ASPEN SELF-STUDY CNSC EXAM PRACTICE
QUESTIONS WITH VERIFIED ANSWERS
Modular products are used to enhance the nutrient profile of a feeding regimen. Which of
the following combinations represents modular products?
1. Safflower oil, protein, glucose and selenium
2. Glucose, glutamine, water and MCT oil
3. Protein, cholecalciferol, fiber and safflower oil
4. MCT oil, glucose, fiber and protein
4. MCT oil, glucose, fiber and protein
Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino
acids are examples of what?
Modular products
Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing
infectious complications, length of hospital stay and even possibly reducing mortality.
Which group of patients might be at significant risk from early enteral feeding?
1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic saline
4. Patients admitted to the hospital with acute on chronic pancreatitis
2. Patients with increasing vasopressor support
What is the risk of feeding a patient before hemodynamic stability has been achieved?
May increase the risk of intestinal ischemia as blood perfusion of the gut may be compromised in
a patient who is still requiring high doses of vasopressor drugs to maintain blood pressure
When should EN be initiated in the hemodynamically unstable patient?
EN should be delayed until fluid resuscitation is complete
A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding
formula containing supplemental
1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids
4. omega-3 fatty acids
,Define ARDS.
Acute respiratory distress syndrome - inflammatory response leading to diffuse alveolar damage
and lung capillary endothelial injury.
Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS?
Inflammatory mediators, including prostaglandins and leukotrienes derived from arachidonic
acid metabolism have been implicated in both ALI and ARDS. Formulas containing omega-3
fatty acids may down regulate the inflammatory response through the production of less
inflammatory prostaglnadins and leukotrienes
What is the evidence for use of omega-3 fatty acids in ARDS and ALI?
Based on 3 level 1 studies the Guidelines for the Provision and Assessment of Nutrition Support
Therapy in the Adult Critically Ill Patient in 2009 recommended patients with ARDS and severe
ALI be placed on an enteral formulation characterized by an anti-inflammatory lipid profile.
Subsequent to the publication of those guidelines and recommendations have been studies
published in 2011 showing that enteral supplementation of omega-3 fatty acids did not result in
improved biomarkers of inflammation or clinical outcomes
The use of enteral nutrition formulas enriched with BCAAs is best used for patients with:
1. cirrhosis
2. hepatic failure
3. liver transplantation
4. refractory encephalopathy
4. refractory encephalopathy
What is the theory behind use of BCAAs in hepatic encephalopathy?
There is believed to be an increased ratio of aromatic amino acids to BCAAs in patients
experiencing hepatic encephalopathy. The decrease in BCAA is suspected to be due to an
increased breakdown in BCAA from skeletal muscles and utilization. The increased levels of
AAA generate false neurotransmitters, resulting in hepatic encephalopathy symptoms.
What is the evidence for BCAA enriched amino acid enteral formulas?
Published randomized trials have shown mixed results in patients with hepatic failure receiving
these specialized formulas. Due to the lack of evidence supporting their use and the increased
cost of such products it has been suggested that the use of these hepatic fomulas be limited to
patients with encephalopathy refractory to standard medical therapy (lactulose, non-absorbed
antibiotics)
Enteral nutrition may be contraindicated in the early post-transplant period in adult
patients with hematopoietic cell transplants because of:
1. increased incidence of sinusitis with enteral feedings
,2. lack of benefit from enteral feedings in allogeneic patients
3. gastrointestinal toxicities related to the conditioning regimen
4. improved survival seen in autologous patients receiving PN
3. Gastrointestinal toxicities related to the conditioning regimen
Why is EN contraindicated in the early post-transplant period in adult patients with
hematopoietic cell transplants?
GI toxicities such as nausea, vomiting, delayed gastric emptying and diarrhea seen in the first 2-3
weeks post-stem cell transplant may preclude EN. GI toxicity is most often related to
chemotherapy and total body irradiatin, however GI toxicity may also result from other
medications or early acute graft-versus-host disease in this patient population.
Which nutrition therapy is preferred in early post-transplant hematopoietic cell transplant
patients (adult)?
Currently there is insufficient data to establish benefits of enteral nutrition over parenteral
nutrition with hematopoietic cell transplants. In one study, parenteral nutrition was found to
increase survival in allogeneic patients
Which of the following medications would be appropriate to crush and deliver via an
enteral feeding tube?
1. Nifedipine XL
2. Metoprolol immediate release
3. Enteric coated aspirin
4. Diltiazem CD
2. Metoprolol immediate release
What type of tablets should be crushed for administration via an enteral feeding tube?
Only immediate release tablets should be crushed fro administration via an enteral feeding tube.
Why are enteric coated and film coated tablets not crushed for administration via an EN
feeding tube?
Enteric coated or film coated tablets do not crush well and tend to clump and increase the risk of
clogging the tube.
Why are modified release dosage forms of drugs inappropriate to crush and give via EN
feeding tubes?
Modified release dosage forms (often designated with abbreviations such as XL, XR, SR, CD
etc.) are inappropriate to crush and give via EN feeding tube because crushing these dosage
forms destroys their modified releasing properties. This may lead to an excessive dose of the
drug being released at one time (instead of slowly over a longer period of time), which can lead
to adverse effects and has even been reported as a cause of death
, Which of the following describes an optimal method of preparing and administering
medications via an enteral feeding tube?
1. Crush tablets and add them directly in the EN formula
2. Administer liquid formulations undiluted to minimize fluid overload
3. Flush the tube with water before and after each medication administered
4. Add crushed tablets to liquid medication sand administer the mixture all together
3. Flush the tube with water before and after each medication administered
Why should the EN tube be flushed before and after each medication?
Helps to avoid physical interactions both between medications and between medications and
formula.
How should liquid formulations be administered? Why?
Many liquid medications are hyperosmolar which can lead to diarrhea and/or have high viscosity
which can lead to tube clogging, so liquid dosage forms should be diluted with water prior to
administration
In patients with severe acute pancreatitis enteral nutrition has been documented to provide
the following benefits over parenteral nutrition EXCEPT:
1. decreased infection rate
2. decreased hospital LOS
3. decreased pain
4. decreased mortality
3. Decreased pain
List 5 benefits in patients with severe acute pancreatitis on EN vs. PN nutrition support
1. significant reduction in infectious morbidity
2. decreased hospital LOS
3. Reduced need for surgical intervention
4. Reduced multiple organ failure
5. Decreased mortality
In patient with fat malabsorption, an enteral product containing which of the following can
provide a concentrated source of energy?
1. MCT
2. Free amino acids
3. Fructooligosaccharides
4. Long chain triglycerides
1. MCTs
QUESTIONS WITH VERIFIED ANSWERS
Modular products are used to enhance the nutrient profile of a feeding regimen. Which of
the following combinations represents modular products?
1. Safflower oil, protein, glucose and selenium
2. Glucose, glutamine, water and MCT oil
3. Protein, cholecalciferol, fiber and safflower oil
4. MCT oil, glucose, fiber and protein
4. MCT oil, glucose, fiber and protein
Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino
acids are examples of what?
Modular products
Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing
infectious complications, length of hospital stay and even possibly reducing mortality.
Which group of patients might be at significant risk from early enteral feeding?
1. Cancer patients who underwent surgery of the GIT
2. Patients with increasing vasopressor support
3. TBI patients with intracranial pressure controlled by hypertonic saline
4. Patients admitted to the hospital with acute on chronic pancreatitis
2. Patients with increasing vasopressor support
What is the risk of feeding a patient before hemodynamic stability has been achieved?
May increase the risk of intestinal ischemia as blood perfusion of the gut may be compromised in
a patient who is still requiring high doses of vasopressor drugs to maintain blood pressure
When should EN be initiated in the hemodynamically unstable patient?
EN should be delayed until fluid resuscitation is complete
A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding
formula containing supplemental
1. arginine
2. glutamine
3. nucleic acids
4. omega-3 fatty acids
4. omega-3 fatty acids
,Define ARDS.
Acute respiratory distress syndrome - inflammatory response leading to diffuse alveolar damage
and lung capillary endothelial injury.
Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS?
Inflammatory mediators, including prostaglandins and leukotrienes derived from arachidonic
acid metabolism have been implicated in both ALI and ARDS. Formulas containing omega-3
fatty acids may down regulate the inflammatory response through the production of less
inflammatory prostaglnadins and leukotrienes
What is the evidence for use of omega-3 fatty acids in ARDS and ALI?
Based on 3 level 1 studies the Guidelines for the Provision and Assessment of Nutrition Support
Therapy in the Adult Critically Ill Patient in 2009 recommended patients with ARDS and severe
ALI be placed on an enteral formulation characterized by an anti-inflammatory lipid profile.
Subsequent to the publication of those guidelines and recommendations have been studies
published in 2011 showing that enteral supplementation of omega-3 fatty acids did not result in
improved biomarkers of inflammation or clinical outcomes
The use of enteral nutrition formulas enriched with BCAAs is best used for patients with:
1. cirrhosis
2. hepatic failure
3. liver transplantation
4. refractory encephalopathy
4. refractory encephalopathy
What is the theory behind use of BCAAs in hepatic encephalopathy?
There is believed to be an increased ratio of aromatic amino acids to BCAAs in patients
experiencing hepatic encephalopathy. The decrease in BCAA is suspected to be due to an
increased breakdown in BCAA from skeletal muscles and utilization. The increased levels of
AAA generate false neurotransmitters, resulting in hepatic encephalopathy symptoms.
What is the evidence for BCAA enriched amino acid enteral formulas?
Published randomized trials have shown mixed results in patients with hepatic failure receiving
these specialized formulas. Due to the lack of evidence supporting their use and the increased
cost of such products it has been suggested that the use of these hepatic fomulas be limited to
patients with encephalopathy refractory to standard medical therapy (lactulose, non-absorbed
antibiotics)
Enteral nutrition may be contraindicated in the early post-transplant period in adult
patients with hematopoietic cell transplants because of:
1. increased incidence of sinusitis with enteral feedings
,2. lack of benefit from enteral feedings in allogeneic patients
3. gastrointestinal toxicities related to the conditioning regimen
4. improved survival seen in autologous patients receiving PN
3. Gastrointestinal toxicities related to the conditioning regimen
Why is EN contraindicated in the early post-transplant period in adult patients with
hematopoietic cell transplants?
GI toxicities such as nausea, vomiting, delayed gastric emptying and diarrhea seen in the first 2-3
weeks post-stem cell transplant may preclude EN. GI toxicity is most often related to
chemotherapy and total body irradiatin, however GI toxicity may also result from other
medications or early acute graft-versus-host disease in this patient population.
Which nutrition therapy is preferred in early post-transplant hematopoietic cell transplant
patients (adult)?
Currently there is insufficient data to establish benefits of enteral nutrition over parenteral
nutrition with hematopoietic cell transplants. In one study, parenteral nutrition was found to
increase survival in allogeneic patients
Which of the following medications would be appropriate to crush and deliver via an
enteral feeding tube?
1. Nifedipine XL
2. Metoprolol immediate release
3. Enteric coated aspirin
4. Diltiazem CD
2. Metoprolol immediate release
What type of tablets should be crushed for administration via an enteral feeding tube?
Only immediate release tablets should be crushed fro administration via an enteral feeding tube.
Why are enteric coated and film coated tablets not crushed for administration via an EN
feeding tube?
Enteric coated or film coated tablets do not crush well and tend to clump and increase the risk of
clogging the tube.
Why are modified release dosage forms of drugs inappropriate to crush and give via EN
feeding tubes?
Modified release dosage forms (often designated with abbreviations such as XL, XR, SR, CD
etc.) are inappropriate to crush and give via EN feeding tube because crushing these dosage
forms destroys their modified releasing properties. This may lead to an excessive dose of the
drug being released at one time (instead of slowly over a longer period of time), which can lead
to adverse effects and has even been reported as a cause of death
, Which of the following describes an optimal method of preparing and administering
medications via an enteral feeding tube?
1. Crush tablets and add them directly in the EN formula
2. Administer liquid formulations undiluted to minimize fluid overload
3. Flush the tube with water before and after each medication administered
4. Add crushed tablets to liquid medication sand administer the mixture all together
3. Flush the tube with water before and after each medication administered
Why should the EN tube be flushed before and after each medication?
Helps to avoid physical interactions both between medications and between medications and
formula.
How should liquid formulations be administered? Why?
Many liquid medications are hyperosmolar which can lead to diarrhea and/or have high viscosity
which can lead to tube clogging, so liquid dosage forms should be diluted with water prior to
administration
In patients with severe acute pancreatitis enteral nutrition has been documented to provide
the following benefits over parenteral nutrition EXCEPT:
1. decreased infection rate
2. decreased hospital LOS
3. decreased pain
4. decreased mortality
3. Decreased pain
List 5 benefits in patients with severe acute pancreatitis on EN vs. PN nutrition support
1. significant reduction in infectious morbidity
2. decreased hospital LOS
3. Reduced need for surgical intervention
4. Reduced multiple organ failure
5. Decreased mortality
In patient with fat malabsorption, an enteral product containing which of the following can
provide a concentrated source of energy?
1. MCT
2. Free amino acids
3. Fructooligosaccharides
4. Long chain triglycerides
1. MCTs
