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CNSC Practice Questions (Updated
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In an intensive care setting, which of the following complications associated with malnutrition is most likely to occur as a result of the failure to begin nutrition support early in the treatment regimen? - answer Increased serum levels of protein-bound drugs Which of the following is the inpatient glycemic target for critically ill patients? 1: 80-110 mg/dL 2: 140-180 mg/dL 3: 181-210 mg/dL 4: 211-240 mg/dL - answer 2: 140-180 mg/dL Targets <110mg/dL are not recommended Under conditions of sepsis and stress, which of the following metabolic alterations are most likely to occur? 1: Increased glucose production and increased glucose uptake 2: Increased glucose production and decreased glucose uptake 3: Decreased glucose production and decreased glucose uptake 4: Decreased glucose production and increased glucose uptake - answer 2: Increased glucose production and decreased glucose uptake Stress hormones induce insulin resistance and hyperglycemia is commonly observed with nutrition support. It is recommended that glucose levels be adequately controlled to avoid polyuria and electrolyte disturbances.
Which of the following immunomodulating nutrients may be harmful in patients with severe sepsis? 1: Arginine 2: Selenium 3: Nucleic acids 4: Omega-3 fatty acids - answer 1: Arginine Nitric oxide can be detrimental by leading to coagulation abnormalities and altered hemodynamic status. In this case, arginine could be considered harmful. Because of these effects, there is still much debate over the value of arginine in nutrition support for critically ill patients. Which of the following best describes enteral glutamine supplementation in the critically ill patient not in multi organ failure? 1: Enteral glutamine decreases mortality 2: Enteral glutamine decreases ventilator days 3: Enteral glutamine decreases hospital length of stay 4: Enteral glutamine decreases nosocomial infections - answer 4: Enteral glutamine decreases nosocomial infections Which of the following are counter-regulatory hormones responsible for the hypercatabolism observed in critically ill trauma patients? 1: Glycogen, insulin, norepinephrine 2: Glucagon, epinephrine, cortisol
1: Routine supplementation of omega-3 fatty acids is essential in the management of CF 2: EFAD usually does not manifest in CF patients until the second decade. 3: CF patients without pancreatic insufficiency rarely develop EFAD 4: EFA profiles have been shown to improve in CF patients after lung transplantation - answer 4: EFA profiles have been shown to improve in CF patients after lung transplantation EFA status is usually evaluated by measuring the triene: tetraene ratio. Although supplementation with omega 3 fatty acids are sometimes used in the management of CF, results from clinical trials have shown mixed results and further trials are needed to determine the efficacy of routine EFA supplementation in the management of CF. Which of the following is the best choice for feeding a pancreatic insufficient infant with cystic fibrosis? 1: Protein hydrolysate formula with medium chain triglyceride (MCT) 2: Free amino acid formula with MCT 3: Human milk 4: Standard infant formula - answer Human milk is the optimal choice over standard formula for any infant due to multiple beneficial components including immunologic properties, growth factors, and both pre- and probiotics. Human milk or standard infant formula with appropriate enzyme dosing is recommended. Protein hydrolysate or free amino acid formulas containing MCT are not indicated for infants with cystic fibrosis (CF) unless there is another medical reason such as bowel resection resulting in malabsorption or liver abnormalities. Which of the following blood chemistries will most effectively indicate the response to the protein component of nutrition support in a patient on hemodialysis? 1: Albumin
2: Prealbumin 3: Urea nitrogen appearance 4: Normalized protein equivalent of total nitrogen - answer 4: Normalized protein equivalent of total nitrogen For a patient requiring nutrition support therapy, which of the following may be necessary for a patient with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT)? 1: Low potassium 2: Increased phosphorus 3: Low protein 4: Increased fluid - answer 4: Increased fluid A nutrition support regimen need not be restricted in fluid for patients receiving CRRT. However, increased fluid provision from nutrition support is not necessary. For acute renal failure patients requiring parenteral nutrition support, recommendations include 1: balanced mixture of essential (EAA) and non-essential amino acids (NEAA). 2: essential amino acids (EAA) plus dextrose. 3: non-essential amino acids (NEAA). 4: dextrose alone, no amino acids. - answer 1: balanced mixture of essential (EAA) and non- essential amino acids (NEAA). What is the glomerular filtration rate (GFR) of a patient with end-stage renal disease?
What is the recommended dietary protein intake in acutely ill adult patients receiving continuous renal replacement therapy (CRRT)? 1: 0.5-0.8 g/kg per day 2: 1.2-1.5 g/kg per day 3: 1.5-2 g/kg per day 4: 2.5-3 g/kg per day - answer 3: 1.5-2 g/kg per day What are the protein requirements for a stable patient receiving peritoneal dialysis (PD)? 1: 0.6-0.8 grams per kilogram per day 2: 1.2-1.3 grams per kilogram per day 3: 1.5-1.8 grams per kilogram per day 4: 2.0-2.2 grams per kilogram per day - answer 2: 1.2-1.3 grams per kilogram per day Which of the following is NOT a cause of protein-energy malnutrition in a patient with liver disease? 1: Malabsorption 2: Decreased caloric intake 3: Abnormal fuel metabolism 4: Reduced energy expenditure - answer 4: Reduced energy expenditure Protein-energy malnutrition is most common in which of the following types of liver disease? 1: Viral hepatitis
2: Cirrhosis 3: Hepatic steatosis 4: Nonalcoholic steatohepatitis (NASH) - answer 2: Cirrhosis Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for 1: hyperkalemia. 2: azotemia. 3: hypermagnesium. 4: hypoglycemia. - answer Loop diuretics are known to cause electrolyte abnormalities as a result of increased urine output. Specific disturbances include excess potassium and magnesium excretion which can result in hypokalemia and hypomagnesemia. Loop diuretics are not associated with hypoglycemia. Azotemia can occur related to volume depletion. Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in which type of liver disease? 1: Hepatic steatosis 2: Well-compensated cirrhosis 3: Decompensated cirrhosis 4: Fulminant hepatic failure - answer Hypoglycemia is seen in the majority of patients with fulminant hepatic failure and may result from impaired glycogenolysis, glycogenesis, gluconeogenesis and hyperinsulinemia requiring aggressive glucose administration. Patients are usually in a hypercatabolic state with an increase in energy expenditure and can become rapidly malnourished. In cirrhotic patients, which of the following should be implemented to assist in avoiding fasting- associated starvation during the night?
1: Lung and colon 2: Breast and ovarian 3: Prostate and testicular 4: Pancreatic and gastric - answer 4: Pancreatic and gastric Which of the following best describes the benefit of megestrol acetate in patients with cancer- associated cachexia? 1: Increase in lean muscle mass 2: Decreases the risk of thromboembolic events 3: Improves blood glucose control in diabetes mellitus 4: Improves appetite and ameliorates weight loss - answer 4: Improves appetite and ameliorates weight loss In the first 1 - 3 months after a bone marrow transplant the nutritional needs of a patient are best met with 1: 20-25 kcal/kg daily with >= 1.5 g protein per kg body weight. 2: 20-25 kcal/kg daily with 80% of total calories from carbohydrate. 3: 30-35 kcal/kg daily with >= 1.5 g protein per kg body weight. 4: 30-35 kcal/kg daily with 80% of total calories from carbohydrate. - answer 3: 30-35 kcal/kg daily with >= 1.5 g protein per kg body weight. Supplementation with which of the following nutrients is routinely restricted during the early stages following hematopoietic stem cell transplantation (HSCT)?
1: calcium 2: Folate 3: Iron 4: Vitamin B12 - answer Blood product support is usually required before, during and following HSCT with resultant iron overload. Iron overload may adversely affect overall survival post-HSCT by increasing the likelihood of acute graft-versus-host disease, blood stream infection, and sinusoidal obstruction syndrome of the liver. Which of the following acute changes in the serum chemistry profile would be expected in a patient who is experiencing tumor lysis syndrome(TLS)? 1: Hypercalcemia and hypomagnesemia 2: Hyperkalemia and hyperphosphatemia 3: Hypernatremia and hypermagnesemia 4: Hypocalcemia and hyperphosphatemia - answer 2: Hyperkalemia and hyperphosphatemia Which of the following best describes the treatment of diarrhea in inflammatory bowel disease? 1: Cholestyramine is effective treatment for steatorrhea 2: Patients with diarrhea should be treated with prebiotics 3: Start antidiarrheal agents once infectious etiology is ruled out 4: Withhold pharmacological therapy until diarrhea exceeds 1 L/day - answer 3: Start antidiarrheal agents once infectious etiology is ruled out A patient with Crohn's disease that involves the distal ileum should be closely monitored for malabsorption of 1: iron.
3: Folate 4: Riboflavin - answer 1: Thiamin Gastric hypersecretions following significant small bowel resection can become problematic. Which of the following medications have shown to be the most successful in suppressing gastric hypersecretions? 1: Cholestyramine 2: Loperamide 3: Histamine2 receptor antagonists 4: Proton pump inhibitors - answer 4: Proton pump inhibitors PPIs suppress significantly more acid than H2-blockers. Fifty centimeters of jejunum are necessary to absorb PPIs. For patients with severe SBS, PPI in liquid forms may be better as the other forms of the PPI(capsules and enteric coated tablets) may be excreted before it has had time to work. Cholestyramine is used for diarrhea associated with excess fecal bile acids. Loperamide is used to slow intestinal transit. Which of the following metabolic complications is most likely to occur in patients with short bowel syndrome with small bowel bacterial overgrowth? 1: Metabolic acidosis 2: Respiratoryalkalosis 3: Metabolic alkalosis 4: Respiratory acidosis - answer 1: Metabolic acidosis Patients with short bowel syndrome would benefit most from octreotide injections in the presence of
1: absence of an ileocecal valve. 2: short bowel secondary to mesenteric ischemia. 3: short bowel secondary to inflammatory bowel disease. 4: refractory diarrhea not controlled with standard antidiarrheal agents. - answer 4: refractory diarrhea not controlled with standard antidiarrheal agents. Octreotide reduces the production of a variety of GI secretions and slows jejunal transit. Which of the following diets should be recommended to patients with a short bowel syndrome (ileal resection) and colon in continuity? 1: High fat 2: High oxalate 3: High simple carbohydrate 4: High complex carbohydrate - answer A diet high in complex carbohydrates (50% to 60%) and low in fat (20% to 30%) has been shown to reduce fecal calorie loss and to increase overall energy absorption in short bowel syndrome (SBS) patients with at least a portion of their colon present. Calcium Oxalate Nephrolithiasis can occur in patients with short bowel syndrome (SBS) with a remnant colon who 1: eat a diet with 20-30% fat. 2: do not maintain adequate hydration. 3: have ileal resection < 100cm. 4: take 500 mg calcium 2-3 times per day. - answer Nephrolithiasis from calcium oxalate stones is multifactorial but is primarily due to accelerated oxalate absorption in the colon. Normally,
A 24-year-old woman is in the 10th week of her pregnancy. She has persistent nausea and vomiting for the past 6 weeks that has been associated with a 10% weight loss. Her nausea and vomiting is refractory to a 48 hour trial of anti-emetics and IV fluids. The decision to provide nutritional support is made to minimize further deterioration of the mother's nutritional status and possible negative effects on the fetus. What is the most appropriate initial nutrition therapy to implement? 1: Peripheral parenteral nutrition 2: Enteral nutrition via nasoenteric feeding tube 3: Total parenteral nutrition 4: Continue supportive care and reassess in 48 hours - answer 2: Enteral nutrition via nasoenteric feeding tube A 14-year-old with a 4-month history of intentional weight loss of 15% of her usual weight and a BMI less than the 5th percentile is diagnosed with anorexia nervosa. She is admitted to the hospital for medical stabilization and is unwilling to consume enough food to meet her nutritional needs. A 24-hour calorie count reveals that the patient is consuming a very restricted diet averaging 850 calories daily. Which of the following is the most appropriate nutrition intervention at this time? 1: Peripheral parenteral nutrition 2: High calorie diet with a calorie count 3: Structured meal plan with supplemental enteral feedings 4: Total parenteral nutrition - answer 3: Structured meal plan with supplemental enteral feedings A critically ill hyperglycemic patient receiving continuous enteral nutrition with a history of insulin dependent diabetes should ideally be placed on
1: basal/bolus subcutaneous insulin. 2: oral glucose-lowering agents given via the feeding tube. 3: continuous IV insulin infusion. 4: correction (sliding scale) subcutaneous insulin. - answer In the critical care setting, continuous intravenous insulin infusion has been shown to be the best method for achieving glycemic targets and allows for off cycles during the 24-hour period when enteral feeding is held or discontinued. Human immunodeficiency virus (HIV) associated lipodystrophy syndrome is most commonly associated with which of the following class of agents used to treat HIV infection 1: integrase strand transfer inhibitors (INSTIs). 2: non-nucleoside reverse transcriptase inhibitors (NNRTIs). 3: nucleoside reverse transcriptase inhibitors (NRTIs). 4: protease inhibitors (PIs). - answer 3: nucleoside reverse transcriptase inhibitors (NRTIs). What is the most appropriate feeding strategy for a morbidly obese trauma patient? 1: High protein, hypocaloric feeding 2: High protein, hypercaloric feeding 3: Low protein, hypocaloric feeding 4: Low protein, hypercaloric feeding - answer 1: High protein, hypocaloric feeding Zinc supplementation should be provided to patients: 1: with chronic wounds. 2: with unexplained skin rashes and alopecia.
A 51-year-old female who is 10 years post gastric bypass surgery for obesity presented with numbness and tingling in her distal lower extremities that had progressively worsened. She has been on an oral multivitamin supplement. She was significantly anemic and neutropenic. Her vitamin B12 level was normal as were her serum iron, ferritin, and transferrin levels. What nutritional deficiency is the most likely cause of all of these symptoms? 1: Thiamin 2: Zinc 3: Folate 4: Copper - answer 4: Copper Copper deficiency is rare, but presents with anemia, leucopenia, neutropenia and symptoms of peripheral neuropathy. Pharmacologic agents such as histamine2-receptor antagonists (H2 blockers) and proton-pump inhibitors (PPIs) are commonly prescribed for a variety of upper GI disorders for the prevention of gastric ulceration. Prolonged use of these medications may contribute to deficiency of this of the following micronutrients? 1: Iron 2: Potassium 3: Vitamin B 4: Vitamin B12 - answer 4: Vitamin B An 85 year old nursing home resident was transferred to the hospital with anorexia, malnutrition, and probable aspiration pneumonia. Which of the following nutrition intervention would be most appropriate for this patient?
1: Regular diet with supplements 2: Establish central access and initiate parenteral nutrition 3: Obtain peripheralaccess and initiate peripheralparenteral nutrition 4: Initiate enteral nutrition and consult for swallowing evaluation - answer 4: Initiate enteral nutrition and consult for swallowing evaluation Which of the following medications is most likely to cause constipation in a patient receiving enteral nutrition (EN)? 1: Clindamycin 2: Kayexalate 3: Codeine 4: Magnesium oxide - answer 3: Codeine Which of the following is NOT appropriate to tell a family regarding nutrition at the end of life? 1: Dying patients rarely feel hungry or thirsty 2: Fewer calories are needed at the end of life 3: The experience of eating remains unchanged at the end of life 4: Patients should not be made to feel guilty if they do not wish to eat - answer 3: The experience of eating remains unchanged at the end of life A patient in a persistent vegetative state has made their wishes known regarding artificial nutrition and hydration whose wishes have been made known through an advance directive. The decision to terminate enteral feeding for this patient is based on the ethical principle of 1: justice.
