By Alaina Darby Parenteral Nutrition

JO is a 22 yo WF who is 1 day p/o for GI surgery and is NPO JO is a 22 yo WF who is 1 day p/o for GI surgery and is NPO. PMH includes obesity, T2DM, and HLD. Which of the following is recommended? Start EN without PN Start TPN Start EN and PN to supplement Don’t start anything yet d

JO is a 22 yo WF who is now 8 days p/o for GI surgery and is still NPO due to complications. PMH includes obesity, T2DM, and HLD. Which of the following is recommended? Start EN without PN Start TPN Start EN and PN to supplement Don’t start anything yet b

FK is a 22 yo WF who is now 1 day p/o for GI surgery and is still NPO FK is a 22 yo WF who is now 1 day p/o for GI surgery and is still NPO. PMH includes anorexia, bradycardia, and hypotension. Which of the following is recommended? Start EN without PN Start TPN Start EN and PN to supplement Don’t start anything yet b

FK is a 22 yo WF who is now 8 days p/o for GI surgery FK is a 22 yo WF who is now 8 days p/o for GI surgery. She has begun taking nutrition but can only tolerate 1150 cal of her 1800 cal need. PMH includes anorexia, bradycardia, and hypotension. Which of the following is recommended? Start EN without PN Start TPN Start EN and PN to supplement Don’t start anything yet a

FK is a 22 yo WF who is now 8 days p/o for GI surgery FK is a 22 yo WF who is now 8 days p/o for GI surgery. She has begun taking nutrition but can only tolerate 1150 cal of her 1800 cal need. PMH includes anorexia, bradycardia, and hypotension. What would be a reason for wanting to start EN without supplementing PN? Better GI stimulation Less chance of malnutrition Less infection risk Shorter duration of stay c

Which of the following would not be an appropriate indication for PN? GI ileus GI obstruction High output fistula Acute pancreatitis d

Which of the following patients would most likely get a peripheral line if TPN was deemed necessary? CHF exacerbation Renal failure Hepatic failure History of thrombotic events c

Which of the following probably should not be given in a peripheral line? Potassium chloride Calcium gluconate Lipid emulsions Sodium chloride b

Which of the following absolutely should not be given in a peripheral line? Potassium chloride 65 mEq/L Solution of with >200 mOsm/L of electrolytes/vitamins/minerals Calcium gluconate Iron dextran a

JD has a peripheral line and needs to receive PN for 2-3 days due to a recent GI surgery. According to calculations, the osmolality of the formulation is 840 mOsm/L. Blood pressure is 110/75. How should it be administered? Peripherally after increasing the volume Peripherally in the current volume Centrally after increasing the volume Centrally in the current volume b

JD has a peripheral line and needs to receive PN for 2-3 days due to a recent GI surgery. According to calculations, the osmolality of the formulation is 1000 mOsm/L. Blood pressure is 110/75. How should it be administered? Peripherally after increasing the volume Peripherally in the current volume Centrally after increasing the volume Centrally in the current volume a

Peripherally after increasing the volume JD has a peripheral line and needs to receive PN for 2-3 days due to a recent GI surgery. According to calculations, the osmolality of the formulation is 1000 mOsm/L. Blood pressure is 110/75, albumin is 2, and has a history of CHF with an admission for exacerbation 1 month prior. How should it be administered? Peripherally after increasing the volume Peripherally in the current volume Centrally after increasing the volume Centrally in the current volume d

Peripherally after increasing the volume JD has a peripheral line and needs to receive PN for 2-3 days due to a recent GI surgery. Her corrected calcium is 7.5, so she needs to receive calcium gluconate. Blood pressure is 110/75. How should it be administered? Peripherally after increasing the volume Peripherally in the current volume Centrally after increasing the volume Centrally in the current volume d

RL has anemia and an intestinal ileus for which she is receiving TPN RL has anemia and an intestinal ileus for which she is receiving TPN. She currently only has a peripheral line. How should iron be given? Peripherally in the total nutrient admixture Peripherally in glucose/amino acids portion of the TPN Centrally in the total nutrient admixture Centrally in glucose/amino acids portion of the TPN d

Which of the following potential problems would be least likely to increase with a TNA (versus glucose/amino acids + lipids)? Bacterial growth Instability Cost of therapy Infection risk a

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. She is also receiving Vancomycin and Zosyn for suspected PNA and is on a ventilator. What would be the most reasonable daily amount of fluid to put in her TPN? 1 L 2 L 3 L 4 L b Think about the fluids she is receiving from her IV meds!!

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. She is also receiving Vancomycin and Zosyn for suspected PNA and is on a ventilator. What would you expect her fluid balance to be? 400 mL/d 600 mL/d 800 mL/d 1000 mL/d b

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. She is also receiving Vancomycin and Zosyn for suspected PNA and is on a ventilator. Which of the following conditions would cause you to be least willing to give extra fluids to this patient? Burns Diarrhea CHF exacerbation Diabetes c

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. If it is running at 85 mL/hr, how much dextrose is she getting per day? 3 g 30 g 300 g 3000 g c

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. If it is running at 85 mL/hr, how many calories per day is she getting of dextrose? 500 1000 1500 2000 b

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. What is the max rate that the 15% dextrose should be run? 5 mL/hr 70 mL/hr 120 mL/hr 140 mL/hr d

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. Which of the following would not put her at greater risk of hyperglycemia? History of DM Sepsis Glucose intake > 5 mg/hr Burns c

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. If it is running at 85 mL/hr, how many grams of amino acids is she getting per day? 5 50 125 1250 c

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. If it is running at 85 mL/hr, how many calories per day is she getting of amino acids? 500 1000 1500 2000 a

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. Which of the following is most likely used in the lipid portion? Fish oil Olive oil Soybean oil Safflower oil c

JR is a 70 kg WF receiving TPN JR is a 70 kg WF receiving TPN. You decide to use the concentration method to give her a solution with dextrose 15%, amino acid 6%, and lipids 2%. Which of the following drugs would put her at least risk for hypertriglyceridemia? Propofol Sirolimus Hydrocortisone Fish oil d

Which of the following is not present in MTE 4? Zinc Copper Chromium Selenium d

Which of the following should be supplemented in a patient that has diarrhea? Zinc Chromium Manganese Copper c

Which of the following tests would indicate if a patient is getting too much protein? Blood glucose LFTs BUN Electrolytes b Hyperglycemia (dextrose), azotemia (protein)

Which of the following would occur it a patient is being overfed? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis c

Which of the following should be supplemented in the TPN of an alcoholic patient? Copper Zinc Manganese Thiamine d