CNSC Exam Questions and Answers 100% Pass

CNSC Exam Questions and Answers 100% Pass A pregnant patient is admitted with hyperemesis gravidarium (HG). Which of the following is a clinical indication for PN use? -Answer-Intolerance to EN trial and supportive care measures Rapid intravenous infusion of potassium phosphate may result in -Answer- Thrombophlebitis most common complication associated with PN administration? -Answer-Hyperglycemia The preferred approach for subcutaneous insulin administration -Answer-Basal-bolus insulin therapy Which form of glutamine supplementation improves physical compatibility and stability for admixture in PN solutions? -Answer-Glutamine Dipeptide Which of the following additives has the greatest risk of destabilizing the lipid injectable emulsion (ILE) in a total nutrient admixture (TNA)? -Answer-Iron dextran- 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. A complete PN order shall contain the following -Answer-complete patient identifiers, birth date or age, allergies, height and dosing weight in metric units, diagnosis/diagnoses, indication(s) for PN, administration route/vascular access device (peripheral versus central), contact information for prescriber, date and time order submitted, administration date and time, volume and infusion rate, infusion schedule (continuous or cyclic), and type of formulation (TNA versus dextrose/amino acids with separate ILE). PN ingredients shall be ordered as follows: -Answer-amounts per day (for adult patients) or amounts per kilogram per day (for pediatric and neonatal patients), electrolytes as complete salt form, full generic name for each ingredient, dose for each macronutrient and electrolyte, dose for vitamins (including MVI and individual entities), dose for trace elements (including multi-components and/or individual entities), dose for each non-nutrient medication. Which of the following is a indication for the use of parenteral nutrition (PN)? 1: High output fistula 2: Crohn's disease 3: Pancreatitis 4: Hyperemesis gravidarum - Answer-1: High output fistula The routine use of preoperative parenteral nutrition (PN) is indicated for patients with a non-functioning GI tract who are -Answer-significant reductions in perioperative complications are achieved in the severely malnourished patient receiving more than 7 days of preoperative PN. TNA are more likely to be stable for 30 hours at _______ or for 9 days ________ followed by 24 hours at ___________ -Answer-room temperature, refrigerated, room temperature. ILE administered via piggyback separate from amino acid and dextrose should have a hang time of -Answer-12 hours and have tubing and filter changes with each new infusion. Recently package inserts for ILE have been updated to state that 1.2 micron filters should be used during ILE administration. A peripherally inserted central catheter (PICC) is defined as a catheter inserted via peripheral vein whose distal tip lies in the -Answer-Superior vena cava PICC line disadvantages include: -Answer-high rate of malposition or coiling; limited patient arm mobility associated with limited ability to perform daily self-care due to the availability of only one hand; and longer catheter that may be more prone to occlusion. Advantages of PICC lines include: -Answer-no risk of pneumothorax or puncture or internal carotid or subclavian arteries; available in single, double, and triple lumens; and repeated skin puncture is not required. A common complication of central venous catheters inserted at the bedside is -Answer- catheter misplacement, including pneumothorax. The use of fluoroscopy during catheter insertion allows -Answer-immediate repositioning of the catheter tip to its correct location in the superior vena cava. central catheters placed at bedside without fluoroscopy should be -Answer- radiographically confirmed and documented in the medical record before initial use. replacement of temporary catheters during bacteremia should not be done over a guidewire due to -Answer-source of infection (colonization of skin to insertion site). Remove the PICC line only if -Answer-it is suspected or known to be the source of infection The Institute for Healthcare Improvement (IHI) Central Line Bundle should -Answer-be used for central vascular access devices. avoidance of central venous access devices with high risk for infection, such as - Answer-femoral catheters Infusion of hypertonic parenteral solutions exceeding 900 mOsm/L through a peripheral catheter may result in -Answer-Phlebitis The lower concentrated dextrose solutions ____ & ____ and amino acid solutions ____ are most often used for peripheral administration. The osmolarity of 10% dextrose= ______ mOsm/L. The osmolarity of 3% amino acid= ______ mOsm/L. -Answer-5% & 10% 3% 500 300 Which of the following reduces the risk of calcium phosphate precipitation in PN? - Answer-Increased amino acid concentration higher concentrations of amino acids may lower the______ of the PN formulation, which also improves ________________ solubility -Answer-pH, calcium phosphate When compounding PN, it is recommended to add the _________first and then add the ________near the end of compounding to utilize the maximum volume of the PN formulation to dilute the salts -Answer-phosphate , calcium Use of branched-chain amino acid-enriched diets nutrition support formulas is only indicated in -Answer-chronic encephalopathy for those who cannot tolerate at least 1gm/kg/day of standard protein despite optimal pharmacotherapy For infants, it is recommended to provide _________of lipid in order to prevent EFAD. - Answer-0.5 to 1 g/kg/day Failure to provide at least 2% to 4% of the total caloric intake as _______ and 0.25% to 0.5% of total caloric intake as ________ may lead to a deficiency of these two fatty acids -Answer-linoleic acid, alpha linolenic acid The adverse effects of lipid injectable emulsion (ILE) administration in adults is best prevented by -Answer-avoiding serum triglyceride levels 400 mg/dL. When two or more oils are mixed together, the emulsion product is called a -Answer- physical mixture lipid injectable emulsion (ILE) produced by the transesterification of fatty acids to form a composite triglyceride molecule? -Answer-Structured Reductions in _____________________ dosing should be considered in patients with hepatobiliary disease due to impaired excretion -Answer-manganese and copper ________ are a major contributor to aluminum contamination of solutions -Answer- Calcium and phosphate salts, A long term parenteral nutrition patient begins to experience Parkinson-like symptoms. Which trace element toxicity is most likely to present with these symptoms? -Answer- Manganese Current water-soluble vitamin daily parenteral doses are _________ than the Recommended Dietary Allowance (RDA) -Answer-2 to 2.5 times greater transfer, measuring, and mixing manipulations with closed or sealed packaging systems that are performed promptly and attentively is what level risk for TPN -Answer-low Compounding of PN using manual or automated devices during which there are multiple injections, detachments, and attachments of nutrient source products to the device or machine to deliver all nutritional components to a final sterile container is classified as - Answer-medium risk extemporaneously (without preperation) compounded L-glutamine for supplementation in a PN formulation is what level risk -Answer-High