ASPEN Self-Study CNSC Exam | Questions and
Correct Answers| Latest Update
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 prostaglandins 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 irradiation, 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.
Correct Answers| Latest Update
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 prostaglandins 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 irradiation, 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.
