a. Extended bowel rest for treatment of ulcerative colitis b. Patients unable to absorb nutrients through the GI tract c. Burn patients when enteral nutrition is not possible d. Patients undergoing bone marrow transplantation e. Patients NPO for two days

2. Which of the following are possible sites for central line placement?

a. Subclavian vein b. Axillary vein c. Internal jugular vein d. a and c e. b and c

3. Which of the following is not a potential adverse effect of parenteral nutrition?

a. Hyperglycemia b. Seizures c. Sepsis d. Hepatomegaly e. Essential fatty acid deficiency

4. What is the basal fluid requirement for a person between 55 and 65 years old?

a. 20 ml/kg/day b. 25 ml/kg/day c. 30 ml/kg/day d. 35 ml/kg/day e. 40 ml/kg/day

5. How do you estimate the patient’s caloric requirements?

a. Indirect calorimetry b. Use the Harris-Benedict equation c. Apply activity and injury factors to calculate the total energy expenditure d. b and c e. all of the above

6. What is the appropriate ratio of carbohydrate to fat to use in "normal" patients for usual repletion of non-protein calories and to cover for essential fatty acids?

a. 75:25 b. 70:30 c. 60:40 d. 55:45 e. 40:60

7. What is the goal respiratory quotient (RQ) for patients receiving TPN?

a. 0.71 b. 0.80 c. 0.85 d. 0.90 e. 1.00

8. A patient in the ICU is receiving TPN, and indirect calorimetry is performed. The energy expenditure (EE) is reported as 2460 kcal/24 hr, and the RQ is 0.69. Which of the following is true?

1. The patient is being underfed.
2. The TEE for this patient is 2952 kcal/day.
3. The amount of kcal provided by the TPN should be decreased.

a. I only b. III only c. I and II d. II and III e. I, II, and III

9. What is the maximum amount of dextrose a patient can metabolize?

a. 35 kcal/kg/day b. 35 kcal/day c. 35 kcal/kg/min d. 35 kcal/min e. 35 g/kg/day

10. What percentage of total calories should be provided as protein?

a. 5-10% b. 10-15% c. 15-20% d. 20-25% e. 25-30%

11. What is the protein requirement for someone who has undergone abdominal surgery?

a. 0.8-1.2 g/day b. 0.8-1.2 g/kg/day c. 1.2 -1.5 g/day d. 1.2-1.5 g/kg/day e. none of the above

12. What is the maximum percentage of dextrose that can be run in a peripheral line?

a. 7.5% b. 20% c. 12.5% d. 15% e. 10%

13. Choose the statement(s) that are true:

1. The normal adult sodium requirement is 60-150 meq/day
2. Refractory hypokalemia may be due to low magnesium or phosphate
3. The normal adult potassium requirement is 60-180 meq/day

a. I only b. III only c. I and II d. II and III e. I, II, and III

14. Which of the following statements are not true?

a. Patients will require more acetate in the TPN when they are experiencing excessive bicarbonate losses b. In acidotic patients, give enough chloride to match sodium and most potassium c. Acetate is used by the pharmacy to balance the number of cations ordered for the solution d. The normal phosphorus requirement for adults is 15-45 mmol/day e. Hypophosphatemia can result from an intracellular shift of PO4, K, and Mg during TPN initiation

15. Which of the following is true?

a. Normal calcium requirement are 9-13.5 meq/day b. For appropriate calcium repletion, calcium levels need to be interpreted with respect to the albumin c. Magnesium replacement should be 8-24 meq/day d. a and b e. all of the above

16. How much MVI-12 should adults receive while on TPN?

a. 5 ml every day b. 10 ml every other day c. 10 ml every day d. 20 ml every other day e. 20 ml every day

17. Choose the answer that is not true:

a. Albumin can be added to the TPN as an additional protein source b. Ranitidine is compatible with TPN solutions and should be added to the bag whenever possible c. TPN infusions should be started at a rate of 50 ml/hr and increased q 4h until final rate is reached d. Patients can be weaned from TPN rapidly (decrease rate by ½ every two hours) e. For cyclic TPN, a one hour taper at ½ of the final hourly rate is sufficient for starting and ending infusion

18. Which of the following is/are true regarding the monitoring of TPN?

a. Prealbumin should be checked before starting, and then every week b. CBC should be monitored before starting, and then daily until stable c. Accu-chek must be done every four hours while initiating, and then every eight hours until stable d. a and c e. all of the above

19. Which of the following is/are true regarding enteral nutrition

a. Enteral nutrition is more costly than TPN b. Patients are more likely to have complications with enteral nutrition c. Enteral nutrition does not maintain gut integrity d. Enteral nutrition should ALWAYS be utilized if the gut is functional e. none of the above

20. Choose the statement(s) that are true regarding enteral nutrition:

1. Bolus feeding carries a higher risk of aspiration and intestinal side effects
2. Intermittent feeding is tolerated better if no more than 250 ml are given over 30 minutes
3. Cyclic feeding provides less mobility for the patient

a. I only b. III only c. I and II d. II and III e. I, II, and III