1. By Alaina Darby
Parenteral Nutrition

2. 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

3. 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

4. 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

5. 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

6. 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

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

8. 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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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!!

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

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

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

30. 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)

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

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