Nutrition Therapy and Pathophysiology 3rd Edition Nelms Test Bank 1

Chapter 05 - Enteral and Parental Nutrition Support
Nutrition Therapy and Pathophysiology 3rd

Edition Nelms Test Bank
Full download at link:
Test Bank: https://testbankpack.com/p/test-bank-for-nutrition-therapy-and-
pathophysiology-3rd-edition-nelms-sucher-1305111966-9781305111967/
Solution Manual: https://testbankpack.com/p/solution-manual-for-nutrition-

therapy-and-pathophysiology-3rd-edition-nelms-sucher-1305111966-
9781305111967/
1. Which example is not considered to be a contraindication to enteral feeding?

a. diffuse peritonitis
b. intestinal obstruction
c. GI bleeding
d. impaired swallowing
e. intractable vomiting
ANSWER: d
DIFFICULTY: Bloom's: Understand
REFERENCES: Enteral Nutrition
2. Which is an example of a research-supported reason to use enteral nutrition support?

a. Decreased risk of respiratory infections
b. Improved wound healing
c. Increased tolerance of formulas
d. Complete nutritional coverage
e. Ease of administration
ANSWER: b
3. The means of prescribing a very small rate of enteral nutrition with the goal to minimize villous atrophy is known as:
a. parenteral nutrition.
b. bolus feedings.
c. refeeding.
d. intermittent feeding.
e. trophic nutrition.
ANSWER: e
Copyright Cengage Learning. Powered by Cognero. Page 1
4. A registered dietitian is assisting with placement of a nasogastric tube in a patient. The patient has just received a dose
of metoclopramide (Reglan). What is the next appropriate step in the process?
a. Insert the tube in the patient’s nose and advance the tube
b. Obtain an abdominal radiograph
c. Remove the stylet from the tube
d. Measure for gastric placement
e. Tape the tube to the patient’s nose
ANSWER: d
DIFFICULTY: Bloom's: Apply
5. Which best describes a disadvantage of using a nasogastric tube in a patient?

a. Discomfort for the patient
b. Formula must be delivered by pump only
c. It requires a surgical procedure
d. There is a risk of infection at the site
e. There is a greater risk of tube clogging
ANSWER: a
6. A surgeon places a feeding tube that provides nutrients directly into the patient’s stomach. This type of tube is called a:
a. nasogastric tube.
b. jejunostomy
c. surgical gastrostomy.
d. percutaneous endoscopic gastrostomy.
e. surgical gastrectomy.
ANSWER: c
DIFFICULTY: Bloom's: Remember
7. The thickness of a liquid is known as its:

a. osmolality.
b. viscosity.
c. nutrient density.
d. osmolarity.
e. coagulation.
ANSWER: b
8. The protein component of most enteral formulas comes from:

a. lactose.
b. monosaccharides.
c. dextrin and fatty acids.

d. albumin and whey.
e. soy or casein.
ANSWER: e
9. Which best describes an advantage of a percutaneous endoscopic gastrostomy (PEG) tube?

a. The tube can be inserted at the bedside
b. The tube is used for short-term feedings
c. It allows for bolus feedings
d. There is little risk of infection
e. The tube can be used for IV fluids
ANSWER: c
10. The usual nutrient density of enteral formulas ranges between:

a. 0.5 and 1.0 kcal/mL
b. 1.0 and 2.0 kcal/mL
c. 2.0 and 2.5 kcal/mL
d. 3.0 and 3.5 kcal/mL
e. 4.0 and 5.5 kcal/mL
ANSWER: b
11. For the critically ill patient in the hospital, enteral feedings should be advanced to meet the nutrition prescription
within:
a. 12 hours.
b. 48 hours.
c. 72 hours.
d. 1 week.
e. 2 weeks.
ANSWER: c
12. Which describes a true statement about continuous enteral feedings?

a. They are administered several times a day -- every 30 minutes.
b. They may be administered by gravity from a container suspended above the patient.
c. They consist of the administration of approximately 250 mL of formula at a time.
d. They are usually more time consuming for staff to administer.
e. They require a pump and other equipment to administer.
ANSWER: e

13. The first step in determining the enteral nutrition prescription is to:
a. consider electrolyte needs.
b. establish a dosing weight.
c. determine fluid needs.
d. determine a kcal goal.
e. consider vitamin and mineral needs.
ANSWER: b
14. Which patient is at highest risk of aspiration when receiving an enteral feeding?
a. A patient with Crohn’s disease
b. A pregnant patient
c. A patient with an endotracheal tube
d. A patient with celiac disease
e. A patient with a concurrent diagnosis of cancer
ANSWER: c
15. A nutritionally unstable patient who is receiving enteral feedings should have fluid status assessed at least:
a. every day.
b. 3 times per week.
c. every week.
d. every 1-2 weeks.
e. prn.
ANSWER: a
16. Which of the following actions is appropriate to prevent a clogged feeding tube?
a. Instill heparin into the tubing
b. Slow the feeding to run at ½ the normal rate for one hour a day
c. Use a small volume syringe and add air into the tube
d. Flush with 25 mL of tap water several times a day
e. Reinsert the stylet that was used during tube placement
ANSWER: d
17. Which patient is most likely at risk of refeeding syndrome?

a. A patient recovering from outpatient surgery
b. A patient with gastroesophageal reflux

c. A patient with hypermagnesemia
d. A patient with osteoporosis
e. A patient with a history of long-term inadequate oral intake
ANSWER: e
18. Which of the following nursing interventions is appropriate to reduce the risk of aspiration during enteral feedings?
a. Instill blue dye into the feeding
b. Check a level of lung aspirate daily
c. Elevate the head of the bed at least 30 degrees
d. Instill the feeding at a faster rate
e. Increase fiber to 8 g in each supplement
ANSWER: c
19. Which is an example of a true statement regarding peripheral parenteral nutrition (PPN)?
a. PPN instills small volumes of concentrated fluids.
b. PPN requires only small amounts to be nutritionally adequate
c. PPN is typically most acceptable for a fluid-restricted patient.
d. The high osmolality of PPN may cause small veins to collapse.
e. Peripheral access for PPN is easier to maintain than a central line.
ANSWER: d
REFERENCES: Parenteral Nutrition
20. In which condition would parenteral nutrition most likely be indicated?

a. Short bowel syndrome
b. Increased oral fluid intake
c. Hyperkalemia
d. Severe dysphagia
e. Cardiovascular disease
ANSWER: a
21. Which statement regarding an implantable port would be considered true?

a. An implantable port may be placed by a surgeon or a specially trained registered nurse.
b. An implantable port is usually inserted into the arm and threaded to the vena cava.
c. An implantable port must have the catheter changed every few days to reduce the risk of infection.
d. An implantable port may be difficult to access by the patient.
e. An implantable port is only suitable for short-term access.

ANSWER: d
22. Which describes an advantage of compounding parenteral solutions in the hospital pharmacy?
a. Cost effectiveness
b. Increased patient satisfaction
c. Decreased risk of infection
d. The ability to combine blood products with the solution, if necessary
e. Reduction in nursing requirements
ANSWER: a
23. The primary source of carbohydrate in parenteral nutrition comes from:

a. modified food starch.
b. maltose oligosaccharides.
c. dextrose monohydrate.
d. arginine polyesterols.
e. high fructose corn syrup.
ANSWER: c
24. The minimum amount of carbohydrate found in parenteral nutrition as specified by the DRI is:
a. 60 g/day.
b. 130 g/day.
c. 200 g/day.
d. 240 g/day.
e. 300 g/day.
ANSWER: b
25. Which element is not added routinely to standard parenteral nutrition formulas?
a. selenium
b. zinc
c. iron
d. chromium
e. copper
ANSWER: c
26. How much folic acid is typically required in an adult preparation of parenteral nutrition?
2 mg
a. 250 mcg
b. 500 mcg
c. 600 mcg
d. 1 mg
e. 2 mg
ANSWER: c
27. Which condition is an example of a gastrointestinal complication that may develop with parenteral feedings?
a. irritable bowel syndrome
b. cholestasis
c. dumping syndrome
d. nausea
e. gastroesophageal reflux
ANSWER: b
28. Which situation must be considered when making a decision to start parenteral nutrition?
a. The length of time nutrition support is needed
b. The patient’s BMI
c. The patient’s need for amino acids in solution
d. The physician’s ability to obtain an order
e. The need for an automated compounder
ANSWER: a
29. The Hickman® catheter is an example of which type of catheter used for parenteral nutrition?
a. peripherally inserted central catheter
b. non-tunneled catheter
c. implantable port
d. tunneled catheter
e. Swan-Ganz catheter
ANSWER: d
30. A three-in-one solution of parenteral nutrition prepared by an automated compounder contains:

a. fatty acids, iron, and monosaccharides.
b. dextrose, amino acids, and lipids.
c. omega-3 fatty acids, triglycerides, and commercial amino acids.
d. oligosaccharides, leucine, and valine.

e. nonessential amino acids, dextrose, and vitamins.
ANSWER: b
31. A lipid-based drug that is often administered to the critically ill patient is called:
a. Hydrosol.
b. Hepatosol.
c. Propofol.
d. Aminess.
e. Clinisol.
ANSWER: c
32. Which type of medication would most likely be added to parenteral nutrition solution for patient care?
a. acetaminophen
b. keterolac
c. fentanyl
d. cimetidine
e. demerol
ANSWER: d
33. Which type of complication is most often associated with parenteral nutrition administration?
a. rash
b. lung damage
c. Osteoporosis
d. kidney stones
e. Infection
ANSWER: e
34. Which best describes a common consequence of malnutrition?

a. increased gastric emptying
b. delayed wound healing
c. Cirrhosis
d. atrophic gastritis
e. hearing loss
ANSWER: b

REFERENCES: Introduction
35. Which describes recommended criteria for use of enteral feedings in a pediatric patient?
a. Weight loss of 5 pounds in 6 months
b. Unable to obtain 20% of caloric needs by mouth
c. Requiring over 4 hours a day to eat
d. Inadequate oral intake for over 48 hours
e. Persistent TSF below the 50th percentile
ANSWER: c
Case Study Multiple Choice

You have an 80 yo M patient that has end-stage Alzheimer’s disease and has recently been diagnosed with severe
dysphagia. This patient is getting ready for discharge from the hospital. His height is 5’ 9’’ and he weighs 162# with
no recent changes in weight.
36. How many grams of protein per kilogram of body weight does this patient need?
a. 0.8
b. 1.0
c. 1.2
d. 1.5
e. 2.0
ANSWER: a
PREFACE NAME: Alzheimer’s disease
37. Calculate the daily fluid requirements for this patient.

a. 1000 mL
b. 1800 mL
c. 2200 mL
d. 3100 mL
e. 3400 mL
ANSWER: c
DIFFICULTY: Bloom's: Analyze
38. Which is the correct amount of kcalories needed daily for this patient to maintain normal body weight?
a. 1110 – 1750 kcal
b. 1840 – 2210 kcal
c. 2350 – 2380 kcal
d. 2900 – 3020 kcal
e. 3150 – 3200 kcal

ANSWER: b
39. Which method of providing enteral nutrition would be most appropriate for this patient?
a. orogastric tube
b. nasointestinal feeding tube
c. Jejunostomy
d. surgical gastrostomy
e. nasogastric tube
ANSWER: e
40. Which situation would require that the patient change from enteral nutrition to parenteral nutrition?
a. The patient loses 5 pounds
b. The patient develops a paralytic ileus
c. The patient can no longer afford enteral nutrition
d. The patient develops sleeping problems
e. The protein content of the enteral nutrition needs to be changed
ANSWER: b
41. Up to 40% of nursing home patients exhibit some signs of malnutrition.

a. True
b. False
ANSWER: False
REFERENCES: Introduction
42. In the geriatric population, nutrition support may not be initiated until oral intake has declined precipitously due to
advanced progression of diseases.
a. True
b. False
ANSWER: True
43. The first decision to make when designing the nutrition prescription is how to establish access to the gastrointestinal
tract.
a. True
b. False
ANSWER: True
44. Post-pyloric access is most often used when the patient is at high risk of aspiration.
a. True
b. False
ANSWER: False
45. One of the most common disadvantages of surgical gastrostomy tubes is that they become dislodged easily.
a. True
b. False
ANSWER: False
46. Recent research has reexamined the use of blenderized feedings and has demonstrated improved tolerance in some
children with feeding disorders.
a. True
b. False
ANSWER: True
47. Benefits attributed to fiber, particularly improved bowel function, have more often been associated with insoluble
fiber.
a. True
b. False
ANSWER: False
48. Enteral formulas are often the sole source of water for patients receiving them.
a. True
b. False
ANSWER: True
49. Peripheral parenteral nutrition requires large volumes to meet nutritional needs, which makes this route unacceptable
for any fluid-restricted patient.
a. True
b. False
ANSWER: True
50. Parenteral solutions may contain as many as 5 different items when they are initially compounded.
a. True
b. False
ANSWER: False
51. Enteral nutrition refers to delivery of nutrients distal to the oral cavity of the gastrointestinal tract via a tube, catheter,
or _______________.
ANSWER: stoma
52. Feeding access is achieved when a feeding tube is placed into the stomach or _______________.
ANSWER: intestine
53. _______________ feeding tubes enter the gastrointestinal tract through the nose and reside in the duodenum or
jejunum.
ANSWER: Nasointestinal, Small bowel
54. Among infants, _______________ or _______________ are typically used for enteral feedings.
ANSWER: breast milk; formula,
formula; breast milk
55. Short-chain fatty acids are used by the intestinal cells, called _______________, as fuel and play a role in maintaining
gastrointestinal integrity.
ANSWER: colonocytes
56. _______________ is added to formulas and is generally thought to improve stool consistency and reduce diarrhea.
ANSWER: Fiber
57. A substance that is water loving or that attracts water is said to be _______________.
ANSWER: hydrophilic

58. The osmolality of body fluids is _______________ mOsm/kg.

ANSWER: 300
59. _______________ feedings consist of the administration of 250–500 mL of formula several times daily.
ANSWER: Bolus
60. The outer lumen diameter of a feeding tube is described using a measurement called _______________ size.
ANSWER: French
61. The wire guide within the enteral tube that assists with insertion is called the _______________.
ANSWER: stylet
62. Providing adequate free _______________ as well as using a fiber-supplemented formula are steps that may be
performed to relieve constipation associated with enteral feedings.
ANSWER: water
63. _______________ is a term used to describe several common metabolic alterations that may occur during nutritional
repletion of patients who are malnourished or in a state of starvation.
ANSWER: Refeeding syndrome
64. The primary difference between enteral and parenteral feedings is that nutrients are provided via the
_______________ rather than the gastrointestinal tract in PN.
ANSWER: veins
65. The most common type of parenteral access is a(n) _______________.

ANSWER: central venous catheter, CVC, central line
66. Parenteral solutions are compounded under the supervision of a licensed _______________.
ANSWER: pharmacist
67. Excessive _______________ in parenteral nutrition may contribute to hyperglycemia, hepatic steatosis, and excessive
carbon dioxide production.
ANSWER: carbohydrate, carbohydrates
68. The lipid in most parenteral solutions available in the United States is an emulsion of _______________.
ANSWER: soybean oil
69. Increased permeability to _______________ has been noted when atrophic intestinal cells result from lack of enteral
stimulation.
ANSWER: bacteria
70. If parenteral nutrition is administered continuously for several weeks, transient elevations in _______________
enzymes may be noted.
ANSWER: liver
71. List five examples of nutrition diagnoses that would indicate a need for enteral nutrition.
ANSWER: Examples of nutrition diagnoses that would lead the practitioner to recommend enteral nutrition as an
intervention include malnutrition, increased energy expenditure, involuntary weight loss, inadequate oral
food/beverage intake, inadequate fluid intake, increased nutrient needs, biting/chewing difficulty,
involuntary weight loss, impaired swallowing, and impaired nutrient utilization.
72. List and describe the three different types of enteral feeding methods.
ANSWER: Bolus feedings consist of the administration of 250–500 mL of formula several times daily. A syringe
may be used to inject feedings through the tube. Intermittent feedings are also administered several times
daily, over 20–30 minutes. A pump is typically used to control the flow rate. Continuous feedings are
administered over 8–24 hours daily, using a pump to control the feeding rate.
73. List the steps of determining the nutrition prescription.

ANSWER: To determine the nutrition prescription, the clinician must first calculate the patient’s dosing weight, as
well as protein, energy, and fluid requirements. The clinician then identifies the most appropriate type of
formula based on the patient’s diagnosis. Total energy needs are calculated and then divided by the
caloric density of the formula. To determine the goal rate of administration, the clinician divides the total
formula volume by the number of hours administered. The starting rate may be lower and then the rate
advanced as tolerated to reach the goal rate.
74. Give two examples of each of the following: short-term venous access, long-term venous access.
ANSWER: Types of short-term venous access include the percutaneous central venous catheter (CVC) and the
peripherally inserted central catheter (PICC) line. Types of long-term venous access include the tunneled
catheter (Hickman®, Broviac®) and implantable ports.
75. List four examples of potential complications associated with parenteral nutrition.
ANSWER: Complications of parenteral nutrition include electrolyte imbalance, under- or over-feeding,
hyperglycemia, refeeding syndrome, cholestasis, increased permeability to bacteria in the intestinal tract,
elevations in liver enzymes, and increased rates of infection.
76. Describe the procedure for inserting a nasogastric feeding tube.

ANSWER: Registered dietitians (RDs) may be responsible for insertion of nasogastric or nasointestinal feeding
tubes for adults in some institutions. A recent review of this practice found a 66% reduction of hospital
costs associated with tube insertion along with a shorter time for insertion and a shorter time for feeding
initiation in institutions where the RD is responsible for bedside placement of postpyloric feeding tubes.
Box 5.3 summarizes the protocol for the insertion of tubes in adults. (See the “Equipment” section later
in the chapter for more information about the tubes and other supplies involved.)
77. Describe indications, advantages, and disadvantages of the following types of enteral feeding tubes: nasogastric tubes,
orogastric tubes, gastrostomy tubes, PEG tubes.
ANSWER: Nasogastric tubes are indicated in cases of normal GI function; they stimulate digestive function, are
easy to insert and maintain, and they allow for medication administration. Disadvantages of nasogastric
tubes include patient discomfort, increased risk of aspiration, irritation of the nasal passages, and the
potential for tube displacement. Orogastric tubes are used with normal GI function but when a
nasogastric tube is not feasible. Advantages include normal stimulation of gut function, they are easy to
insert and maintain, and medications can be placed in the tube. Disadvantages include tube displacement,
increased risk of aspiration, and discomfort for the patient. Gastrostomy and PEG tubes bypass the upper
GI tract and are used for long-term feedings. Gastrostomy tubes allow for boluses, they are used long
term, and there is less risk of aspiration or tube displacement, but they require surgery for placement and
the patient can develop skin irritation at the insertion site. PEG tubes can be inserted on an outpatient
basis, they allow for bolus feedings, and there is little risk of tube displacement but there is a greater risk
of skin irritation at the insertion site.
78. List and describe four examples of complications associated with enteral feedings.
ANSWER: Enteral feeding is not a simple procedure. Patients who receive enteral feedings may experience a variety
of complications, and some of these—such as aspiration or tube misplacement—are serious.
Complications of enteral feedings may develop at any point during a course of therapy. High-risk
patients who have concurrent illnesses require an experienced dietitian to successfully manage enteral
feedings. Information about the tube-related and gastrointestinal complications, as well as other issues,
can be found in the section Monitoring and Evaluation: Complications.
79. Explain indications for using parenteral nutrition and list several conditions that would require parenteral nutrition
instead of enteral nutrition.
ANSWER: Parenteral nutrition is indicated in those clinical situations where the patient is unable to meet nutritional
needs either by an oral diet or through the use of enteral nutrition. The clinical conditions that may
require parenteral nutrition include an inability to digest and absorb nutrients, such as in massive bowel
resection or short bowel syndrome; intractable vomiting, as in hyperemesis gravidarum; GI tract
obstruction;impaired GI motility; and abdominal trauma, injury, or infection. Nutrition diagnoses
associated with candidates for PN are the same as those for EN.
80. Describe the use of a pharmacy compounder with the nutrition prescription and list advantages as well as
disadvantages.
ANSWER: Automated compounders can be used to manufacture nutrient solutions that combine dextrose and amino
acids (two-in-one formulas) or dextrose, amino acids, and lipids (three-in-one formulas). PN can be
provided in either a two-in-one or three-in-one system, and each system has both advantages and
disadvantages. In the two-in-one, lipids are added separately based on the available container sizes (100
mL, 250 mL, or 500 mL). This system provides a greater degree of flexibility in the amounts of dextrose
and amino acids that can be given. A disadvantage of the two-in-one system is the need for an additional
administration set (intravenous tubing and other devices required for the delivery of parenteral nutrition)
for the lipids. The three-in-one system requires a single administration set, which saves nursing time and
reduces costs. On the other hand, the addition of lipids with the three-in-one system results in an opaque
solution, which obscures precipitate and increases the risk of particulate being infused into the patient.
Addition of lipid into the three-in-one solution limits the electrolytes and ﬁnal concentration of amino
acids in solution.

Nutrition Therapy and Pathophysiology 3rd Edition Nelms Test Bank 1

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nutrition Therapy and Pathophysiology 3rd Edition Nelms Test Bank 1

Uploaded by

Copyright:

Available Formats

Chapter 05 - Enteral and Parental Nutrition Support

Nutrition Therapy and Pathophysiology 3rd

Solution Manual: https://testbankpack.com/p/solution-manual-for-nutrition-

1. Which example is not considered to be a contraindication to enteral feeding?

2. Which is an example of a research-supported reason to use enteral nutrition support?

5. Which best describes a disadvantage of using a nasogastric tube in a patient?

7. The thickness of a liquid is known as its:

8. The protein component of most enteral formulas comes from:

c. dextrin and fatty acids.

9. Which best describes an advantage of a percutaneous endoscopic gastrostomy (PEG) tube?

10. The usual nutrient density of enteral formulas ranges between:

12. Which describes a true statement about continuous enteral feedings?

DIFFICULTY: Bloom's: Apply

17. Which patient is most likely at risk of refeeding syndrome?

b. A patient with gastroesophageal reflux

20. In which condition would parenteral nutrition most likely be indicated?

21. Which statement regarding an implantable port would be considered true?

Copyright Cengage Learning. Powered by Cognero. Page 5

23. The primary source of carbohydrate in parenteral nutrition comes from:

30. A three-in-one solution of parenteral nutrition prepared by an automated compounder contains:

d. oligosaccharides, leucine, and valine.

34. Which best describes a common consequence of malnutrition?

Copyright Cengage Learning. Powered by Cognero. Page 8

Case Study Multiple Choice

37. Calculate the daily fluid requirements for this patient.

Copyright Cengage Learning. Powered by Cognero. Page 9

41. Up to 40% of nursing home patients exhibit some signs of malnutrition.

DIFFICULTY: Bloom's: Remember

58. The osmolality of body fluids is _______________ mOsm/kg.

65. The most common type of parenteral access is a(n) _______________.

73. List the steps of determining the nutrition prescription.

76. Describe the procedure for inserting a nasogastric feeding tube.

Copyright Cengage Learning. Powered by Cognero. Page 16

You might also like