CSG CSG Enteral & Parenteral Nutrition Support 2 — Questions and Answers
Question 1: A high gastric residual volume (GRV) during tube feeding typically indicates:
- Adequate formula absorption
- Delayed gastric emptying requiring feeding rate adjustment (Correct answer)
- Need for increased caloric density
- Dehydration requiring additional free water
Correct answer: Delayed gastric emptying requiring feeding rate adjustment
Elevated GRV suggests delayed gastric emptying, which increases aspiration risk and warrants holding or reducing the feeding rate and assessing for prokinetic therapy.
Question 2: Which enteral formula type is MOST appropriate for an older adult with glucose intolerance or type 2 diabetes?
- Standard polymeric formula
- High-protein formula
- Diabetes-specific formula with modified carbohydrate content (Correct answer)
- Elemental formula
Correct answer: Diabetes-specific formula with modified carbohydrate content
Diabetes-specific enteral formulas contain lower glycemic index carbohydrates and higher fat content to reduce postprandial glucose excursions in older adults with diabetes.
Question 3: Parenteral nutrition is indicated in an older adult when:
- The patient has mild anorexia but functional GI tract
- The gastrointestinal tract is non-functional or inaccessible for more than 7 days (Correct answer)
- Oral intake is temporarily decreased due to a minor procedure
- The patient prefers IV over oral feeding
Correct answer: The gastrointestinal tract is non-functional or inaccessible for more than 7 days
Parenteral nutrition is reserved for situations where the GI tract cannot be used safely or adequately for at least 5–7 days, such as bowel obstruction or severe malabsorption.
Question 4: Free water flushes via feeding tube are primarily used to:
- Dilute the enteral formula for better tolerance
- Maintain hydration and prevent tube occlusion (Correct answer)
- Provide additional calories
- Administer medications
Correct answer: Maintain hydration and prevent tube occlusion
Regular free water flushes (typically 30 mL before and after medications and every 4–6 hours during feeding) prevent tube occlusion and ensure adequate hydration in tube-fed patients.
Question 5: Which complication of long-term parenteral nutrition in older adults is related to liver function?
- Peripheral neuropathy
- Parenteral nutrition-associated liver disease (PNALD) (Correct answer)
- Hypocalcemia
- Anemia of chronic disease
Correct answer: Parenteral nutrition-associated liver disease (PNALD)
Long-term PN can cause hepatic steatosis, cholestasis, and cirrhosis (PNALD) due to continuous glucose and lipid infusion without enteral stimulation of bile flow.
Question 6: When transitioning an older adult from tube feeding to oral intake, the BEST approach is to:
- Stop tube feeding abruptly and offer full oral meals immediately
- Gradually decrease tube feeding volume while encouraging oral intake and monitoring tolerance (Correct answer)
- Continue full tube feeding simultaneously with unrestricted oral diet
- Switch directly to parenteral nutrition during the transition
Correct answer: Gradually decrease tube feeding volume while encouraging oral intake and monitoring tolerance
A gradual transition allows the patient to increase oral intake while tube feeding supplements remaining needs, preventing undernutrition while rebuilding oral feeding capacity.
CSG CSG Enteral & Parenteral Nutrition Support 2
A high gastric residual volume (GRV) during tube feeding typically indicates: