WorksheetsNutrition
Total questions: 18
Worksheet time: 18mins
A 70 kg 66-year-old woman with end-stage renal disease (ESRD) on hemodialysis (HD) requires total parenteral nutrition (TPN) during her hospitalization. Which TPN composition parameter would be considered appropriate for this patient?
15% dextrose solution
30% IV fat emulsion
210 g protein (3 g/kg/day)
105 G protein (1.5 g/kg/day)
3,500 mL water (50 mL/kg/day)
A 25-year-old man is admitted following a major trauma that was complicated by sepsis.
Which of the following is the CORRECT daily calorie and protein requirements?
25 kcal/kg/day and 1.0 g protein/kg/day
25 kcal/kg/day and 1.5 g protein/kg/day
35 kcal/kg/day and 1.5 g protein/kg/day
35 kcal/kg/day and 2.5 g protein/kg/day
40 kcal/kg/day and 2.5 g protein/kg/day
A 35-year-old man is hospital day 7 in the ICU due to a severe attack of acute necrotizing pancreatitis. His current weight is 100 kg. Several attempts to start him on enteral feeding have failed due to persistent ileus, so he was started on total parenteral nutrition (TPN). Assuming his current daily caloric requirement is 25 kcal/kg per day and his protein requirement is 1.5 g/kg per day. How many non-protein calories should the patient get per day through his TPN?
2,200 kcal/day
1,500 kcal/day
1,900 kcal/day
1,650 kcal/day
2,500 kcal/day
When administering parenteral nutrition, central administration is preferred. When placing central venous catheter in the IJ, what is the best reason for using ultrasound?
To reduce CLABSI regardless of site
To reduce pneumothoraces
To reduce all complications from IJ catheters
To properly situate catheter tips after all lines
To reduce number of placement attempts
Which of the following is the definition of respiratory quotient?
CO2 produced/O2 consumed
O2 consumed/CO2 produced
CO2 consumed/O2 produced
CO2 produced/O2 produced
O2 produced/CO2 consumed
Which one of the following statements about nitrogen balance is correct?
Nitrogen balance is the ratio of intake of nitrogenous compounds / output of nitrogenous metabolites from. the body
In nitrogen equilibrium the excretion of nitrogenous metabolites is greater than the dietary intake of nitrogenous compounds.
Positive nitrogen balance means that there is a net loss of protein from the body
In positive nitrogen balance the excretion of nitrogenous metabolites is less than the dietary intake of nitrogenous compounds.
In negative nitrogen balance the excretion of nitrogenous metabolites is less than the dietary intake of nitrogenous compounds
A 72-year-old male smoker is found to have an oropharyngeal squamous cell carcinoma. He has lost 18 kg (40 lb) over the last month and has not been able to tolerate oral intake. He is referred for a Stamm gastrostomy. What is the recommended position of the gastrostomy through the skin?
1 cm below costal margin and 1 cm left of midline
1 cm below costal margin and 1 cm to the right of midline
3 cm below costal margin and 1 cm to the left of midline
3 cm below costal margined 3 cm to the left of midline
3 cm below the costal margin and 3 cm to the right of midline
What is the most common complication of PEG placement?
Refeeding syndrome
Gastrocolocutaneous fistula
Infection at PEG tube site
Hemorrhage
Accidental extubation of PEG tube
In what conditions would you prefer jejunal feeding tube placement over gastric?
Gastroparesis
Delayed gastric emptying
Gastric outlet obstruction
All the above
What is the best marker of nutritional status in a stable patient in the outpatient setting?
Albumin
Prealbumin
Transferrin
C reactive protein
Enteral nutrition maintains the brush border and gut barrier function by:
Avoiding increased permeability of gut (culprit in bacterial translocation)
Decreasing inflammatory response to stressors
Maintaining normal gut microbiome
All of the above
BMI is least reliable in patients who are: _____ (may select one or more choice)
Pregnant
Muscular
Edematous
BMI is reliable regardless of these factors
What is clinically significant weight loss:
A. 1-2% weight loss in 1 week
B. 10% weight loss in 6 months
Both A and B
None of the above
Malnutrition is defined by: decreased energy intake, weight loss, body fat loss, muscle mass loss, edema, reduced grip strength. How many of these factors must be met for a patient to be considered malnourished?
All factors
2 or more
1 or more
1 plus your clinical judgment
When compared to parenteral nutrition, enteral nutrition is ____ expensive and is associated with ____ complications.
More; greater
Less; fewer
Less; greater
More; fewer
Which type of feed is most physiologic?
Continuous
Bolus
Cyclic (8-16 hrs a day)
Intermittent (4-6 times daily)
Normal weight based on BMI?
> 40 kg/m^2
25-29.9 kg/m^2
18.5-24.9 kg/m^2
<18.5 kg/m^2
Malnutrition can be impacted by utilization of nutrients. Conditions of: CKD, DM, metabolic disease describe ____. Whereas, conditions of: trauma, burns, critical illness describe ___.
Poor utilization; Over utilization
Over utilization; poor utilization
Utilization of nutrients is not impacted by these factors
None of the above
