PN Final Exam UPDATED ACTUAL Questions and CORRECT Answers
Question: Which of the following is not an indication for PN? A.Short bowel syndrome B.Malnourished
patient not tolerating EN C.Patient with advanced dementia D.Patient with a severe GI bleed
Correct Answer: C.Patient with advanced dementia
Question: Indications for PN
Correct Answer: •GI tract not available or EN is not feasible (MAP 50-60), abdomen firm & distended or
Nasogastric tube (NGT) with output over 1000 mL/d) •start EN if MAP > 60 & patient stable •No access
available •Malnourished patient in the ICU OR patient at high nutritional risk & EN NOT feasible •Patient
expected to undergo major upper GI surgery è initiated PN for 5-7 days preop & continue into postop period
Unable to initiate EN due to persistent vomiting/diarrhea/high output fistula/short bowel syndrome
Question: MAP (mean arterial Pressure)
Correct Answer: •Measured via an "arterial line" into peripheral artery in arm •Reflects adequacy of
perfusion to the GI tract •Use to access if EN can be safely provided •Only obtained on ICU patients
Question: Common Indications for PN
Correct Answer: •Patient has failed EN with appropriate tube placement •Severe acute pancreatitis - but
can also do EN •Severe short bowel syndrome •Mesenteric ischemia •Paralytic ileus •Small bowel
obstruction •GI fistula unless enteral access can be placed distal to the fistula or where volume of output
warrants trial of EN
Question: Contraindications (reasons PN couldn't be given)
Correct Answer: •Functional and accessible GI tract •Patient is taking oral diet •Prognosis does not
warrant aggressive nutrition support (terminally ill) -Insurance requires PN needed for >3 months •Risk
exceeds benefit
Question: PN Infusion Routes
Correct Answer: •Central access: -Broviac, central line, implanted catheter & PICC line •Mid-point:
-PICC line inserted only to mid-point in vein •Peripheral line: -Radial or other vein - osmolarity of PN
solution limits # of days PN can run at this site
Question: Parenteral Base Solutions
Correct Answer: •Carbohydrate -Available in concentrations from 5% to 70% -D50 and D70 commonly
used •Amino acids -Available in 3, 3.5, 5, 7, 8.5, 10, 15, 20% solutions -8.5% and 10% typically used •Fat
-10% emulsions = 1.1 kcal/ml -20% emulsions = 2 kcal/ml -30% emulsions = 3 kcal/ml (used only in
mixing TNA, not for direct venous delivery)
Question: Which of the following is NOT an adverse effect of using PN lipids? A.Hypertriglyceridemia
B.Immunosuppression C.Hypercholesterolemia D.Abnormal liver function tests
Correct Answer: C.Hypercholesterolemia
Question: Macronutrients
Correct Answer: Lipids: Potential Adverse Effects: •Egg allergy •Hypertriglyceridemia •Comprised of
soybean oil -Decreased cell-mediated immunity (limit to <1 g/kg/day in critically ill immunosuppressed
patients) •Non-ICU patients: can go up to 2 g/kg/d •Abnormal LFTs
Question: Which of the following is not an indication for PN? A.Short bowel syndrome B.Malnourished
patient not tolerating EN C.Patient with advanced dementia D.Patient with a severe GI bleed
Correct Answer: C.Patient with advanced dementia
Question: Indications for PN
Correct Answer: •GI tract not available or EN is not feasible (MAP 50-60), abdomen firm & distended or
Nasogastric tube (NGT) with output over 1000 mL/d) •start EN if MAP > 60 & patient stable •No access
available •Malnourished patient in the ICU OR patient at high nutritional risk & EN NOT feasible •Patient
expected to undergo major upper GI surgery è initiated PN for 5-7 days preop & continue into postop period
Unable to initiate EN due to persistent vomiting/diarrhea/high output fistula/short bowel syndrome
Question: MAP (mean arterial Pressure)
Correct Answer: •Measured via an "arterial line" into peripheral artery in arm •Reflects adequacy of
perfusion to the GI tract •Use to access if EN can be safely provided •Only obtained on ICU patients
Question: Common Indications for PN
Correct Answer: •Patient has failed EN with appropriate tube placement •Severe acute pancreatitis - but
can also do EN •Severe short bowel syndrome •Mesenteric ischemia •Paralytic ileus •Small bowel
obstruction •GI fistula unless enteral access can be placed distal to the fistula or where volume of output
warrants trial of EN
Question: Contraindications (reasons PN couldn't be given)
Correct Answer: •Functional and accessible GI tract •Patient is taking oral diet •Prognosis does not
warrant aggressive nutrition support (terminally ill) -Insurance requires PN needed for >3 months •Risk
exceeds benefit
Question: PN Infusion Routes
Correct Answer: •Central access: -Broviac, central line, implanted catheter & PICC line •Mid-point:
-PICC line inserted only to mid-point in vein •Peripheral line: -Radial or other vein - osmolarity of PN
solution limits # of days PN can run at this site
Question: Parenteral Base Solutions
Correct Answer: •Carbohydrate -Available in concentrations from 5% to 70% -D50 and D70 commonly
used •Amino acids -Available in 3, 3.5, 5, 7, 8.5, 10, 15, 20% solutions -8.5% and 10% typically used •Fat
-10% emulsions = 1.1 kcal/ml -20% emulsions = 2 kcal/ml -30% emulsions = 3 kcal/ml (used only in
mixing TNA, not for direct venous delivery)
Question: Which of the following is NOT an adverse effect of using PN lipids? A.Hypertriglyceridemia
B.Immunosuppression C.Hypercholesterolemia D.Abnormal liver function tests
Correct Answer: C.Hypercholesterolemia
Question: Macronutrients
Correct Answer: Lipids: Potential Adverse Effects: •Egg allergy •Hypertriglyceridemia •Comprised of
soybean oil -Decreased cell-mediated immunity (limit to <1 g/kg/day in critically ill immunosuppressed
patients) •Non-ICU patients: can go up to 2 g/kg/d •Abnormal LFTs
