ASPEN Modules Questions and Correct Answers the Latest Update and Recommended Version
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Which of the following is the inpatient glycemic target for critically ill patients?
1: 80-110 mg/dL
2: 140-180 mg/dL
3: 181-210 mg/dL
4: 211-240 mg/dL
→ 2: 140-180 mg/dL
→
→ For the critically ill patient, blood glucose levels should be maintained between 140-
180 mg/dL. Lower gluco...
ASPEN Modules Questions and Correct
Answers the Latest Update and
Recommended Version
Which of the following is the inpatient glycemic target for critically ill patients?
1: 80-110 mg/dL
2: 140-180 mg/dL
3: 181-210 mg/dL
4: 211-240 mg/dL
→ 2: 140-180 mg/dL
→
→ For the critically ill patient, blood glucose levels should be maintained between 140-
180 mg/dL. Lower glucose targets may be appropriate for selected patients, but
targets <110 mg/dL are not recommended
Under conditions of sepsis and stress, which of the following metabolic alterations most likely
occur?
1: Increased glucose production and increased glucose uptake
2: Increased glucose production and decreased glucose uptake
3: Decreased glucose production and decreased glucose uptake
4: Decreased glucose production and increased glucose uptake
→ 2: Increased glucose production and decreased glucose uptake
→
→ The metabolic response to sepsis and stress is characterized by an increase in glucose
production and a decrease in glucose uptake. Stress hormones induce insulin resistance
and hyperglycemia is commonly observed in stressed patients. It is recommended that
glucose levels be adequately controlled to avoid polyuria, electrolyte disturbances,
and infectious complications.
Which of the following immunomodulating nutrients may be harmful in patients with
sepsis/septic shock?
1: Arginine
2: Selenium
3: Nucleic acids
4: Omega-3 fatty acids
→ 1: Arginine
→
→ Arginine is a major substrate for nitric oxide production. Under normal conditions, small
quantities of nitric oxide have a beneficial effect on immune function and tissue
oxygenation. Thus, arginine is considered an "immune-enhancing" agent. However,
nitric oxide can be detrimental by leading to coagulation abnormalities and altered
hemodynamic status. In this case, arginine could be considered harmful for patients
with sepsis/septic shock. Because of these effects, there is still much debate over the
value of arginine in nutrition support for critically ill patients.
Which of the following best describes enteral glutamine supplementation in the critically ill
→ 4: Enteral glutamine decreases nosocomial infections
→
→ A recent meta-analysis investigated the impact of glutamine-supplemented nutrition on
the outcomes of critically ill patients and found that glutamine supplementation did not
decrease mortality and length of hospital stay in critically ill patients. However,
glutamine supplementation did reduce nosocomial infections among critically ill
patients.
Which of the following are counter-regulatory hormones responsible for the hypercatabolism
observed in critically ill trauma patients?
1: Glycogen, insulin, norepinephrine
2: Glucagon, epinephrine, cortisol
3: Glycerol, serotonin, thymoglobulin
4: Glycerin, leptin, adenosine
→ 2: Glucagon, epinephrine, cortisol
→
→ The inflammation following a traumatic injury provokes a release of systemic catabolic
hormones including epinephrine, glucagon, and cortisol. These hormones are
responsible for glycogenolysis, gluconeogenesis, proteolysis, and free fatty acid
release. The goal of this metabolic response is to maintain survival and homeostasis
and promote recovery. Therapeutic intervention is geared toward blunting the
inflammatory response without making the patient susceptible to immunosuppression.
Timely resuscitation, including restoration of perfusion, oxygenation, and hemodynamic
stability is the top priority. The early initiation of nutrition is an important component of
supportive therapy in the care of the trauma patient.
In patients with burns, providing caloric support above energy expenditure has been found to
4: have no effect on preservation of lean body mass
→ 4: have no effect on preservation of lean body mass
→
→ The metabolic stress that occurs in burn injury generates a hypercatabolic state that
increases energy expenditure. Although patients with burns have increased needs,
feeding in excess of energy expenditure may cause hyperglycemia, hepatic steatosis,
and prolonged ventilator dependence. One study of critically ill burn patients showed
that caloric delivery beyond 1.2 x REE did not conserve lean body mass but did
increase fat mass.
In pulmonary insufficiency, excessive calorie administration may cause increased blood pCO2
resulting in
1: metabolic acidosis
2: metabolic alkalosis
3: respiratory acidosis
4: respiratory alkalosis
→ 3: respiratory acidosis
→
→ Respiratory acidosis results from disorders producing alterations in ventilatory control,
increased production of CO2, and respiratory muscle weakness. The increased CO2
production is greatest when overfeeding occurs (2 x REE) due to an excess generation
of CO2 relative to O2 consumption during carbohydrate metabolism.
Which of the following is true of essential fatty acid deficiency (EFAD) in patients with cystic
fibrosis (CF)?
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