Page 1 of 34
NUTRITION AND THERAPEUTICS EXAM
2||ACTUAL QUESTIONS AND
ANSWERS|A+GRADE
1. A 68-year-old stroke patient with dysphagia requires
nutrition support. Which tube type is most appropriate for
short-term (<4 weeks) use?
A) PEG tube
B) Nasogastric (NG) tube
C) Jejunostomy tube
D) Gastrostomy tube
Correct Answer: B) Nasogastric (NG) tube
Rationale: NG tubes are indicated for short-term enteral access
(<4 weeks). PEG and surgical gastrostomy are for long-term (>4
weeks). Jejunostomy is for gastric intolerance or high aspiration
risk.
,Page 2 of 34
2. Scenario: A patient receiving continuous enteral nutrition
via a nasogastric tube has a gastric residual volume (GRV) of
450 mL on two consecutive checks. What is the most
appropriate action?
A) Discard the residual and increase the infusion rate
B) Hold feeds and reassess in 2 hours
C) Continue feeds at same rate; GRV is not clinically significant
D) Immediately place a jejunal tube
Correct Answer: B) Hold feeds and reassess in 2 hours
Rationale: ASPEN guidelines suggest holding feeds for GRV
>500 mL if accompanied by signs of intolerance (distension,
nausea). 450 mL with two consecutive high volumes warrants
withholding and reassessment. Discarding residual is not
recommended routinely.
3. What is the osmolality of a standard polymeric enteral
formula (e.g., Jevity 1.0)?
,Page 3 of 34
A) 150–200 mOsm/kg
B) 300–500 mOsm/kg
C) 600–800 mOsm/kg
D) >1000 mOsm/kg
Correct Answer: B) 300–500 mOsm/kg
Rationale: Polymeric formulas are near isotonic (300-500
mOsm/kg), which minimizes osmotic diarrhea.
Elemental/hydrolyzed formulas have higher osmolality (600-
900).
4. Which of the following is a contraindication to enteral
nutrition?
A) Severe pancreatitis
B) High-output proximal fistula
C) Mechanical bowel obstruction
D) Inflammatory bowel disease
, Page 4 of 34
Correct Answer: C) Mechanical bowel obstruction
Rationale: Complete mechanical obstruction prevents passage of
enteral formula, increasing risk of perforation or
vomiting/aspiration. Severe pancreatitis often benefits from
early enteral (jejunal) feeding.
5. A patient develops diarrhea 48 hours after starting
continuous NG tube feeds. Which initial intervention is
evidence-based?
A) Stop all enteral feeds immediately
B) Add soluble fiber (e.g., psyllium) if no contraindications
C) Switch to a hydrolyzed formula
D) Start loperamide 4 mg
Correct Answer: B) Add soluble fiber (e.g., psyllium) if no
contraindications
Rationale: Diarrhea on enteral nutrition is often due to
medications (antibiotics, sorbitol), not the formula. Soluble fiber
NUTRITION AND THERAPEUTICS EXAM
2||ACTUAL QUESTIONS AND
ANSWERS|A+GRADE
1. A 68-year-old stroke patient with dysphagia requires
nutrition support. Which tube type is most appropriate for
short-term (<4 weeks) use?
A) PEG tube
B) Nasogastric (NG) tube
C) Jejunostomy tube
D) Gastrostomy tube
Correct Answer: B) Nasogastric (NG) tube
Rationale: NG tubes are indicated for short-term enteral access
(<4 weeks). PEG and surgical gastrostomy are for long-term (>4
weeks). Jejunostomy is for gastric intolerance or high aspiration
risk.
,Page 2 of 34
2. Scenario: A patient receiving continuous enteral nutrition
via a nasogastric tube has a gastric residual volume (GRV) of
450 mL on two consecutive checks. What is the most
appropriate action?
A) Discard the residual and increase the infusion rate
B) Hold feeds and reassess in 2 hours
C) Continue feeds at same rate; GRV is not clinically significant
D) Immediately place a jejunal tube
Correct Answer: B) Hold feeds and reassess in 2 hours
Rationale: ASPEN guidelines suggest holding feeds for GRV
>500 mL if accompanied by signs of intolerance (distension,
nausea). 450 mL with two consecutive high volumes warrants
withholding and reassessment. Discarding residual is not
recommended routinely.
3. What is the osmolality of a standard polymeric enteral
formula (e.g., Jevity 1.0)?
,Page 3 of 34
A) 150–200 mOsm/kg
B) 300–500 mOsm/kg
C) 600–800 mOsm/kg
D) >1000 mOsm/kg
Correct Answer: B) 300–500 mOsm/kg
Rationale: Polymeric formulas are near isotonic (300-500
mOsm/kg), which minimizes osmotic diarrhea.
Elemental/hydrolyzed formulas have higher osmolality (600-
900).
4. Which of the following is a contraindication to enteral
nutrition?
A) Severe pancreatitis
B) High-output proximal fistula
C) Mechanical bowel obstruction
D) Inflammatory bowel disease
, Page 4 of 34
Correct Answer: C) Mechanical bowel obstruction
Rationale: Complete mechanical obstruction prevents passage of
enteral formula, increasing risk of perforation or
vomiting/aspiration. Severe pancreatitis often benefits from
early enteral (jejunal) feeding.
5. A patient develops diarrhea 48 hours after starting
continuous NG tube feeds. Which initial intervention is
evidence-based?
A) Stop all enteral feeds immediately
B) Add soluble fiber (e.g., psyllium) if no contraindications
C) Switch to a hydrolyzed formula
D) Start loperamide 4 mg
Correct Answer: B) Add soluble fiber (e.g., psyllium) if no
contraindications
Rationale: Diarrhea on enteral nutrition is often due to
medications (antibiotics, sorbitol), not the formula. Soluble fiber
