ability to synthesize nonessential amino acids
is reduced in patients with acute renal insufficiency. Enrichment of parenteral nutrition
with branched chain amino acids has been studied, but there is insufficient evidence to
recommend this approach. Renal amino acid formulations are composed primarily of
essential amino acids and are relatively dilute. Studies have found no difference in
,mortality with a renal acid formulation. Therefore it is recommended to provide standard
AA formulation for AKI patients.
Branched-chain amino acid (BCAA) formulas would be most appropriate for:
1. a patient with a recent diagnosis of hepatocellular cancer
2. prevention of a first episode of hepatic encephalopathy in a patient who has
undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure
3. Initial management of acute hepatic encephalopathy
4. A cirrhotic patient with chronic encephalopathy who is intolerant of standard protein
sources despite optimal pharmacotherapy - correct answer 4. A cirrhotic patient with
chronic encephalopathy who is intolerant of standard protein sources despite optimal
pharmacotherapy
When are BCAA formulas indicated? - correct answer Use of BCAA enriched diets and
nutrition support formulas is only indicated in chronic encephalopathy for those who
cannot tolerate at least 1 gm/kg/day of standard protein despite optimal
pharmacotherapy. The use of BCAA solutions is not fully supported by the literature in
hepatic encephalopathy.
What is the protein recommendation for patients with hepatic encephalopathy? -
correct answer Protein consumption with the recommended range does not worsen
hepatic encephalopathy and in fact leads to improved body composition. ASPEN
recommends the use of standard formulations for critically ill patients with acute or
chronic liver disease.
Failure to provide linoleic and alpha linolenic acids with PN will most likely result in
1. metabolic acidosis
2. hyperglycemia
3. metabolic bone disease
4. essential fatty acid deficiency (EFAD) - correct answer 4. essential fatty acid
deficiency (EFAD)
, What is the recommended percentage of calories provided from linoleic and alpha
linolenic acid to prevent EFAD? - correct answer Failure to provide at least 2-4$ of the
total caloric intake as linoleic acid and 0.25-0.5% of total caloric intake as alpha linolenic
acid may lead to a deficiency of these tow fatty acids.
What is the recommended lipid delivery for infants to prevent EFAD? - correct answer
For infants, it is recommended to provide 0.5 to 1 g/kg/day of lipid in order to prevent
EFAD
The adverse effects of intravenous fat emulsion (IVFE) administration in adults is best
prevented by
1. supplementing with L-carnitine
2. avoiding infusion rates > 0.05 grams/kg/hour
3. using 10% IVFE preparations
4. avoiding serum triglyceride levels > 400 mg/dL - correct answer 4. Avoiding serum
triglyceride levels > 400 mg/dL
What are the recommended IVFE infusion rates (g/kg/hr) in adults? children? neonates?
- correct answer Several investigators have determined that the infusion rate of IVFE
not exceed 0.11 grams/kg/hour in adults, 0.15 grams/kg/hour in children and 0.17
grams/kg/hour in neonates in order to avoid serious metabolic effects.
Why is 20% IVFE recommended over 10%? - correct answer The excess phospholipid
content of 10% versus 20% IVFE is associated with plasma lipid alterations. Use of 20%
IVFE allows more efficient triglyceride clearance and metabolism
What are serum triglyceride levels that limit IVFE in adults? children? - correct answer
IVFE should be infused at dosages to avoid serum triglyceride levels > 400 mg/dL in
adults and > 200 mg/dL in pediatric populations
Guide Exam Questions with Certified for
Accuracy Answers 2024/2025
What is the ASPEN Clinical Guideline for osmolarity in peripheral parenteral nutrition? -
correct answer ASPEN Clinical Guidelines suggest that PN with an osmolarity of up to
900 mOsm/L can be safely infused peripherally.
What can occur if hypertonic parenteral solutions exceeding 900 mOsm/L are infused
through a peripheral catheter? - correct answer May result in phlebitis
What is required for PN solutions with an osmolarity > 900 mOsm/L? - correct answer
Central access
What concentrations of dextrose are most often used for peripheral administration? -
correct answer The lower concentrated dextrose solutions (5, 10%) and amino acid
solutions (3%)
What is the osmolarity of 10% dextrose solution? - correct answer 500 mOsm/L
What is the osmolarity of a 3% amino acid solution? - correct answer 300 mOsm/L
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 - correct answer 1.
Increased amino acid concentration
How does increasing the amino acid concentration in PN reduce the risk of calcium
phosphate precipitation? - correct answer Increased concentration of amino acids
,reduces the risk of calcium phosphate precipitation by forming soluble complexes with
calcium, thereby reducing the free calcium ions available to form insoluble dibasic
calcium phosphate precipitates. Additionally, higher concentrations of amino acids may
lower the pH of the PN formulation, which also improves calcium phosphate solubility.
How do the different forms of calcium (calcium chloride vs. calcium gluconate) impact
calcium phosphate precipitation? - correct answer Calcium chloride dissociated more
readily than calcium gluconate, increasing the free calcium ions available to bind with
phosphate ions when using calcium chloride
How does temperature impact calcium phosphate precipitation? - correct answer
Increasing temperature increases the dissociation of calcium salts. Storage under
refrigeration reduces risk of calcium phosphate precipitation.
How should calcium and phosphate be added to PN to help reduce calcium phosphate
precipitation? - correct answer When compounding PN, it is recommended to add the
phosphate first and then add the calcium near the end of compounding to utilize the
maximum volume of the PN formulation to dilute the salts. Adding the calcium and
phosphate salts back-to-back causes locally high concentrations of these salts prior to
adequate mixing
Which parenteral amino acid (AA) formulation should be used in a hospitalized adult
patient with acute kidney injury (AKI) requiring parenteral nutrition support?
1. Standard AA formulation
2. Branched chain AA formulation
3. Essential AA formulation
4. Renal specialty AA formulation - correct answer 1. Standard AA formulation
Why is standard AA formulation recommended for parenteral nutrition support in
patients with AKI? - correct answer The ability to synthesize nonessential amino acids
is reduced in patients with acute renal insufficiency. Enrichment of parenteral nutrition
with branched chain amino acids has been studied, but there is insufficient evidence to
recommend this approach. Renal amino acid formulations are composed primarily of
essential amino acids and are relatively dilute. Studies have found no difference in
,mortality with a renal acid formulation. Therefore it is recommended to provide standard
AA formulation for AKI patients.
Branched-chain amino acid (BCAA) formulas would be most appropriate for:
1. a patient with a recent diagnosis of hepatocellular cancer
2. prevention of a first episode of hepatic encephalopathy in a patient who has
undergone a transjugular intrahepatic portosystemic shunt (TIPS) procedure
3. Initial management of acute hepatic encephalopathy
4. A cirrhotic patient with chronic encephalopathy who is intolerant of standard protein
sources despite optimal pharmacotherapy - correct answer 4. A cirrhotic patient with
chronic encephalopathy who is intolerant of standard protein sources despite optimal
pharmacotherapy
When are BCAA formulas indicated? - correct answer Use of BCAA enriched diets and
nutrition support formulas is only indicated in chronic encephalopathy for those who
cannot tolerate at least 1 gm/kg/day of standard protein despite optimal
pharmacotherapy. The use of BCAA solutions is not fully supported by the literature in
hepatic encephalopathy.
What is the protein recommendation for patients with hepatic encephalopathy? -
correct answer Protein consumption with the recommended range does not worsen
hepatic encephalopathy and in fact leads to improved body composition. ASPEN
recommends the use of standard formulations for critically ill patients with acute or
chronic liver disease.
Failure to provide linoleic and alpha linolenic acids with PN will most likely result in
1. metabolic acidosis
2. hyperglycemia
3. metabolic bone disease
4. essential fatty acid deficiency (EFAD) - correct answer 4. essential fatty acid
deficiency (EFAD)
, What is the recommended percentage of calories provided from linoleic and alpha
linolenic acid to prevent EFAD? - correct answer Failure to provide at least 2-4$ of the
total caloric intake as linoleic acid and 0.25-0.5% of total caloric intake as alpha linolenic
acid may lead to a deficiency of these tow fatty acids.
What is the recommended lipid delivery for infants to prevent EFAD? - correct answer
For infants, it is recommended to provide 0.5 to 1 g/kg/day of lipid in order to prevent
EFAD
The adverse effects of intravenous fat emulsion (IVFE) administration in adults is best
prevented by
1. supplementing with L-carnitine
2. avoiding infusion rates > 0.05 grams/kg/hour
3. using 10% IVFE preparations
4. avoiding serum triglyceride levels > 400 mg/dL - correct answer 4. Avoiding serum
triglyceride levels > 400 mg/dL
What are the recommended IVFE infusion rates (g/kg/hr) in adults? children? neonates?
- correct answer Several investigators have determined that the infusion rate of IVFE
not exceed 0.11 grams/kg/hour in adults, 0.15 grams/kg/hour in children and 0.17
grams/kg/hour in neonates in order to avoid serious metabolic effects.
Why is 20% IVFE recommended over 10%? - correct answer The excess phospholipid
content of 10% versus 20% IVFE is associated with plasma lipid alterations. Use of 20%
IVFE allows more efficient triglyceride clearance and metabolism
What are serum triglyceride levels that limit IVFE in adults? children? - correct answer
IVFE should be infused at dosages to avoid serum triglyceride levels > 400 mg/dL in
adults and > 200 mg/dL in pediatric populations
