ASPEN Self-Study CNSC UPDATED Exam Questions and CORRECT Answers
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ASPEN Self-Study CNSC UPDATED Exam
Questions and CORRECT Answers
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 M...
ASPEN Self-Study CNSC UPDATED Exam
Questions and CORRECT Answers
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 - CORRECT ANSWER- 4. MCT oil, glucose, fiber
and protein
Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino
acids are examples of what? - CORRECT ANSWER- 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 - CORRECT
ANSWER- 2. Patients with increasing vasopressor support
What is the risk of feeding a patient before hemodynamic stability has been achieved? -
CORRECT ANSWER- 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? - CORRECT
ANSWER- 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
Define ARDS. - CORRECT ANSWER- 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? -
CORRECT ANSWER- 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? - CORRECT
ANSWER- 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:
What is the theory behind use of BCAAs in hepatic encephalopathy? - CORRECT
ANSWER- 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? - CORRECT
ANSWER- 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 - CORRECT ANSWER- 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? - CORRECT ANSWER- 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)? - CORRECT ANSWER- 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?
What type of tablets should be crushed for administration via an enteral feeding tube? -
CORRECT ANSWER- 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? - CORRECT ANSWER- 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? - CORRECT ANSWER- 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 -
CORRECT ANSWER- 3. Flush the tube with water before and after each medication
administered
Why should the EN tube be flushed before and after each medication? - CORRECT
ANSWER- Helps to avoid physical interactions both between medications and between
medications and formula.
How should liquid formulations be administered? Why? - CORRECT ANSWER- 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
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