ASPEN Self-Assessment questions with correct

ASPEN Self-Assessment questions with correct answers

• Intolerance to EN trial and supportive care measures. CORRECT ANSWER A

pregnant patient is admitted with hyperemesis gravidarium. Which of the following is a clinical indication for PN use?

• Vomiting not controlled with supportive care within 48 hrs.
• Intolerance to EN trial and supportive care measures.
• Patient refusal of EN tube placement.
• Fluid and electrolyte imbalances.

B6 & B12 CORRECT ANSWER Deficiencies in what two vitamins may lead to neuropathies?Thiamine CORRECT ANSWER Deficiency of what vitamin may lead to Wernicke's Encephalopathy?Folic acid CORRECT ANSWER Deficiency of what vitamin may lead to neural tube defects?If a pt is unable to take PO feeds after 24-48 hours of supportive therapy.CORRECT ANSWER When would EN be trialed on a patient with HG?

• Thrombophlebitis CORRECT ANSWER Rapid IV infusion of KPhos may result

in:

• Thrombophlebitis 1 / 4

• Hypercalcemia
• Metabolic alkalosis
• Vitamin D deficiency
• mmol/hr CORRECT ANSWER What is the maximum infusion rate for

phosphorus?Metastatic Ca/Phos deposition with potential resultant organ dysfunction CORRECT ANSWER What are 2 potential consequences of exceeding the maximum rate of phos infusion?

• Hyperglycemia CORRECT ANSWER What is the most common complication

associated with PN administration?

• Hypophosphatemia
• Hypokalemia
• Hyponatremia
• Hyperglycemia

Insulin resistance, increased gluconeogenesis and glycogenolysis, and suppressed insulin secretion CORRECT ANSWER What are 4 reasons for stress-associated hyperglycemia in critically ill patients?140-180 mg/dl CORRECT ANSWER What is the glycemic target for the majority of critically ill patients?Only when can safely be achieved CORRECT ANSWER When are lower glucose targets (110-140 mg/dl) appropriate? 2 / 4

Hypoglycemia CORRECT ANSWER Why are targets <110 mg/dl not recommended?Basal-bolus insulin therapy CORRECT ANSWER What is the preferred approach recommended by the American Association of Clinical Endocrinologists & American Diabetes Association for subcutaneous insulin administration in the hospitalized adult patient with diabetes mellitus?Basal insulin CORRECT ANSWER Insulin scheduled to control hepatic glucose output Bolus insulin CORRECT ANSWER Insulin scheduled for mealtimes Basal insulin, nutritional component prior to meals, and correctional insulin CORRECT ANSWER What are the 3 components of basal-bolus insulin therapy?Glutamine dipeptide CORRECT ANSWER What form of glutamine supplementation improves physical compatibility and stability for admixture in PN solutions?Glutamine dipeptide CORRECT ANSWER Improves water solubility, stability during heat sterilization, and capability for prolonged shelf life when compounding in PN solutions.Enteral glutamine CORRECT ANSWER Protein bound and difficult to determine the exact content.L glutamine powder CORRECT ANSWER Used in oral nutrition supplements 3 / 4

Do not exceed 65-70% of target energy requirements CORRECT ANSWER Recommendation for providing calories estimated by indirect calorimetry in all obese patients (BMI >30) 11-14 kcal/kg/d CORRECT ANSWER SCCM and ASPEN calorie recommendations for critically ill obese patients with a BMI 30-50 22-25 kcal/kg IBW/d CORRECT ANSWER SCCM and ASPEN calorie recommendations for critically ill obese patients with a BMI >50 >/=2 gm/kg IBW/d CORRECT ANSWER SCCM and ASPEN protein recommendations for critically ill obese patients with a BMI 30-50 Up to 2.5 gm/kg IBW/d CORRECT ANSWER SCCM and ASPEN protein recommendations for critically ill obese patients with a BMI >50 Iron dextran (Fe 3+; trivalent cation) CORRECT ANSWER Which of the following additives has the greatest risk of destabilizing the ILE in a TNA?

• NaCl
• Ca acetate
• Iron dextran
• KPhos

Excess of cations (the higher the cation valence the greater the destabilizing power) CORRECT ANSWER What can cause phase separation and liberation of free oil from the destabilization of TNAs

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