ASPEN Self-Study CNSC questions with complete solution 2023

ASPEN Self-Study CNSC questions with complete solution 2023Modular 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 4. MCT oil, glucose, fiber and protein Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino acids are examples of what? 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 2. Patients with increasing vasopressor support What is the risk of feeding a patient before hemodynamic stability has been achieved? 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? 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 4. omega-3 fatty acids Define ARDS. 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? 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? 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 4. refractory encephalopathy What is the theory behind use of BCAAs in hepatic encephalopathy? 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? 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 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? 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)? 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 2. Metoprolol immediate release What type of tablets should be crushed for administration via an enteral feeding tube? 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? 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? 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? 1. Crush tablets and add them directly in the EN formula 2. Administer liquid formulations undiluted to minimize fluid overload 3. Flush the tube with water before and after each medication administered 4. Add crushed tablets to liquid medication sand administer the mixture all together 3. Flush the tube with water before and after each medication administered Why should the EN tube be flushed before and after each medication? Helps to avoid physical interactions both between medications and between medications and formula. How should liquid formulations be administered? Why? Many liquid medications are hyperosmolar which can lead to diarrhea and/or have high viscosity which can lead to tube clogging, so liquid dosage forms should be diluted with water prior to administration In patients with severe acute pancreatitis enteral nutrition has been documented to provide the following benefits over parenteral nutrition EXCEPT: 1. decreased infection rate 2. decreased hospital LOS 3. decreased pain 4. decreased mortality 3. Decreased pain List 5 benefits in patients with severe acute pancreatitis on EN vs. PN nutrition support 1. significant reduction in infectious morbidity 2. decreased hospital LOS 3. Reduced need for surgical intervention 4. Reduced multiple organ failure 5. Decreased mortality In patient with fat malabsorption, an enteral product containing which of the following can provide a concentrated source of energy? 1. MCT 2. Free amino acids 3. Fructooligosaccharides 4. Long chain triglycerides 1. MCTs What nutrient can be used to provide a concentrated source of energy to patients with fat malabsorption or damage to lymphatic vessels? Why? MCT MCT are absorbed directly into the bloodstream and enter portal circulation bypassing the need for pancreatic enzymes, bile, bile transport in the lymphatic system and carnitine dependent transport into the mitochondria. Which of the following is true regarding infectious complications associated with enteral feedings? 1. Bacterial contamination may originate from the patient's throat, lung and stomach 2. Exceeding manufacture hang-time guidelines is not a risk for bacterial contamination 3. Open systems have less exogenous bacterial contamination 4. The enteral tube site should be routinely cultured 1. Bacterial contamination may originate from the patient's throat, lung and stomach Name the 2 routes of bacterial contamination of enteral feeds. 1. Exogenously through the feeding equipment 2. Endogenously through retrograde contamination of the feeding apparatus from the patient's own infected secretions What is bacterial contamination correlated with? there is a correlation between prolonged length of enteral product hang time and bacterial contamination Which type of system provides the most opportunity for contamination? Why? Open-system due to nursing manipulation when adding more formula to the bag Is there an indication for routine cultures in the uncomplicated enterally fed patient? No Mrs. Jones suffered from a stroke 2 weeks ago and has significant dysphagia. A PEG was placed and an isotonic enteral formula has been infusing continuously at goal rate for 2 days with appropriate flushing (30 mL 3x/day). Mrs. Jones begins to complain of bloating and is mildly distended (to 4 cm from baseline) upon examination. Which of the following interventions would be the best initial strategy to reduce her unpleasant symptoms? 1. Initiate a bowel regimen if constipation suspected 2. Hold enteral nutrition and initiate a pain reliever 3. Switch to a higher fiber enteral nutrition formula 4. Change to bolus feeding regimen 1. Initiate a bowel regimen if constipation suspected List 10 possible reason for abdominal distention upon enteral tube feeding. 1. Rapid administration of feeding (i.e. bolus feeds) 2. Use of hyperosmolar solution (concentrated formulas) 3. Medications that slow peristalsis (pain relievers, anticholinergics) 4. Excess air in the stomach or intestines 5. Tube migration from stomach to small intestine 6. Infection 7. Cold formula 8. Inadequate fluid provision leading to constipation 9. Bacterial contamination 10. Fat, fiber or lactose intolerance What should be considered in the enterally fed patient with abdominal distention? Aggressive bowel regimens need to be considered in these patients to reduce distention and prevent impaction Is holding enteral feedings indicated with abdominal distention? Holding enteral feedings is generally not indicated unless abdominal girth exceeds the baseline measurement by at least 8-10 cm What GI effects do agents such as narcotics or diphenhydramine have? Documented anticholinergic effects often resulting in constipation Should fiber be used in abdominal distention? Fiber may help to promote regular bowel movements in patients receiving enteral nutrition, but may also lead to excess gas production and increased abdominal distention. Providing additional free water flushes may help to decrease distention A terminally ill patient at home on hospice complains of nausea during enteral feedings. A decision is made to discontinue enteral feeding. Which of the following is true regarding the tying patient? 1. Intravenous hydration should be used to reduce symptoms of nausea, vomiting, diarrhea and respiratory distress 2. Dehydration, starvation and ketosis produces a euphoric state that enhances the perception of hunger 3. The most common symptom when nutrition and hydration are withheld is dry mouth 4. Electrolyte imbalance should be expected and may produce a degree of analgesia 3. The most common symptom when nutrition and hydration are withheld is dry mouth In the terminally ill hospice patient what is the recommendation for EN? Why? Enteral feeding and hydration do not always ensure comfort. During starvation the body begins to use fat as the predominant energy source leading to increased ketone production with a resulting euphoria. Feeding even small amounts can prevent ketonemia and prolong the sense of hunger. What is the most common symptom when feeding or fluids are withheld? Dry mouth Easily alleviated with good mouth care Should IV hydration be performed in the terminal patient? Why? IV hydration in the terminal patient can raise the risk of patient discomfort and respiratory distress One method of minimizing the complications associated with refeeding syndrome is to initiate an electrolyte replacement protocol before nutrition therapy begins. Which of the following is true regarding such a plan? 1. Potassium, magnesium and calcium are the most important electrolytes to closely monitor 2. Patients considered not-at-risk should also be included in the protocol 3. The protocol should replete all electrolytes ONLY via the feeding tube 4. Feeding should be delayed until the risk of electrolyte imbalance is eliminated 2. Patients considered not-at-risk should also be included in the protocol