CNSC EXAM PRACTICE QUESTIONS WITH
VERIFIED ANSWERS
A pregnant patient is admitted with hyperemesis gravidarium (HG). Which of the
following is a clinical indication for PN use?
Intolerance to EN trial and supportive care measures
Rapid intravenous infusion of potassium phosphate may result in
Thrombophlebitis
most common complication associated with PN administration?
Hyperglycemia
The preferred approach for subcutaneous insulin administration
Basal-bolus insulin therapy
Which form of glutamine supplementation improves physical compatibility and stability
for admixture in PN solutions?
Glutamine Dipeptide
Which of the following additives has the greatest risk of destabilizing the lipid injectable
emulsion (ILE) in a total nutrient admixture (TNA)?
Iron dextran- The higher the cation valence, the greater the destabilizing power; thus, trivalent
cations such as Fe+3 (from iron dextran) are more disruptive than divalent cations such as
calcium and magnesium.
A complete PN order shall contain the following
complete patient identifiers, birth date or age, allergies, height and dosing weight in metric units,
diagnosis/diagnoses, indication(s) for PN, administration route/vascular access device (peripheral
versus central), contact information for prescriber, date and time order submitted, administration
date and time, volume and infusion rate, infusion schedule (continuous or cyclic), and type of
formulation (TNA versus dextrose/amino acids with separate ILE).
PN ingredients shall be ordered as follows:
amounts per day (for adult patients) or amounts per kilogram per day (for pediatric and neonatal
patients), electrolytes as complete salt form, full generic name for each ingredient, dose for each
macronutrient and electrolyte, dose for vitamins (including MVI and individual entities), dose for
trace elements (including multi-components and/or individual entities), dose for each non-
nutrient medication.
Which of the following is a indication for the use of parenteral nutrition (PN)?
1: High output fistula 2: Crohn's disease 3: Pancreatitis 4: Hyperemesis gravidarum
,1: High output fistula
The routine use of preoperative parenteral nutrition (PN) is indicated for patients with a
non-functioning GI tract who are
significant reductions in perioperative complications are achieved in the severely malnourished
patient receiving more than 7 days of preoperative PN.
TNA are more likely to be stable for 30 hours at _______ or for 9 days ________ followed
by 24 hours at ___________
room temperature, refrigerated, room temperature.
ILE administered via piggyback separate from amino acid and dextrose should have a
hang time of
12 hours and have tubing and filter changes with each new infusion. Recently package inserts for
ILE have been updated to state that 1.2 micron filters should be used during ILE administration.
A peripherally inserted central catheter (PICC) is defined as a catheter inserted via
peripheral vein whose distal tip lies in the
Superior vena cava
PICC line disadvantages include:
high rate of malposition or coiling; limited patient arm mobility associated with limited ability to
perform daily self-care due to the availability of only one hand; and longer catheter that may be
more prone to occlusion.
Advantages of PICC lines include:
no risk of pneumothorax or puncture or internal carotid or subclavian arteries; available in single,
double, and triple lumens; and repeated skin puncture is not required.
A common complication of central venous catheters inserted at the bedside is
catheter misplacement, including pneumothorax.
The use of fluoroscopy during catheter insertion allows
immediate repositioning of the catheter tip to its correct location in the superior vena cava.
central catheters placed at bedside without fluoroscopy should be
radiographically confirmed and documented in the medical record before initial use.
replacement of temporary catheters during bacteremia should not be done over a
guidewire due to
source of infection (colonization of skin to insertion site).
Remove the PICC line only if
,it is suspected or known to be the source of infection
The Institute for Healthcare Improvement (IHI) Central Line Bundle should
be used for central vascular access devices.
avoidance of central venous access devices with high risk for infection, such as
femoral catheters
Infusion of hypertonic parenteral solutions exceeding 900 mOsm/L through a peripheral
catheter may result in
Phlebitis
The lower concentrated dextrose solutions ____ & ____ and amino acid solutions ____ are
most often used for peripheral administration. The osmolarity of 10% dextrose= ______
mOsm/L. The osmolarity of 3% amino acid= ______ mOsm/L.
5% & 10%
3%
500
300
Which of the following reduces the risk of calcium phosphate precipitation in PN?
Increased amino acid concentration
higher concentrations of amino acids may lower the______ of the PN formulation, which
also improves ________________ solubility
pH, calcium phosphate
When compounding PN, it is recommended to add the _________first and then add the
________near the end of compounding to utilize the maximum volume of the PN
formulation to dilute the salts
phosphate , calcium
Use of branched-chain amino acid-enriched diets nutrition support formulas is only
indicated in
chronic encephalopathy for those who cannot tolerate at least 1gm/kg/day of standard protein
despite optimal pharmacotherapy
For infants, it is recommended to provide _________of lipid in order to prevent EFAD.
0.5 to 1 g/kg/day
Failure to provide at least 2% to 4% of the total caloric intake as _______ and 0.25% to
0.5% of total caloric intake as ________ may lead to a deficiency of these two fatty acids
, linoleic acid, alpha linolenic acid
The adverse effects of lipid injectable emulsion (ILE) administration in adults is best
prevented by
avoiding serum triglyceride levels >400 mg/dL.
When two or more oils are mixed together, the emulsion product is called a
physical mixture
lipid injectable emulsion (ILE) produced by the transesterification of fatty acids to form a
composite triglyceride molecule?
Structured
Reductions in _____________________ dosing should be considered in patients with
hepatobiliary disease due to impaired excretion
manganese and copper
________ are a major contributor to aluminum contamination of solutions
Calcium and phosphate salts,
A long term parenteral nutrition patient begins to experience Parkinson-like symptoms.
Which trace element toxicity is most likely to present with these symptoms?
Manganese
Current water-soluble vitamin daily parenteral doses are _________ than the
Recommended Dietary Allowance (RDA)
2 to 2.5 times greater
transfer, measuring, and mixing manipulations with closed or sealed packaging systems
that are performed promptly and attentively is what level risk for TPN
low
Compounding of PN using manual or automated devices during which there are multiple
injections, detachments, and attachments of nutrient source products to the device or
machine to deliver all nutritional components to a final sterile container is classified as
medium risk
extemporaneously (without preperation) compounded L-glutamine for supplementation in
a PN formulation is what level risk
High
Creaming of a total nutrient admixture (TNA) appears as
VERIFIED ANSWERS
A pregnant patient is admitted with hyperemesis gravidarium (HG). Which of the
following is a clinical indication for PN use?
Intolerance to EN trial and supportive care measures
Rapid intravenous infusion of potassium phosphate may result in
Thrombophlebitis
most common complication associated with PN administration?
Hyperglycemia
The preferred approach for subcutaneous insulin administration
Basal-bolus insulin therapy
Which form of glutamine supplementation improves physical compatibility and stability
for admixture in PN solutions?
Glutamine Dipeptide
Which of the following additives has the greatest risk of destabilizing the lipid injectable
emulsion (ILE) in a total nutrient admixture (TNA)?
Iron dextran- The higher the cation valence, the greater the destabilizing power; thus, trivalent
cations such as Fe+3 (from iron dextran) are more disruptive than divalent cations such as
calcium and magnesium.
A complete PN order shall contain the following
complete patient identifiers, birth date or age, allergies, height and dosing weight in metric units,
diagnosis/diagnoses, indication(s) for PN, administration route/vascular access device (peripheral
versus central), contact information for prescriber, date and time order submitted, administration
date and time, volume and infusion rate, infusion schedule (continuous or cyclic), and type of
formulation (TNA versus dextrose/amino acids with separate ILE).
PN ingredients shall be ordered as follows:
amounts per day (for adult patients) or amounts per kilogram per day (for pediatric and neonatal
patients), electrolytes as complete salt form, full generic name for each ingredient, dose for each
macronutrient and electrolyte, dose for vitamins (including MVI and individual entities), dose for
trace elements (including multi-components and/or individual entities), dose for each non-
nutrient medication.
Which of the following is a indication for the use of parenteral nutrition (PN)?
1: High output fistula 2: Crohn's disease 3: Pancreatitis 4: Hyperemesis gravidarum
,1: High output fistula
The routine use of preoperative parenteral nutrition (PN) is indicated for patients with a
non-functioning GI tract who are
significant reductions in perioperative complications are achieved in the severely malnourished
patient receiving more than 7 days of preoperative PN.
TNA are more likely to be stable for 30 hours at _______ or for 9 days ________ followed
by 24 hours at ___________
room temperature, refrigerated, room temperature.
ILE administered via piggyback separate from amino acid and dextrose should have a
hang time of
12 hours and have tubing and filter changes with each new infusion. Recently package inserts for
ILE have been updated to state that 1.2 micron filters should be used during ILE administration.
A peripherally inserted central catheter (PICC) is defined as a catheter inserted via
peripheral vein whose distal tip lies in the
Superior vena cava
PICC line disadvantages include:
high rate of malposition or coiling; limited patient arm mobility associated with limited ability to
perform daily self-care due to the availability of only one hand; and longer catheter that may be
more prone to occlusion.
Advantages of PICC lines include:
no risk of pneumothorax or puncture or internal carotid or subclavian arteries; available in single,
double, and triple lumens; and repeated skin puncture is not required.
A common complication of central venous catheters inserted at the bedside is
catheter misplacement, including pneumothorax.
The use of fluoroscopy during catheter insertion allows
immediate repositioning of the catheter tip to its correct location in the superior vena cava.
central catheters placed at bedside without fluoroscopy should be
radiographically confirmed and documented in the medical record before initial use.
replacement of temporary catheters during bacteremia should not be done over a
guidewire due to
source of infection (colonization of skin to insertion site).
Remove the PICC line only if
,it is suspected or known to be the source of infection
The Institute for Healthcare Improvement (IHI) Central Line Bundle should
be used for central vascular access devices.
avoidance of central venous access devices with high risk for infection, such as
femoral catheters
Infusion of hypertonic parenteral solutions exceeding 900 mOsm/L through a peripheral
catheter may result in
Phlebitis
The lower concentrated dextrose solutions ____ & ____ and amino acid solutions ____ are
most often used for peripheral administration. The osmolarity of 10% dextrose= ______
mOsm/L. The osmolarity of 3% amino acid= ______ mOsm/L.
5% & 10%
3%
500
300
Which of the following reduces the risk of calcium phosphate precipitation in PN?
Increased amino acid concentration
higher concentrations of amino acids may lower the______ of the PN formulation, which
also improves ________________ solubility
pH, calcium phosphate
When compounding PN, it is recommended to add the _________first and then add the
________near the end of compounding to utilize the maximum volume of the PN
formulation to dilute the salts
phosphate , calcium
Use of branched-chain amino acid-enriched diets nutrition support formulas is only
indicated in
chronic encephalopathy for those who cannot tolerate at least 1gm/kg/day of standard protein
despite optimal pharmacotherapy
For infants, it is recommended to provide _________of lipid in order to prevent EFAD.
0.5 to 1 g/kg/day
Failure to provide at least 2% to 4% of the total caloric intake as _______ and 0.25% to
0.5% of total caloric intake as ________ may lead to a deficiency of these two fatty acids
, linoleic acid, alpha linolenic acid
The adverse effects of lipid injectable emulsion (ILE) administration in adults is best
prevented by
avoiding serum triglyceride levels >400 mg/dL.
When two or more oils are mixed together, the emulsion product is called a
physical mixture
lipid injectable emulsion (ILE) produced by the transesterification of fatty acids to form a
composite triglyceride molecule?
Structured
Reductions in _____________________ dosing should be considered in patients with
hepatobiliary disease due to impaired excretion
manganese and copper
________ are a major contributor to aluminum contamination of solutions
Calcium and phosphate salts,
A long term parenteral nutrition patient begins to experience Parkinson-like symptoms.
Which trace element toxicity is most likely to present with these symptoms?
Manganese
Current water-soluble vitamin daily parenteral doses are _________ than the
Recommended Dietary Allowance (RDA)
2 to 2.5 times greater
transfer, measuring, and mixing manipulations with closed or sealed packaging systems
that are performed promptly and attentively is what level risk for TPN
low
Compounding of PN using manual or automated devices during which there are multiple
injections, detachments, and attachments of nutrient source products to the device or
machine to deliver all nutritional components to a final sterile container is classified as
medium risk
extemporaneously (without preperation) compounded L-glutamine for supplementation in
a PN formulation is what level risk
High
Creaming of a total nutrient admixture (TNA) appears as
