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Module 1 Self Study ASPEN.Complete questions and answers all correct
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Module 1 Self Study ASPEN1.Copper deficiency is associated with
1: leukocytosis.
2: macrocytic anemia.
3: microcytic hypochromic anemia.
4: erythrocytosis. - ANSWER3: microcytic hypochromic anemia.
A pregnant patient is admitted with hyperemesis gravidarium (HG). Which of the
following is a clinical indication for PN use?
1: Vomiting NOT controlled with supportive care within 48 hours
2: Intolerance to EN trial and supportive care measures
3: Patient refusal of EN tube placement
4: Fluid and electrolyte imbalances - ANSWERHyperemesis gravidarum (HG) is a
severe form of pregnancy-induced nausea and vomiting. Due to the likelihood that the
patient's nutritional intake has been poor for several weeks due to vomiting, EN or PN
may be required. Prior to implementation of nutritional therapy for HG, fluid and
electrolyte imbalances, ketonuria, and dehydration would be treated via IV fluid.
Multivitamins with additional B vitamins are typically added to address suboptimal
vitamin intake and prevent complications such as neuropathies (B6 and B12),
Wernicke's encephalopathy (thiamine), and neural tube defects (folic acid). Antiemetic
treatment would begin and oral intake would temporarily be avoided. Initiation of an EN
trial for HG would be appropriate if the patient is still unable to take oral feedings after
24-48 hours of supportive therapy as listed above. If the EN trial fails due to
exacerbated nausea, vomiting, diarrhea, significant gastric residuals, or tube
displacement and is associated with clinically significant weight loss (greater than 5% of
body weight), it is appropriate to begin PN.
Rapid intravenous infusion of potassium phosphate may result in
1: thrombophlebitis.
2: hypercalcemia.
3: metabolic alkalosis.
4: vitamin D deficiency. - ANSWERInfusion rates of phosphate should not exceed 7
mmol/h because faster infusion rates can often cause thrombophlebitis (ie, potassium
phosphate) and metastatic calcium-phosphate deposition with potential resultant organ
dysfunction.
3. What is the most common complication associated with PN administration?
1: Hypophosphatemia
2: Hyperkalemia
3: Hyponatremia
4: Hyperglycemia - ANSWERHyperglycemia is the most common complication
associated with PN administration and can be caused by various factors. Stress-
associated hyperglycemia in acutely ill and septic patients often develops as a result of
,insulin resistance, increased gluconeogenesis and glycogenolysis, and suppressed
insulin secretion.
4 What is the glycemic target for the majority of critically ill adult patients?
1: 80 to 110 mg/dL
2: 220 to 240 mg/dL
3: 140 to 180 mg/dL
4: 180 to 220 mg/dL - ANSWERThe current recommendation for glycemic target by the
American Association of Clinical Endocrinologists (AACE) and the American Diabetes
Association (ADA) is to maintain the glucose level between 140-180 mg/dL for the
majority of critically ill adult patients. Lower glucose targets (110 mg/dl to 140 mg/dL)
may be appropriate for some patients, but this is only appropriate when this can be
safely achieved. Targets less than 110 mg/dl are not recommended due to the adverse
effects of hypoglycemia.
5. What is the preferred approach recommended by the American Association of
Clinical Endocrinologists (AACE) and the American Diabetes Association (ADA) for
subcutaneous insulin administration in the hospitalized adult patient with diabetes
mellitus?
1: Sliding-scale insulin therapy
2: Basal insulin therapy
3: Bolus insulin therapy
4: Basal-bolus insulin therapy - ANSWERThe preferred approach for subcutaneous
insulin administration is basal-bolus insulin therapy. This approach allows for basal
insulin administered for hepatic glucose output combined with scheduled bolus insulin
administered for meal times. There are three components to basal-bolus insulin therapy;
basal insulin, nutritional component prior to meals and a correctional insulin.
Which form of glutamine supplementation improves physical compatibility and stability
for admixture in PN solutions?
1: Glutamine dipeptide
2: Free glutamine
3: L-glutamine powder
4: Protein bound glutamine. - ANSWERGlutamine supplementation is available in
parenteral solutions, some predigested enteral formulas, and oral nutrition supplements.
However, IV glutamine supplements are not commercially available in the United
States. Glutamine dipeptide products such as L-alanyl-L-glutamine and Glycyl-L-
glutamine improve water solubility, stability during heat sterilization, and the capability
for prolonged shelf life when compounding in parenteral solutions. Free glutamine is
unstable in parenteral solutions. Parenteral glutamine supplementation is more
beneficial than enteral supplementation. Enteral glutamine is protein bound and it is
difficult to determine the exact glutamine content. L glutamine powder is used in oral
nutrition supplements.
In the critically ill obese patient, specific guidelines for the provision of calories and
protein have been recommended by both the Society of Critical Care Medicine and the
, American Society for Parenteral and Enteral Nutrition. For a patient with a BMI 33.4
kg/m2, which of the following choices best reflects the calorie recommendations for
parenteral and enteral nutrition?
1: 11- 14 Kcal/kg ideal body weight/day
2: 11 - 14 Kcal/kg actual body weight/day
3: 22 - 25 Kcal/kg actual body weight/day
4: 22 - 25 Kcal/kg ideal body weight/day - ANSWERFor all classes of obesity where BMI
is >30 kg/m2, the goal of the parenteral and enteral regimen should not exceed 65% to
70% of target energy requirements as measured by indirect calorimetry. If indirect
calorimetry is not available, using the weight based equation 11-14 kcal/kg actual body
weight/day for patients with BMI 30-50 kg/m2 and 22-25 kcal/kg ideal body weight/day
for patients with BMI > 50 kg/m2 is recommended. Protein should be provided in a
range greater than or equal to 2.0 g/kg ideal body weight/day for patients with BMI 30-
40 kg/m2, and up to 2.5 g/kg ideal body weight/day for patients with BMI ≥40 kg/m2.
Which of the following additives has the greatest risk of destabilizing the lipid injectable
emulsion (ILE) in a total nutrient admixture (TNA)?
1: Sodium chloride 2: Calcium acetate 3: Iron dextran 4: Potassium phosphate -
ANSWERPhase separation and the liberation of free oil from the destabilization of TNAs
can result over time when an excess of cations is added to a given formulation. The
higher the cation valence, the greater the destabilizing power; thus, trivalent cations
such as Fe+3 (from iron dextran) are more disruptive than divalent cations such as
calcium and magnesium. Monovalent cations such as sodium and potassium are least
disruptive to the emulsifier, yet when given in sufficiently high concentrations, they may
also produce instability. There is no safe concentration of iron dextran in any TNA.
Question: 9
Which of the following factors has been associated with an increase in prescribing
errors related to PN formulations?
1: Standardized PN order form
2: Calculation of PN dosages
3: PN components ordered as amount per day
4: PN components listed in same sequence on order form as PN label - ANSWER2
According to the ASPEN PN Safety Consensus Recommendations, which of the
following is the best method to express the dextrose content on the label of a PN
formulation in order to avoid misinterpretation?
1: Volume of the percent original concentration added (e.g., 500 mL of 50% dextrose)
2: Grams per liter (e.g., 250g/L)
3: Percent of final concentration after admixture (e.g., 35% dextrose)
4: Grams per 24-hour nutrient infusion (e.g., 225 g/day) - ANSWERPN ingredients shall
be ordered in amounts per day for adults and amounts per kilogram per day for pediatric
and neonatal patients. This limits the confusion of conversion from amounts per liter,
percent concentration, or volume. Amount per day refers to macronutrients in grams per
day and micronutrients in mEq, mmol, mcg, or mg per day.
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