Deck 20: Enteral Nutrition Support

Question 1

A formula with an osmolality greater than that of blood serum is known as a(n)

A)isotonic formula.
B)hypertonic formula.
C)enteral formula.
D)complete formula.

Answer 1

B

Question 2

Parenteral nutrition refers to which of the following?

A)Provision of nutrients using the GI tract
B)Provision of nutrients intravenously
C)Provision of nutrients through oral diets and supplements
D)a and b
E)a and c
Questions for Section 20.1 Enteral Formulas

Answer 2

B

Question 3

A characteristic of an elemental formula is that

A)it may be low in fat or contain MCT.
B)it reduces the amount of work needed for digestion.
C)it contains complete proteins.
D)a and b
E)a, b, and c

Answer 3

D

Question 4

A general-purpose enteral formula that contains intact proteins is a(n)

A)standard formula.
B)elemental formula.
C)modular formula.
D)isotonic formula.

Question 5

Which of the following statements is true?

A)The effectiveness of disease-specific formulas to manage particular conditions is considered controversial.
B)Polymeric formulas are designed to meet the specific needs of patients with certain illnesses.
C)Disease-specific formulas cost the same as standard formulas.
D)Special formulas have been developed to treat liver disease but not kidney disease.

Question 6

Which of the following enteral formulas would you expect to have the lowest osmolality?

A)Hydrolyzed formulas
B)Nutrient-dense formulas
C)Standard formulas
D)Elemental formulas

Question 7

For clients suffering from constipation or diarrhea, health care professionals recommend increasing

A)fat intake.
B)fiber intake.
C)vitamin intake.
D)mineral intake.

Question 8

Which type(s) of enteral formula tends to cost the most?

A)Modular formulas
B)Disease-specific formulas
C)Standard formulas
D)Polymeric formulas

Question 9

Enteral formulas usually provide energy from the macronutrients within which of the following ranges (expressed as percentages of total kcalories)?

A)8-10% protein, 55-60% carbohydrate, 30% fat
B)20-30% protein, 40-50% carbohydrate, 20-40% fat
C)12-20% protein, 40-60% carbohydrate, 30-40% fat
D)40-50% protein, 8-29% carbohydrate, 30-45% fat

Question 10

Daniel Davis is suffering from abnormal digestion and malabsorption.The physician orders Daniel to be placed on enteral nutrition.What type of formula would be prescribed?

A)Standard formula
B)Elemental formula
C)Polymeric formula
D)Modular formula

Question 11

Standard formulas are used for clients who

A)require large amounts of kcalories.
B)are able to digest and absorb nutrients.
C)are severely malnourished.
D)require intravenous feedings.

Question 12

Which of the following is not a potential fat source for enteral formulas?

A)Corn oil
B)Palm kernel oil
C)Medium-chain triglycerides (MCT) oil
D)Fish oil

Question 13

An isotonic formula has

A)approximately the same osmolality of blood serum.
B)an osmolality of about 300 mOsm/kg.
C)a greater osmolality than blood serum.
D)a and b
E)b and c

Question 14

Which of the following solutions provides the most energy and nutrients in the smallest volume?

A)0.5 kcal/mL
B)1.0 kcal/mL
C)1.5 kcal/mL
D)2.0 kcal/mL

Question 15

Which one of the following formulas is not nutritionally complete?

A)Hydrolyzed
B)Modules
C)Protein isolate
D)Polymeric

Question 16

Which of the following is not used as a carbohydrate source in enteral formulas?

A)Corn syrup
B)Corn starch
C)Lactose
D)Sucrose

Question 17

Vincenzo, a well-nourished patient in a coma with a normally functioning GI tract, will most likely receive an enteral formula that provides _____ kcalories per milliliter.

A)0.5-1.0
B)1.0-1.2
C)1.2-1.5
D)1.5-2.0

Question 18

Standard formulas usually provide _____ kcal/mL, _____ of which come from protein.

A)1.0-1.2; 30%-40%
B)1.0-1.2; 12%-20%
C)1.2-3.0; 30%-40%
D)1.2-3.0; 12%-20%

Question 19

Enteral nutrition refers to which of the following?

A)Provision of nutrients using the GI tract
B)Provision of nutrients intravenously
C)Provision of nutrients through oral diets and supplements
D)a and b
E)a and c

Question 20

A standard formula is to intact proteins as a modular formula is to

A)broken-down proteins.
B)single macronutrient(s).
C)polyunsaturated fat.
D)saturated fat.

Question 21

Which of the following is appropriate to meet the nutritional needs of a 36-year-old patient in the intensive care unit on a mechanical ventilator?

A)Elemental feeding via gastrostomy
B)Pareneteral nutrition
C)Regular diet
D)Standard feeding via nasogastric tube

Question 22

Jane is a nursing student.She is getting ready to insert a feeding tube with her preceptor.Jane should not worry as she is going to start with the tube that is the easiest to insert, _____.

A)the gastrostomy tube
B)the nasojejunal tube
C)the nasogastric tube
D)none of the above

Question 23

Which of the following feeding sites is most appropriate for clients requiring long-term nutrition support?

A)Enterostomy
B)Nasoenteric
C)Nasogastric
D)Orogastric

Question 24

Roberta is a registered dietitian and is visiting one of her tube-fed patients.She notices that there are many unopened cans of the tube feeding formula at the patient's bedside.What could be the primary cause of this accumulation of cans?

A)The can are expired.
B)The cans will be used as part of a closed system.
C)The patient's feeding has been held.
D)The nursing staff forgot to put them in the refrigerator.

Question 25

A disadvantage of transnasal tube placement is that

A)it is not an effective means for tube feeding.
B)the tube can be easily pulled out.
C)the tube is inserted through the nose.
D)the tube can be passed to the jejunum.

Question 26

Which of the following is not a recommended method for helping patients accept oral formulas?

A)Assist patients with sampling a variety of oral formulas.
B)Serve the oral formulas in an attractive way (i.e.in a glass vs.in a can).
C)Lecture the patient on the importance of drinking the formula.
D)Check back with the patients to see if they still like what they are receiving.

Question 27

Mr.Smith is 63 years old with Alzheimer's disease.He has an order for a feeding tube because he refuses to eat and is becoming malnourished.Which of the following feeding tubes would be a good choice?

A)Nasogastric
B)Nasoduodenal
C)Gastrostomy
D)Transnasal

Question 28

Intermittent feeding using the gravity drip is the delivery of no more than how much formula over 30 minutes?

A)100 mL
B)200 mL
C)300 mL
D)400 mL

Question 29

Mr.Heiman has suffered a stroke and now has dysphagia (difficulty swallowing).He is 5'8" and weighs 127 lbs.The most appropriate method of nutrition support for him would be

A)gastrostomy feedings.
B)nasojejunal feedings.
C)liquid supplements.
D)jejunostomy feedings.

Question 30

Mrs.Arthur is receiving 2000 mL of an enteral ready-to-feed formula continuously over 24 hours.She is not on a fluid restriction.Mrs.Arthur will receive _____ of formula each hour.

A)42 mL
B)63 mL
C)83 mL
D)none of the above

Question 31

The delivery of up to 500 mL of formula within 20 minutes is termed

A)minimal residual.
B)intermittent feeding.
C)a bolus feeding.
D)a continuous drip.

Question 32

Tom Teenager is a 15 year old who is eating some but must also receive enteral feedings for malnutrition associated with Crohn's disease.To help Tom carry on normal activities, the health care team might try

A)continuous feedings.
B)intermittent feedings.
C)a neon-colored feeding tube.
D)all of the above

Question 33

Which of the following measures will not help to reduce the risk of aspiration for patients receiving a tube feeding?

A)Elevate the patient's upper body to at least a 30- to 45-degree angle during the feeding.
B)Elevate the patient's upper body to at least a 30- to 45-degree angle for 30 minutes after the feeding.
C)Use X-ray to verify the position of the feeding tube before initiating tube feeding.
D)Flush the tube with water before and after administering the formula.

Question 34

Which feeding tube placement may require a surgical procedure?

A)Nasogastric
B)Nasojejunal
C)Enterostomy
D)Nasoduodenal

Question 35

Which of the following statements is true?

A)An open feeding system reduces the risk of bacterial contamination.
B)An enteral formula delivery system ready to be attached to a feeding tube is called a closed feeding system.
C)Formulas in cans, bottles, or powders can all be used in a closed feeding system.
D)None of the above

Question 36

Which of the following tube feeding delivery methods would allow the most flexibility for feeding a school-age child?

A)Continuous feedings
B)Bolus feedings
C)Intermittent feedings
D)a and b

Question 37

Mr.Simpson is receiving formula intermittently six times a day.He needs 1500 mL each 24 hours.How many milliliters of formula is Mr.Simpson receiving at each feeding?

A)250
B)333
C)900
D)120

Question 38

Mrs.Smith, a client with congestive heart failure, requires 2000 kcal/day.She is receiving a formula with 2 kcal/mL by continuous drip.How many milliliters of formula will be given each hour?

A)33
B)42
C)66
D)83

Question 39

Techniques used to prevent the risk of bacterial contamination include all of the following except:

A)cleaning the can lid before opening a can of formula.
B)changing the feeding bags every 8 to 12 hours in an open system.
C)mixing new formula with remaining formula into one bag.
D)discarding open containers of formula not used within 24 hours.

Question 40

When determining nutrient requirements for patients, which of the following should not be considered?

A)Medical condition
B)Ability to digest and absorb nutrients
C)Patient's age
D)Feeding tube diameter

Question 41

Which of the following is not a possible cause of diarrhea in a tube fed client?

A)Lactose malabsorption
B)Bacterial contamination
C)Low fiber intake
D)Hypertonic solutions

Question 42

Daily assessment data to be collected on a client on a feeding tube should include all of the following except

A)administration schedule.
B)body weight.
C)fat fold measurements.
D)lab values.

Question 43

All of the following statements are true except:

A)inborn errors of metabolism are inherited and present at birth.
B)all inborn errors of metabolism are fatal.
C)PKU is an inborn error of amino acid metabolism.
D)galactosemia is an inborn error of carbohydrate metabolism.

Question 44

Typically, adults require _____ of water daily.

A)1000 milliliters
B)1500 milliliters
C)1750 milliliters
D)2000 milliliters

Question 45

Which of the following conditions would probably not increase the body's requirement for water?

A)Fever
B)Decreased urine output
C)Fistula drainage or high-output ostomies
D)Open wounds

Question 46

Mr.Thomas is receiving an enteral feeding product at 60 cc/hr by continuous drip.At 2:00 p.m., it is time to hang additional feeding product since there are only 40 cc left in the feeding bag.When you check the residual you note that there is 50 cc of gastric contents, so you should

A)stop the feeding and contact the physician.
B)stop the feeding, irrigate the tube, and then contact the physician.
C)continue the feeding but decrease the rate to 50 cc/hr.
D)continue the feeding as ordered.

Question 47

Cale, a nurse, determines that his patient's jejunostomy tube is clogged.Which of the following is a possible cause?

A)Using liquid medications
B)Using a viscous energy-dense formula
C)Excessive water flushing
D)Using a high-fiber formula

Question 48

Which of the following nursing interventions is appropriate for the delivery of medications through a feeding tube?

A)Flush the feeding tube with water before and after administering the medication.
B)Give sustained-release medications through the feeding tube.
C)Discontinue the tube feeding every hour to enhance drug absorption.
D)Rinse the feeding tube with a solution of meat tenderizer and sterile water before and after medication is administered.

Question 49

Which of these statements is false?

A)Formulas should be diluted if a patient's fluid needs are high and cannot be met by other means.
B)In general, almost all patients need to receive a diluted formula at the initiation of a tube feeding.
C)A viscous formula can be diluted to improve its flow through the tube.
D)Concentrated formulas are often started at slower rates than more dilute formulas.

Question 50

Which of the following is not a goal of medical nutrition therapy for an inborn error of metabolism?

A)Prevent the accumulation of toxic metabolites.
B)Replace the nutrients that are deficient.
C)Completely eliminate substances from the diet that cannot be properly metabolized.
D)Provide a diet that supports normal growth and development.

Question 51

Which of the following is not a possible complication of a nutritionally complete tube feeding?

A)Aspiration
B)Hypoproteinemia
C)Dehydration
D)Fluid imbalance

Question 52

Sarah has been receiving enteral nutrition support for the past 4 days.She has developed diarrhea.What is the most likely culprit?

A)Allergies
B)Dehydration
C)Medication
D)Lactose intolerance

Question 53

Mr.Peterson is receiving 1500 mL of standard formula daily, is 80 years old, and weighs 178 lb.Based on this information, are his fluid needs being met by the formula?

A)No; he needs about 1.2 L additional water daily
B)No; he needs to receive another 1000 mL of formula daily
C)Yes; he only needs 15 mL/kg so this is adequate
D)Yes; the formula is 95% water so this is adequate

Question 54

Mr.Preston has just started a bolus feeding.However, the doctor has decided to stop it because:

A)the patient complains of nausea and fullness.
B)the patient wants a more flexible regimen.
C)the patient has become critically ill.
D)Either a or c could be correct.

Question 55

Why are bolus feedings used only in patients who are not critically ill?

A)Bolus feedings restrict the patient's movements for long periods of time.
B)Risk of aspiration is greater than with other delivery methods.
C)Bolus feedings wouldn't be adequate to meet the patient's nutrition needs in this situation.
D)Bolus feedings require the use of an infusion pump.

Question 56

Which of the following does not contribute to dehydration of a tube fed patient?

A)Malfunctioning feeding pumps
B)Diarrhea
C)Clogged feeding tubes
D)Providing supplemental water flushes

Question 57

In the United States, phenylketonuria (PKU) affects approximately 1 out of _____ births annually.

A)5,000
B)10,000
C)50,000
D)100,000

Question 58

The only current treatment for phenylketonuria (PKU) is a diet that:

A)restricts phenylalanine and tyrosine.
B)supplies tyrosine and valine.
C)supplies valine and restricts phenylalanine.
D)supplies tyrosine and restricts phenylalanine.

Question 59

Which type of formula delivery is generally used in patients who receive intestinal feedings?

A)Continuous
B)Bolus
C)Intermittent
D)b and c

Question 60

In general, gastric residual is considered excessive if it is greater than

A)50 mL.
B)100 mL.
C)200 mL.
D)300 mL.

Question 61

For the first 24 hours the tube feeding should be delivered by a(n) _____ feeding method.

A)continuous
B)daily
C)intermittent
D)bolus

Question 62

The patient obtains 100% of her nutrients via her tube feeding.However, she is found to have food poising (Salmonella).Which is the most plausible cause?

A)Closed system
B)Open system
C)Improper hand washing
D)Improper tube placement

Question 63

Case Studies
Eighty-year-old Antonio Hernandez has a past medical history of hypertension, elevated cholesterol, and diabetes.He suffers a massive stroke and is stabilized in the CCU (coronary care unit).It is determined that it is unsafe to feed him orally and a tube feeding will be started immediately.
Which feeding route would be the most appropriate for Antonio?

A)Orogastric
B)Nasogastric
C)Gastrostomy
D)Jejunostomy

Question 64

Which type of tube feeding does Ms.Grey most likely have?

A)Nasogastric
B)Orogastric
C)Gastrostomy
D)Double lumen

Question 65

Which of the following may have caused her to become dehydrated?

A)Dysphagia
B)Food allergy
C)Tube feeding rate
D)Diarrhea

Question 66

The main focus of the dietary treatment for galactosemia is:

A)the exclusion of galactose.
B)the provision of galactose.
C)the exclusion of protein.
D)the provision of essential fatty acids.

Question 67

Which nutrient(s) must be supplemented in order to meet Antonio's nutritional needs?

A)Protein
B)Vitamins and minerals
C)MCT
D)Water

Question 68

Kristina is a 4 year old with galactosemia.Which nutrient should her caregivers take special care to make sure she receives enough of?

A)Vitamin C
B)Calcium
C)Vitamin E
D)Potassium

Question 69

In order to prevent further weight loss and to better meet nutritional needs, the dietitian will recommend a(n) _____.

A)standard formula
B)energy-dense formula
C)low-fiber formula
D)isotonic formula

Question 70

While reviewing the nursing home's medical record, the nurse discovers that Maureen's weight loss can be linked to the addition of phenytoin, a medication that requires the tube feeding to be _____.

A)halted
B)increased
C)diluted
D)bolused

Question 71

Which formula would be the most appropriate for Antonio?

A)Modular formula
B)Blenderized formula
C)Specialized formula
D)Elemental formula
Maureen Grey is a 75-year-old nursing home patient.She has been obtaining her nutrition via tube feeding for over three years.She is admitted to Good Valley Hospital with a diagnosis of dehydration with an eight-pound weight loss in one month.

Question 72

The nurse will determine whether the patient is tolerating the tube feeding by:

A)diluting the formula.
B)adding dye to the formula.
C)checking gastric residuals.
D)adding drug therapy.