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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...

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  • October 19, 2024
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ASPEN Self-Study CNSC Questions and
Correct Answers the Latest Update and
Recommended Version
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


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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


Define ARDS.

→ Acute respiratory distress syndrome - inflammatory response leading to diffuse
alveolar damage and lung capillary endothelial injury.


Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS?



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→ 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


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


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?




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→ 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


Why is EN contraindicated in the early post-transplant period in adult patients with

hematopoietic cell transplants?


→ GI toxicities such as nausea, vomiting, delayed gastric emptying and diarrhea seen in
the first 2-3 weeks post-stem cell transplant may preclude EN. GI toxicity is most often
related to chemotherapy and total body irradiatin, however GI toxicity may also
result from other medications or early acute graft-versus-host disease in this patient
population.


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




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