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ASPEN Self-Study CNSC QUESTIONS WITH PASSED ANSWERS!!
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Define ARDS. - ️️Acute respiratory distress syndrome - inflammatory response leading to diffuse alveolar damage and lung capillary endothelial injury. What is the evidence for use of omega-3 fatty acids in ARDS and ALI? - ️️Based on 3 level 1 studies the Guidelines for the Provision and ...

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  • September 17, 2024
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ASPEN Self-Study CNSC
Define ARDS. - ✔️✔️Acute respiratory distress syndrome - inflammatory response
leading to diffuse alveolar damage and lung capillary endothelial injury.

What is the evidence for use of omega-3 fatty acids in ARDS and ALI? - ✔️✔️Based on
3 level 1 studies the Guidelines for the Provision and Assessment of Nutrition Support
Therapy in the Adult Critically Ill Patient in 2009 recommended patients with ARDS and
severe ALI be placed on an enteral formulation characterized by an anti-inflammatory
lipid profile. Subsequent to the publication of those guidelines and recommendations
have been studies published in 2011 showing that enteral supplementation of omega-3
fatty acids did not result in improved biomarkers of inflammation or clinical outcomes


Modular products are used to enhance the nutrient profile of a feeding regimen. Which
of the following combinations represents modular products?

1. Safflower oil, protein, glucose and selenium
2. Glucose, glutamine, water and MCT oil
3. Protein, cholecalciferol, fiber and safflower oil
4. MCT oil, glucose, fiber and protein - ✔️✔️4. MCT oil, glucose, fiber and protein

Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino
acids are examples of what? - ✔️✔️Modular products

Early initiation of enteral feeding has been suggested to benefit ICU patients by
reducing infectious complications, length of hospital stay and even possibly reducing
mortality. Which group of patients might be at significant risk from early enteral feeding?

1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic saline
4. Patients admitted to the hospital with acute on chronic pancreatitis - ✔️✔️2. Patients
with increasing vasopressor support

What is the risk of feeding a patient before hemodynamic stability has been achieved? -
✔️✔️May increase the risk of intestinal ischemia as blood perfusion of the gut may be
compromised in a patient who is still requiring high doses of vasopressor drugs to
maintain blood pressure

When should EN be initiated in the hemodynamically unstable patient? - ✔️✔️EN
should be delayed until fluid resuscitation is complete

,A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding
formula containing supplemental

1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids - ✔️✔️4. omega-3 fatty acids


Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS? -
✔️✔️Inflammatory mediators, including prostaglandins and leukotrienes derived from
arachidonic acid metabolism have been implicated in both ALI and ARDS. Formulas
containing omega-3 fatty acids may down regulate the inflammatory response through
the production of less inflammatory prostaglnadins and leukotrienes


The use of enteral nutrition formulas enriched with BCAAs is best used for patients with:

1. cirrhosis
2. hepatic failure
3. liver transplantation
4. refractory encephalopathy - ✔️✔️4. refractory encephalopathy

What is the theory behind use of BCAAs in hepatic encephalopathy? - ✔️✔️There is
believed to be an increased ratio of aromatic amino acids to BCAAs in patients
experiencing hepatic encephalopathy. The decrease in BCAA is suspected to be due to
an increased breakdown in BCAA from skeletal muscles and utilization. The increased
levels of AAA generate false neurotransmitters, resulting in hepatic encephalopathy
symptoms.

What is the evidence for BCAA enriched amino acid enteral formulas? - ✔️✔️Published
randomized trials have shown mixed results in patients with hepatic failure receiving
these specialized formulas. Due to the lack of evidence supporting their use and the
increased cost of such products it has been suggested that the use of these hepatic
fomulas be limited to patients with encephalopathy refractory to standard medical
therapy (lactulose, non-absorbed antibiotics)

Enteral nutrition may be contraindicated in the early post-transplant period in adult
patients with hematopoietic cell transplants because of:

1. increased incidence of sinusitis with enteral feedings
2. lack of benefit from enteral feedings in allogeneic patients
3. gastrointestinal toxicities related to the conditioning regimen
4. improved survival seen in autologous patients receiving PN - ✔️✔️3. Gastrointestinal
toxicities related to the conditioning regimen

,Which nutrition therapy is preferred in early post-transplant hematopoietic cell transplant
patients (adult)? - ✔️✔️Currently there is insufficient data to establish benefits of
enteral nutrition over parenteral nutrition with hematopoietic cell transplants. In one
study, parenteral nutrition was found to increase survival in allogeneic patients

Which of the following medications would be appropriate to crush and deliver via an
enteral feeding tube?

1. Nifedipine XL
2. Metoprolol immediate release
3. Enteric coated aspirin
4. Diltiazem CD - ✔️✔️2. Metoprolol immediate release

What type of tablets should be crushed for administration via an enteral feeding tube? -
✔️✔️Only immediate release tablets should be crushed fro administration via an
enteral feeding tube.

Why are enteric coated and film coated tablets not crushed for administration via an EN
feeding tube? - ✔️✔️Enteric coated or film coated tablets do not crush well and tend to
clump and increase the risk of clogging the tube.

Why are modified release dosage forms of drugs inappropriate to crush and give via EN
feeding tubes? - ✔️✔️Modified release dosage forms (often designated with
abbreviations such as XL, XR, SR, CD etc.) are inappropriate to crush and give via EN
feeding tube because crushing these dosage forms destroys their modified releasing
properties. This may lead to an excessive dose of the drug being released at one time
(instead of slowly over a longer period of time), which can lead to adverse effects and
has even been reported as a cause of death

Which of the following describes an optimal method of preparing and administering
medications via an enteral feeding tube?

1. Crush tablets and add them directly in the EN formula
2. Administer liquid formulations undiluted to minimize fluid overload
3. Flush the tube with water before and after each medication administered
4. Add crushed tablets to liquid medication sand administer the mixture all together -
✔️✔️3. Flush the tube with water before and after each medication administered

Why should the EN tube be flushed before and after each medication? - ✔️✔️Helps to
avoid physical interactions both between medications and between medications and
formula.

How should liquid formulations be administered? Why? - ✔️✔️Many liquid medications
are hyperosmolar which can lead to diarrhea and/or have high viscosity which can lead

, to tube clogging, so liquid dosage forms should be diluted with water prior to
administration

In patients with severe acute pancreatitis enteral nutrition has been documented to
provide the following benefits over parenteral nutrition EXCEPT:

1. decreased infection rate
2. decreased hospital LOS
3. decreased pain
4. decreased mortality - ✔️✔️3. Decreased pain

List 5 benefits in patients with severe acute pancreatitis on EN vs. PN nutrition support -
✔️✔️1. significant reduction in infectious morbidity
2. decreased hospital LOS
3. Reduced need for surgical intervention
4. Reduced multiple organ failure
5. Decreased mortality

In patient with fat malabsorption, an enteral product containing which of the following
can provide a concentrated source of energy?

1. MCT
2. Free amino acids
3. Fructooligosaccharides
4. Long chain triglycerides - ✔️✔️1. MCTs

What nutrient can be used to provide a concentrated source of energy to patients with
fat malabsorption or damage to lymphatic vessels? Why? - ✔️✔️MCT

MCT are absorbed directly into the bloodstream and enter portal circulation bypassing
the need for pancreatic enzymes, bile, bile transport in the lymphatic system and
carnitine dependent transport into the mitochondria.

Which of the following is true regarding infectious complications associated with enteral
feedings?

1. Bacterial contamination may originate from the patient's throat, lung and stomach
2. Exceeding manufacture hang-time guidelines is not a risk for bacterial contamination
3. Open systems have less exogenous bacterial contamination
4. The enteral tube site should be routinely cultured - ✔️✔️1. Bacterial contamination
may originate from the patient's throat, lung and stomach

Name the 2 routes of bacterial contamination of enteral feeds. - ✔️✔️1. Exogenously
through the feeding equipment
2. Endogenously through retrograde contamination of the feeding apparatus from the
patient's own infected secretions

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