NTR 604 EXAM QUESTIONS WITH
COMPLETE ANSWERS
The BLANK step of the PES asks the question "why" - Answer-etiology
The 3 main domains of nutrition diagnostic terminology - Answer-intake
medical
behavioral/environmental
symptoms including spoon shaped nails, pallor, and change in energy level may
indicate a deficiency of - Answer-iron
easy hair pluck ability may be a sign of - Answer-protein/calorie malnutrition
Mr. H is a 65 year old male who drinks about 3 alcoholic drinks/day and sometimes
more on weekends. He presents with symptoms including loss of balance, decrease in
ankle and knee reflexes, confusion and pallor. These might reflect a deficiency of -
Answer-vitamin b12
You are seeing a patient who complains of fatigue. She has been chewing ice chips
frequently and on physical exam you note her fingernails are concave in appearance.
What nutrient deficiency might she have? - Answer-iron
the most common form of microcytic anemia is - Answer-iron deficiency
upon examination of a patient, you notice temporal wasting. this most likely is seen with
which of the following nutritional deficiencies? - Answer-protein/energy
Hypovolemia is considered as extracellular fluid deficit. What is not considered a sign of
hypovolemia? - Answer-dry mucous membranes
Mrs. S is a 76 year old female complaining of hypoguesia (altered taste). What
measurement would you recommend to be checked to rule out a nutrient deficiency? -
Answer-zinc
Spongy, swollen gums, gums that bleed easily, skin that bruises easily might indicate a
deficiency of: - Answer-vitamin C
Redness and swelling of the lips and mouth and cheilosis may indicate a deficiency of: -
Answer-B complex and vitamin b6
What is a benefit of using enteral nutrition (EN) over parenteral nutrition (PN)? -
Answer-nutrients enter the gastrointestinal tract
, Which best describes an advantage (regarding nutrition) of a percutaneous endoscopic
gastrostomy (PEG) tube? - Answer-it allows for bolus feedings
The usual nutrient density of enteral formulas ranges between: - Answer-1.0 and 2.0
kcal/ml
Which of the following actions is appropriate to prevent a clogged feeding tube? -
Answer-flush with 25ml of water several times a day
Mr. F is a 60 year old male with a past medical history significant for obesity, diabetes
mellitus, hypertension and coronary artery disease. He was admitted to the hospital for
coronary artery bypass graft and aortic valve replacement. Postoperatively the patient
experienced prolonged respiratory failure. Because he remained ventilator dependent
he was started on enteral nutrition through a nasogastric feeding tube. A 1.0 kcal/ml
formula was ordered to be infused at 20 ml/hr. Twelve hours after starting the tube
feeding the gastric residual volumes obtained were 275 ml and 300 ml. The MD is
worried about potential aspiration and orders the TF to be held.
Medications include: Albuterol, Atrovent, Vancomycin, Morphine elixir, Hydrocortisone,
Tylenol elixir
You will not need to calculate his energy/protein needs to answer the following 3
questions.
Name at least 3 things that can be done to help decrease the risk of as - Answer-
monitor residual volumes
elevate the head of the bed 30-45 min after eating
check tube placement with radiology before feedings
place the tube past the pylorus
A week later, upon reassessing the Mr. F, you note that he has had diarrhea. He is
receiving full enteral nutrition to meet his needs at that time. What recommendations (at
least 2) for this particular patient can you make to help with diarrhea management? -
Answer-Keep enteral nutrition going until you find the etiology of the diarrhea. Check if
his medications may be causing his diarrhea (he is taking elixirs). Assess the rate of the
feedings and formula. Possibly up his fiber intake or give fiber supplements. He is taking
vancomycin so if diarrhea is caused by antibiotic use, start a probiotic. You can also
treat with antidiarrheal medications
After Mr. F is extubated (off the ventilator) his swallowing function is assessed by the
speech pathologist. He is found to have profound swallowing difficulties and the speech
pathologist recommends that he remain NPO. His is currently receiving Glucerna 1.2
Cal at 70 ml/hr with 20 ml/hr water flush. As he is being transferred to a rehab facility
you are consulted to provide recommendations for bolus feedings. Give a bolus feeding
schedule with frequency and volume of tubefeeding and water. - Answer-70*24 = 1680
ml Glucerna 1.2 and 480 ml H20
u 1680/4 (4 feedings/day) = 420 ml qdi Glucerna 1.2
u 480/4= 120 ml H2O qid
COMPLETE ANSWERS
The BLANK step of the PES asks the question "why" - Answer-etiology
The 3 main domains of nutrition diagnostic terminology - Answer-intake
medical
behavioral/environmental
symptoms including spoon shaped nails, pallor, and change in energy level may
indicate a deficiency of - Answer-iron
easy hair pluck ability may be a sign of - Answer-protein/calorie malnutrition
Mr. H is a 65 year old male who drinks about 3 alcoholic drinks/day and sometimes
more on weekends. He presents with symptoms including loss of balance, decrease in
ankle and knee reflexes, confusion and pallor. These might reflect a deficiency of -
Answer-vitamin b12
You are seeing a patient who complains of fatigue. She has been chewing ice chips
frequently and on physical exam you note her fingernails are concave in appearance.
What nutrient deficiency might she have? - Answer-iron
the most common form of microcytic anemia is - Answer-iron deficiency
upon examination of a patient, you notice temporal wasting. this most likely is seen with
which of the following nutritional deficiencies? - Answer-protein/energy
Hypovolemia is considered as extracellular fluid deficit. What is not considered a sign of
hypovolemia? - Answer-dry mucous membranes
Mrs. S is a 76 year old female complaining of hypoguesia (altered taste). What
measurement would you recommend to be checked to rule out a nutrient deficiency? -
Answer-zinc
Spongy, swollen gums, gums that bleed easily, skin that bruises easily might indicate a
deficiency of: - Answer-vitamin C
Redness and swelling of the lips and mouth and cheilosis may indicate a deficiency of: -
Answer-B complex and vitamin b6
What is a benefit of using enteral nutrition (EN) over parenteral nutrition (PN)? -
Answer-nutrients enter the gastrointestinal tract
, Which best describes an advantage (regarding nutrition) of a percutaneous endoscopic
gastrostomy (PEG) tube? - Answer-it allows for bolus feedings
The usual nutrient density of enteral formulas ranges between: - Answer-1.0 and 2.0
kcal/ml
Which of the following actions is appropriate to prevent a clogged feeding tube? -
Answer-flush with 25ml of water several times a day
Mr. F is a 60 year old male with a past medical history significant for obesity, diabetes
mellitus, hypertension and coronary artery disease. He was admitted to the hospital for
coronary artery bypass graft and aortic valve replacement. Postoperatively the patient
experienced prolonged respiratory failure. Because he remained ventilator dependent
he was started on enteral nutrition through a nasogastric feeding tube. A 1.0 kcal/ml
formula was ordered to be infused at 20 ml/hr. Twelve hours after starting the tube
feeding the gastric residual volumes obtained were 275 ml and 300 ml. The MD is
worried about potential aspiration and orders the TF to be held.
Medications include: Albuterol, Atrovent, Vancomycin, Morphine elixir, Hydrocortisone,
Tylenol elixir
You will not need to calculate his energy/protein needs to answer the following 3
questions.
Name at least 3 things that can be done to help decrease the risk of as - Answer-
monitor residual volumes
elevate the head of the bed 30-45 min after eating
check tube placement with radiology before feedings
place the tube past the pylorus
A week later, upon reassessing the Mr. F, you note that he has had diarrhea. He is
receiving full enteral nutrition to meet his needs at that time. What recommendations (at
least 2) for this particular patient can you make to help with diarrhea management? -
Answer-Keep enteral nutrition going until you find the etiology of the diarrhea. Check if
his medications may be causing his diarrhea (he is taking elixirs). Assess the rate of the
feedings and formula. Possibly up his fiber intake or give fiber supplements. He is taking
vancomycin so if diarrhea is caused by antibiotic use, start a probiotic. You can also
treat with antidiarrheal medications
After Mr. F is extubated (off the ventilator) his swallowing function is assessed by the
speech pathologist. He is found to have profound swallowing difficulties and the speech
pathologist recommends that he remain NPO. His is currently receiving Glucerna 1.2
Cal at 70 ml/hr with 20 ml/hr water flush. As he is being transferred to a rehab facility
you are consulted to provide recommendations for bolus feedings. Give a bolus feeding
schedule with frequency and volume of tubefeeding and water. - Answer-70*24 = 1680
ml Glucerna 1.2 and 480 ml H20
u 1680/4 (4 feedings/day) = 420 ml qdi Glucerna 1.2
u 480/4= 120 ml H2O qid
