ASPEN Post Assessment Actual Final Exam
Questions with all Questions Accurately
Answered 2024/2025
What occurs during the terminal state of emulsion destabilization, commonly known as
cracking? - correct answer In this stage, small lipid particles coalesce to form large
droplets ranging in size from 5-50 or more microns. These oil droplets pose potential
clinical danger.
When does the initial stage in emulsion breakdown (creaming) occur? - correct answer
Occurs almost immediately upon standing once IVFE has been mixed with other
chemical constituents?
How does the initial stage in emulsion breakdown (creaming) appear? - correct answer
The presence of a cream layer is visible at the surface of the emulsion as a translucent
band separate from the remaining TNA dispersion
Is creaming dangerous? - correct answer Although the lipid particles in the cream layer
are destabilized their individual droplet identifies are generally preserved. In general,
light creaming is a common occurrence and not a significant determinant of infusion
safety except in extreme cases
Which of the following complications is most likely to occur when transitioning a critically
ill patient from parenteral to enteral nutrition?
1. Hypocalcemia
2. Hypercalcemia
3. Hypoglycemia
4. Hyperglycemia - correct answer 4. Hyperglycemia
Why is hyperglycemia the most common complication when transitioning a critically ill
patient from parenteral to enteral nutrition? How can it be minimized? - correct answer
,When transitioning from parenteral to enteral nutrition, patients may receive nutrients in
excess during overlap of therapy leading to hyperglycemia. Appropriate adjustments to
limit total carbohydrate intake to no greater than 4 mg/kg/min can prevent this metabolic
complication in many critically ill adult patients
Rapid intravenous infusion of sodium or potassium phosphate may result in
1. tetany
2. hypercalcemia
3. metabolic alkalosis
4. vitamin D deficiency - correct answer 1. tetany
Why can rapid infusion of sodium or potassium phosphate result in tetany? - correct
answer Rapid infusion of phosphate can result in tetany due to an abrupt decrease in
serum calcium concentration.
Would alkalosis be expected with intravenous infusion of sodium or potassium
phosphate? - correct answer Since phosphate salts are acidifying in nature, alkalosis
would not be anticipated
A patient receiving PN develops metabolic acidosis. Which serum electrolyte level
needs to be monitored most closely?
1. Sodium
2. Chloride
3. Potassium
4. Magnesium - correct answer 3. Potassium
What 3 physiological processes can result in an extracellular shift of potassium? -
correct answer 1. Metabolic acidosis
2. Tissue catabolism
,3. Pseudohyperkalemia
How does metabolic acidosis impact serum potassium? - correct answer Metabolic
acidosis results in an extracellular shift to maintain electroneutrality. For every 0.1
change in pH potassium will increase by 0.6 mEq/L generally. Correction of the
underlying metabolic acidosis redistributes potassium into the intracellular space and
corrects the hyperkalemia
What are clinical manifestations of hyperkalemia? - correct answer Related to changes
in neuromuscular and cardiac function
What may need to be adjusted in a PN patient with metabolic acidosis? Why? - correct
answer The potassium content int he PN formula and exogenous potassium may need
to be adjusted based on serum potassium level. Metabolic acidosis results in an
extracellular shift to maintain electroneutrality. For every 0.1 change in PH, potassium
will increase by 0.6 mEq/L generally
What is considered to be the most serious complication of significant
hyperphosphatemia?
1. Osteoporosis and fractures
2. Soft tissue and vascular complications
3. Hypoventilation
4. Hypocalcemia - correct answer 2. Soft tissue and vascular complications
What is the most serious complication of hyperphosphatemia? - correct answer soft
tissue and vascular calcifications
When can soft tissue and vascular calcifications be expected? - correct answer
Calcification occurs when the serum calcium level multiplied by the serum phosphorus
level exceeds 55 mg per deciliter
, What are additional consequences of hyperphosphatemia, other than soft tissue and
vascular calcifications? (3) - correct answer Additional consequences of
hyperphosphatemia are secondary hyperparathyroidism, renal osteodystrophy and
hypocalcemia
What biochemical evidence indicates essential fatty acid deficiency EFAD?
1. a serum triglyceride level < 50 mg/dL
2. a lymphocyte absolute count < 1000 microliter
3. a serum cholesterol level < 100 mg/dL
4. A triene to tetraene ratio > 0.2 - correct answer 4. A triene to tetraene ratio > 0.2
What biochemical evidence is used to determine EFAD? - correct answer Biochemical
evidence of EFAD is determined by a triene:tetraene ratio greater than 0.2 (Holman
Index)
How quickly can EFAD occur? - correct answer Can occur within 1 to 3 weeks in adults
receiving PN without intravenous fat emulsion IVFE
What are the essential fatty acids? - correct answer 2 polyunsaturated fatty acids
(linoleic, alpha-linolenic) cannot be synthesized by the body and are considered
essential. Thus, an exogenous source of fat must be provided.
How is EFAD prevented? - correct answer To prevent EFAD, 2% to 4% of daily energy
requirements should be derived from linoleic and about 0.25-0.5% of energy from alpha-
linolenic acid. 500 mL of 10% IVFE, 250 mL of 20% IVFE administered twice weekly or
500 mL of a 20% IVFE can be given once a week to prevent EFAD.
What can be done to prevent EFAD in patients intolerant of IVFE? - correct answer A
trial of topical skin application or oral ingestion of oils to alleviate biochemical deficiency
of EFAD may be given to patients who are intolerant to IVFE
Questions with all Questions Accurately
Answered 2024/2025
What occurs during the terminal state of emulsion destabilization, commonly known as
cracking? - correct answer In this stage, small lipid particles coalesce to form large
droplets ranging in size from 5-50 or more microns. These oil droplets pose potential
clinical danger.
When does the initial stage in emulsion breakdown (creaming) occur? - correct answer
Occurs almost immediately upon standing once IVFE has been mixed with other
chemical constituents?
How does the initial stage in emulsion breakdown (creaming) appear? - correct answer
The presence of a cream layer is visible at the surface of the emulsion as a translucent
band separate from the remaining TNA dispersion
Is creaming dangerous? - correct answer Although the lipid particles in the cream layer
are destabilized their individual droplet identifies are generally preserved. In general,
light creaming is a common occurrence and not a significant determinant of infusion
safety except in extreme cases
Which of the following complications is most likely to occur when transitioning a critically
ill patient from parenteral to enteral nutrition?
1. Hypocalcemia
2. Hypercalcemia
3. Hypoglycemia
4. Hyperglycemia - correct answer 4. Hyperglycemia
Why is hyperglycemia the most common complication when transitioning a critically ill
patient from parenteral to enteral nutrition? How can it be minimized? - correct answer
,When transitioning from parenteral to enteral nutrition, patients may receive nutrients in
excess during overlap of therapy leading to hyperglycemia. Appropriate adjustments to
limit total carbohydrate intake to no greater than 4 mg/kg/min can prevent this metabolic
complication in many critically ill adult patients
Rapid intravenous infusion of sodium or potassium phosphate may result in
1. tetany
2. hypercalcemia
3. metabolic alkalosis
4. vitamin D deficiency - correct answer 1. tetany
Why can rapid infusion of sodium or potassium phosphate result in tetany? - correct
answer Rapid infusion of phosphate can result in tetany due to an abrupt decrease in
serum calcium concentration.
Would alkalosis be expected with intravenous infusion of sodium or potassium
phosphate? - correct answer Since phosphate salts are acidifying in nature, alkalosis
would not be anticipated
A patient receiving PN develops metabolic acidosis. Which serum electrolyte level
needs to be monitored most closely?
1. Sodium
2. Chloride
3. Potassium
4. Magnesium - correct answer 3. Potassium
What 3 physiological processes can result in an extracellular shift of potassium? -
correct answer 1. Metabolic acidosis
2. Tissue catabolism
,3. Pseudohyperkalemia
How does metabolic acidosis impact serum potassium? - correct answer Metabolic
acidosis results in an extracellular shift to maintain electroneutrality. For every 0.1
change in pH potassium will increase by 0.6 mEq/L generally. Correction of the
underlying metabolic acidosis redistributes potassium into the intracellular space and
corrects the hyperkalemia
What are clinical manifestations of hyperkalemia? - correct answer Related to changes
in neuromuscular and cardiac function
What may need to be adjusted in a PN patient with metabolic acidosis? Why? - correct
answer The potassium content int he PN formula and exogenous potassium may need
to be adjusted based on serum potassium level. Metabolic acidosis results in an
extracellular shift to maintain electroneutrality. For every 0.1 change in PH, potassium
will increase by 0.6 mEq/L generally
What is considered to be the most serious complication of significant
hyperphosphatemia?
1. Osteoporosis and fractures
2. Soft tissue and vascular complications
3. Hypoventilation
4. Hypocalcemia - correct answer 2. Soft tissue and vascular complications
What is the most serious complication of hyperphosphatemia? - correct answer soft
tissue and vascular calcifications
When can soft tissue and vascular calcifications be expected? - correct answer
Calcification occurs when the serum calcium level multiplied by the serum phosphorus
level exceeds 55 mg per deciliter
, What are additional consequences of hyperphosphatemia, other than soft tissue and
vascular calcifications? (3) - correct answer Additional consequences of
hyperphosphatemia are secondary hyperparathyroidism, renal osteodystrophy and
hypocalcemia
What biochemical evidence indicates essential fatty acid deficiency EFAD?
1. a serum triglyceride level < 50 mg/dL
2. a lymphocyte absolute count < 1000 microliter
3. a serum cholesterol level < 100 mg/dL
4. A triene to tetraene ratio > 0.2 - correct answer 4. A triene to tetraene ratio > 0.2
What biochemical evidence is used to determine EFAD? - correct answer Biochemical
evidence of EFAD is determined by a triene:tetraene ratio greater than 0.2 (Holman
Index)
How quickly can EFAD occur? - correct answer Can occur within 1 to 3 weeks in adults
receiving PN without intravenous fat emulsion IVFE
What are the essential fatty acids? - correct answer 2 polyunsaturated fatty acids
(linoleic, alpha-linolenic) cannot be synthesized by the body and are considered
essential. Thus, an exogenous source of fat must be provided.
How is EFAD prevented? - correct answer To prevent EFAD, 2% to 4% of daily energy
requirements should be derived from linoleic and about 0.25-0.5% of energy from alpha-
linolenic acid. 500 mL of 10% IVFE, 250 mL of 20% IVFE administered twice weekly or
500 mL of a 20% IVFE can be given once a week to prevent EFAD.
What can be done to prevent EFAD in patients intolerant of IVFE? - correct answer A
trial of topical skin application or oral ingestion of oils to alleviate biochemical deficiency
of EFAD may be given to patients who are intolerant to IVFE
