CDN CDN Enteral & Parenteral Nutrition 2 — Questions and Answers
Question 1: Which complication is most associated with rapid advancement of enteral tube feeding in a critically ill patient?
- Constipation
- Aspiration pneumonia (Correct answer)
- Hypoglycemia
- Hyponatremia
Correct answer: Aspiration pneumonia
Aspiration pneumonia is a major risk of enteral feeding, particularly with gastric feeds in patients with impaired gastric motility or altered consciousness.
Question 2: A patient's TPN order includes 25% dextrose, 10% amino acids, and 20% lipid emulsion. Which component provides the most calories per gram?
- Dextrose
- Amino acids
- Lipid emulsion (Correct answer)
- All provide equal calories per gram
Correct answer: Lipid emulsion
Lipid emulsions provide 9 kcal/gram, compared to dextrose at 3.4 kcal/gram (in IV form) and amino acids at 4 kcal/gram.
Question 3: Which lab value is most important to monitor for hepatic complications in a patient on long-term PN?
- Serum albumin
- Serum bilirubin and liver enzymes (ALT/AST) (Correct answer)
- Blood urea nitrogen (BUN)
- Serum creatinine
Correct answer: Serum bilirubin and liver enzymes (ALT/AST)
Elevated bilirubin and liver enzymes indicate PN-associated liver disease (PNALD), a common complication of long-term parenteral nutrition.
Question 4: For a patient with high gastric residual volumes on tube feeds, what feeding strategy is most appropriate?
- Increase the rate of gastric feeding
- Switch to post-pyloric (jejunal) feeding (Correct answer)
- Discontinue enteral nutrition
- Add fiber to the formula
Correct answer: Switch to post-pyloric (jejunal) feeding
Post-pyloric feeding bypasses the stomach, reducing aspiration risk in patients with delayed gastric emptying and high residual volumes.
Question 5: What is the typical protein requirement (g/kg/day) for a critically ill patient receiving nutrition support?
- 0.5–0.8 g/kg/day
- 1.2–2.0 g/kg/day (Correct answer)
- 2.5–3.0 g/kg/day
- 0.8–1.0 g/kg/day
Correct answer: 1.2–2.0 g/kg/day
Critical illness increases catabolism and protein needs; ASPEN and SCCM guidelines recommend 1.2–2.0 g/kg/day for most critically ill adults.
Question 6: Which electrolyte abnormality is most commonly associated with initiating PN in a patient who has been NPO for an extended period?
- Hypernatremia
- Hypophosphatemia (Correct answer)
- Hyperkalemia
- Hypercalcemia
Correct answer: Hypophosphatemia
Hypophosphatemia is the hallmark of refeeding syndrome, occurring when carbohydrate infusion drives phosphorus into cells during anabolic activity.
CDN CDN Enteral & Parenteral Nutrition 2
Which complication is most associated with rapid advancement of enteral tube feeding in a critically ill patient?