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Understanding Normal and Clinical Nutrition 9th Edition Rolfes Whitney Test Bank

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Understanding Normal and Clinical Nutrition 9th Edition Rolfes Whitney Test Bank

ISBN-13: 978-0840068453

ISBN-10: 084006845X

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Understanding Normal and Clinical Nutrition 9th Edition Rolfes Whitney Test Bank

ISBN-13: 978-0840068453

ISBN-10: 084006845X

 

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Chapter 21 – Parenteral Nutrition Support

 

An.  Page(s)/difficulty                                                                                            K = knowledge-level, A = application level

 

Multiple Choice

 

Questions for Section 21.0 Introduction

 

c      662-664 (K)          01.  Delivery of nutrient solutions directly into the vein is called

  1. standard nutrition.
  2. enteral nutrition.
  3. parenteral nutrition.
  4. tube feeding.

 

Questions for Section 21.1 Indications for Parenteral Nutrition

 

d      664 (K)                   02.  Which of these conditions is least likely to require TPN by central vein?

  1. GI tract obstructions
  2. Severe pancreatitis with intractable vomiting
  3. Bone marrow transplants
  4. Chronic kidney disease

 

c      664 (K)                   03.  Veins that are small in diameter and carry blood from the arms and legs are the

  1. central veins.
  2. hepatic veins.
  3. peripheral veins.
  4. portal veins.

 

b      664 (K)                   04.  The large-diameter central veins are located near the

  1. extremities.
  2. heart.
  3. liver.
  4. lungs.

 

b      664 (K)                   05.  What is a likely cause of redness, swelling and tenderness at the infusion site?

  1. A dislodged catheter
  2. Phlebitis
  3. A clogged catheter
  4. a and c

 

b      664 (K)                   06.  Which of the following statements is false?

  1. Phlebitis can result when veins are damaged by overly concentrated PN solutions.
  2. Osmolality refers to the milliosmoles solute/L solution, whereas osmolarity refers to milliosmoles solute/kg solvent.
  3. Rotating venous access sites regularly can help prevent inflammation around PPN catheters.
  4. PPN may not be appropriate for patients with weak veins in their arms and legs.

 

a      664-665 (A)          07.  Judy Smith is a 36 year old who just had a bowel resection. She is expected to be NPO for approximately seven days. Which of the following would be appropriate nutrition support?

  1. Peripheral parenteral nutrition
  2. Total parenteral nutrition
  3. Simple IV solutions with amino acids
  4. Enteral feeding via nasogastric tube

e      664-665 (K)          08.  Which of the following is not a characteristic of peripheral parenteral nutrition?

  1. The solution’s osmolarity is usually limited to 900 mOsm/L.
  2. PPN can only supply limited amounts of energy and protein.
  3. PPN is most often used short term (7-10 days).
  4. PPN is most often used for patients who don’t have high nutrient needs.
  5. None of the above; all of these are characteristics of PPN

 

d      664,665 (A)           09.  Joan Sussman is in her second trimester of pregnancy and has experienced hyperemesis gravidarum (excessive vomiting, possible fluid and electrolyte imbalances) for 14 days. At this point she is a candidate for

  1. a clear liquid diet.
  2. a tube feeding.
  3. peripheral parenteral nutrition.
  4. total parenteral nutrition.

 

a      664,665 (K)           10.  Candidates for TPN are patients

  1. who are unable to use their GI tracts for long periods (> 10 days).
  2. who are malnourished and exhibit anorexia.
  3. who have high nutrient needs that they cannot meet orally.
  4. who are in a prolonged unconscious state post head injury.

 

d      665 (A)                   11.  A client receiving greater than 2000 kcalories per day via parenteral nutrition should

  1. have it administered via peripheral vein.
  2. receive dextrose and amino acids only.
  3. have it administered in bolus form.
  4. be given nutrition by the central venous route.

 

a      665 (K)                   12.  A method of infusing formula into a large-diameter central vein for meeting all nutrient needs is called

  1. total parenteral nutrition.
  2. peripheral parenteral nutrition.
  3. piggyback.
  4. all of the above

 

Questions for Section 21.2 Parenteral Solutions

 

c      666 (K)                   13.  Which department within health care institutions is typically responsible for the preparation of parenteral nutrition solutions?

  1. Nutrition/food service
  2. Central supply
  3. Pharmacy
  4. Gastroenterology

 

c      666 (K)                   14.  For which of the following conditions are disease-specific amino acid solutions commercially available?

  1. Hyperglycemia
  2. Congestive heart failure
  3. Kidney failure
  4. Crohn’s disease

 

a      666 (K)                   15.  Which of the following forms of glucose is available in parenteral solutions?

  1. Dextrose
  2. Fructose
  3. Lactose
  4. Glucose

 

b      666 (K)                   16.  How much energy does glucose provide?

  1. 3 kcal/g
  2. 4 kcal/g
  3. 5 kcal/g
  4. 6 kcal/g

 

a      666 (K)                   17.  How much energy does dextrose provide?

  1. 3.4 kcal/g
  2. 4.0 kcal/g
  3. 4.4 kcal/g
  4. 5.0 kcal/g

 

a      666 (K)                   18.  The protein in a TPN solution is primarily in the form of

  1. amino acids.
  2. protein hydrolysate.
  3. short-chain fatty acids.
  4. intact protein.

 

a      666 (A)                   19.  A physician writes an order for Mrs. Wilson to receive parenteral lipids twice a week. The purpose of this order is to

  1. provide essential fatty acids.
  2. provide nonessential amino acids.
  3. provide excessive energy.
  4. suppress the immune response.

 

c      666 (K)                   20.  When lipids are administered parenterally on a daily basis, what is the main objective?

  1. Increase the use of dextrose for energy
  2. Promote the immune response
  3. Provide a concentrated energy source
  4. Avoid hypoglycemia

 

c      666 (K)                   21.  A 20% IV fat emulsion provides how many kcalories per mL?

  1. 1.0
  2. 1.1
  3. 2.0
  4. 2.1

 

a      666 (K)                   22.  What is usually the main source of energy provided by parenteral nutrition?

  1.              Carbohydrate
  2. Protein
  3. Fat
  4. Amino acids

 

a      666 (K)                   23. Caution should be taken when administering parenteral lipids to people with which condition?

  1. Hypertriglyceridemia
  2. Hyperglycemia
  3. Diabetes
  4. Kidney failure

 

c      666 (K)                   24.  Daily fluid needs in young adults are approximately _____ per kg body weight versus approximately _____ per kg body weight in older adults.

  1. 25-30 mL, 30-40 mL
  2. 30-40 mL, 40-50 mL
  3. 30-40 mL, 25-30 mL
  4. 40-50 mL, 30-40 mL

d      666-667 (K)          25.  Which of the following nutrients is not found in parenteral solutions?

  1. Vitamins and minerals
  2. Amino acids
  3. Fat
  4. Fiber

 

b      667 (K)                   26.  Which of the following trace minerals is not usually added to parenteral solutions?

  1.              Zinc
  2. Nickel
  3. Chromium
  4. Selenium

 

c      667 (K)                   27.  Which trace mineral is excluded from parenteral solutions because it alters the stability of the other ingredients in the solution?

  1. Zinc
  2. Copper
  3. Iron
  4. Selenium

 

d      667 (K)                   28. Which vitamin is omitted from parenteral solutions designed for patients on warfarin therapy?

  1. Vitamin C
  2. Vitamin D
  3. Vitamin E
  4. Vitamin K

 

a      667 (K)                   29.  Which statement is false?

  1. To “piggyback” means to administer a second solution through a second catheter.
  2. Few medications are added to parenteral solutions so that potential drug-nutrient interactions can be avoided.
  3. Two separate ports may be attached to a single catheter using a Y-connector.
  4. Heparin may be added to TPN by piggyback to prevent clotting at the catheter tip.

 

d      667 (A)                   30.  If a TPN solution contains 80 grams of amino acids per 1 L solution, what is the contribution of these amino acids to the osmolarity of the TPN?

  1. 100 mOsm/L
  2. 200 mOsm/L
  3. 400 mOsm/L
  4. 800 mOsm/L

 

b      669 (A)                   31. How many grams of amino acids would be provided to a client receiving 2,000 mL of a 5% amino acid solution?

  1. 50 grams
  2. 100 grams
  3. 200 grams
  4. 400 grams

 

b      669 (A)                   32. How many kcalories are provided by 3 liters of a 5% dextrose solution?.

  1. 150.
  2. 510
  3. 600
  4. 660

 

b      669 (A)                   33. How much dextrose would a person receive from 2000 milliliters of 50% dextrose?

  1. 750 grams
  2. 1000 grams
  3. 1250 grams
  4. None of the above

 

c      669 (A)                   34. Suppose a person is receiving 2000 milliliters of a 10% amino acid solution. What is the amount of amino acids provided?

  1. 100 grams
  2. 150 grams
  3. 200 grams
  4. 250 grams

 

d      670 (K)                   35.  To prevent bacterial contamination and maintain stability, parenteral solutions are:

  1. warmed to room temperature prior to infusion.
  2. exposed to light.
  3. pasteurized.
  4. compounded in the pharmacy under aseptic conditions.

 

Questions for Section 21.3 Administering Parenteral Nutrition

 

b      670-671 (K)          36.  A(n) _____ is made up of physicians, nurses, dietitians, and pharmacists.

  1. food service department
  2. nutrition support team
  3. eating disorder treatment team
  4. physical rehabilitation team

 

d      670-671 (K)          37.  Which of the following is a possible catheter-related complication in parenteral nutrition?

  1. Phlebitis
  2. Hypertriglyceridemia
  3. Air embolism
  4. a and c

 

d      671 (K)                   38.  Nutrition-related complications that may develop from parenteral nutrition include all of the following except

  1. abnormal liver function.
  2. hypoglycemia.
  3. vitamin and mineral deficiencies.
  4. hypotriglyceridemia

 

d      671;673 (K)          39. A complication of parenteral nutrition that is not related to catheter insertion or care is:

  1. phlebitis.
  2. sepsis.
  3. obstructed blood flow.
  4. hyperglycemia.

 

d      671;673-674 (K)  40.  Which of the following is a possible metabolic complication of parenteral nutrition?

  1. Hypoglycemia or hyperglycemia
  2. Gallbladder disease
  3. Refeeding syndrome
  4. All of the above

 

c      672 (K)                   41. The benefits of cyclic infusion of TPN include

  1. maintenance of high insulin levels.
  2. increase in fat stores.
  3. flexibility in the daily scheduling of activities.
  4. achievement of a negative nitrogen balance.

 

c      672 (K)                   42. A person on cyclic parenteral nutrition receives an infusion at a constant rate for

  1. 3 to 6 hours per day.
  2. 6 to 8 hours per day.
  3. 8 to 16 hours per day.
  4. 12 to 18 hours per day.

 

a      672 (A)                   43. Which of the following would be the best method of delivery of long-term TPN to a 14 year old?

  1. Cyclic infusion
  2. PPN
  3. Continuous TPN with lipids daily
  4. Continuous TPN with lipids five times a week

 

b      672 (K)                   44.  Which type of parenteral nutrition is provided at night so patients can participate in routine activities during the day?

  1. Continuous parenteral nutrition
  2. Cyclic parenteral nutrition
  3. Peripheral parenteral nutrition
  4. Piggyback parenteral nutrition

 

c      672 (A)                   45. Which of the following does not need to be monitored daily for a client receiving TPN?

  1. Weight changes
  2. Fluid intake and output records
  3. Liver enzymes
  4. Serum glucose

 

d      672 (K)                   46. To ensure a patient who is receiving TPN is adapting to the solution, health care professionals monitor

  1. electrolyte balance.
  2. blood glucose concentration.
  3. arterial blood gases.
  4. a and b
  5. a, b, and c

 

a      672 (A)                   47. The health care team has just ordered Mr. Carter to begin TPN. He is a 58-year-old man who is suffering from intractable diarrhea. Before Mr. Carter starts TPN, what procedure should be performed?

  1. X-ray to confirm catheter placement
  2. Body mass index assessment
  3. Calcium balance
  4. Hand grip strength

 

b      672 (A)                   48. The health care team has just ordered Mr. Carter to begin TPN. He is a 58-year-old man who is suffering from intractable diarrhea. Which of the following should be monitored daily while Mr. Carter is on TPN?

  1. Nutrition status
  2. Fluid intake/output
  3. Serum albumin
  4. All of the above

 

c      672 (A)                   49. The health care team has just ordered Mr. Carter to begin TPN. He is a 58-year-old man who is suffering from intractable diarrhea. On a weekly basis, the health care team should perform what part of the nutrition care process?

  1. Diagnose nutrition problems
  2. Develop a health care plan
  3. Assess nutrition status
  4. Implement the nutrition care plan

 

a      672 (K)                   50. Which of the following measurements should be taken daily for a client receiving TPN?

  1. Weight
  2. Serum calcium
  3. Serum ammonia
  4. CBC

 

d      672 (K)                   51.  Which of the following is checked daily until the patient is stabilized in order to determine tolerance to parenteral feedings?

  1. Blood glucose
  2. Electrolyte levels
  3. Vitamin levels
  4. a and b
  5. b and c

 

a      672-673 (A)          52. Greg Thomas is a 12 year old who is being weaned off of TPN. In addition to TPN, Greg is on a soft diet. Greg is 5’2” and weighs 110 lbs. His energy needs are estimated to be approximately 2100 kcal/day. His calorie count reveals he is consuming 1700 kcal/day. Which intervention is appropriate at this time?

  1. Discontinue TPN.
  2. Oral feeding should be doubled.
  3. Enteral feeding should be considered.
  4. TPN should be increased to provide an additional 1100 kcal.

 

d      672-673 (K)          53. All of the following may occur when long-term TPN is discontinued and oral feedings are gradually reintroduced except

  1. diarrhea.
  2. suppression of appetite for several weeks.
  3. bloating.
  4. a reduction in albumin levels.

 

c      673 (K)                   54. Before parenteral nutrition is discontinued, oral intake, tube feeding, or a combination should provide at least what proportion of the estimated energy needs?

  1. 55%
  2. 60%
  3. 67%
  4. 82%

 

b      673 (K)                   55. In order to prevent the development of hyperglycemia, what is the recommended maximum amount of carbohydrate in a TPN solution that should be provided daily?

  1. 4 mg/kg body weight/minute
  2. 5 mg/kg body weight/minute
  3. 6 mg/kg body weight/minute
  4. 7 mg/kg body weight/minute

 

a      673 (A)                   56.  Mrs. Jackson is admitted to the hospital with a diagnosis of severe pancreatitis due to hypertriglyceridemia. Which macronutrient(s) in her TPN may need to be restricted?

  1. Lipids
  2. Carbohydrates
  3. Amino acids
  4. a and b

 

c      673 (K)                   57.  What is the maximum blood glucose level that is considered acceptable for most patients receiving parenteral nutrition?

  1. 100 mg/dL
  2. 150 mg/dL
  3. 200 mg/dL
  4. 250 mg/dL

 

d      673 (A)                   58.  Max, a 67-year-old homeless man with a history of alcoholism, is admitted with frostbite and severe malnutrition. What lab values should be monitored when his TPN is started to avoid the development of refeeding syndrome?

  1. Folate, vitamin B6, and vitamin B12
  2. Sodium, iron, and zinc
  3. Calcium, vitamin D, and vitamin K
  4. Phosphate, potassium, and magnesium

 

c      674 (K)                   59.  A patient on TPN for longer than _____ is at risk for “sludge” buildup in the gallbladder and gall stone formation.

  1. 2 weeks
  2. 3 weeks
  3. 4 weeks
  4. 5 weeks

 

b      674 (A)                   60.  Kristin Sullivan is on long-term parenteral nutrition. This place her at risk for:

  1. type 1 diabetes.
  2. osteoporosis.
  3. liver cancer.
  4. heart disease.

 

Questions for Section 21.4 Nutrition Support at Home

 

a      674-675 (A)          61. Which of the following clients would not be a candidate for a home cyclic TPN program?

  1. An 86 year old with congestive heart failure
  2. A 36 year old with Crohn’s disease
  3. A 52 year old with intestinal cancer
  4. An 18 year old with radiation enteritis

 

b      674-675 (K)          62. For which of the following would home TPN be an appropriate means for maintaining adequate nutrition status?

  1. Individuals with dysphagia
  2. Individuals with intestinal obstructions.
  3. Individuals with head and neck cancers
  4. Individuals with neurological impairments affecting the esophagus

 

e      675-676 (A)          63.  Mrs. Harper has been tolerating her tube feeding and is being discharged to her home this afternoon. The insurance company requests the dietitian to:

  1. change the tube feeding method to continuous.
  2. change the tube feeding product.
  3. change the tube feeding method to bolus.
  4. a and b
  5. b and c

 

b      676 (A)                   64.  Maria is a home health dietitian. She is evaluating a new TPN patient. She expects that the patient will want to change his regimen to:

  1. continuous infusion.
  2. cyclic infusion.
  3. NPO.
  4. bolus infusion.

 

d      676 (K)                   65.  Which of the following factors should be considered when planning home parenteral nutrition?

  1. Refrigeration space
  2. Back-up batteries
  3. Catheter care
  4. All of the above

 

d      676 (A)                   66.  Mr. Ming has been on home nutrition support for two months. He has become more withdrawn and depressed due to:

  1. his inability to enjoy meals.
  2. lack of sleep.
  3. an increase in bathroom visits.
  4. all of the above

 

Questions for Section 21.5 Ethical Issues in Nutrition Care

 

b      679 (K)                   67.  What is the general term for a written or oral instruction regarding one’s preferences for medical treatment to be used in the event that one becomes incapacitated?

  1. Do-not-resuscitate order
  2. Advance directive
  3. Durable power of attorney
  4. Living will

 

d      679 (K)                   68.  What is the specific term for a written statement that specifies the medical procedures desired or not desired in the event that a person is unable to communicate or is incapacitated?

  1. Do-not-resuscitate order
  2. Advance directive
  3. Durable power of attorney
  4. Living will

 

c      680 (K)                   69.  If a person’s or family’s religious beliefs are not in accord with medical recommendations, health care providers are expected to:

  1. consult the facility administrator.
  2. lecture the family on what the best medical decision would be.
  3. consider the family’s viewpoint and try to resolve the issue in some way.
  4. seek legal advice.

 

a      681 (A)                   70.  When a person is brought into the emergency room from a nursing home where she was found unresponsive in her room, and CPR is not administered, this is because the physicians are following the _____ in the patient’s medical record.

  1. do-not-resuscitate order
  2. advance directive
  3. durable power of attorney
  4. living will

 

b      681 (K)                   71.  Which statement is true?

  1. If a person has signed an organ donor card, his physician can remove his organs for donation even if his family members refuse to give their consent.
  2. To avoid a conflict of interest, the care of organ donors and organ recipients is always performed by separate physicians.
  3. If an individual is near death and has agreed to be an organ donor, her physician can initiate treatments that may cause harm to her in order to preserve the organs.
  4. Physicians cannot alert the organ procurement team about available organs until the donor has shown no vital signs for at least 10 minutes.

 

Case Studies

 

Marc Jejune is a 30-year-old single male who exercises and follows a healthy diet. His physician admits Marc to the medical-surgical unit for evaluation. At his doctor’s appointment prior to his admission, he complained of poor appetite, constipation, nausea, and vomiting for 3 days.

 

a      663 (A)                   72.  Upon admission, what diet should the doctor prescribe for Marc?

  1. NPO
  2. Clear liquid
  3. Low fiber
  4. High protein/high kcalorie

 

d      663-664 (A)          73.  Marc’s nausea and vomiting continued after he was admitted. Nasogastric decompression has been started. Which diet should be recommended to completely meet his nutritional needs?

  1. Clear liquid
  2. Elemental formula
  3. Low fiber
  4. TPN

 

d      665 (A)                   74.  Marc will need intestinal surgery and will be NPO for 10-14 days. How can his medical team meet his nutritional needs?

  1. Regular diet
  2. Elemental formula
  3. PPN
  4. PICC

 

c      672 (A)                   75.  After surgery, Marc remains on ventilator support but his gut function is improving. The doctor should initiate:

  1. a soft diet.
  2. a clear liquid diet.
  3. an elemental tube feeding.
  4. PPN.

 

d      672-673 (A)          76.  What should the nutritional support team do to ensure that Marc can consume enough food orally to meet his energy needs?

  1. Send double portions
  2. Discontinue the tube feeding
  3. Discontinue the TPN
  4. Switch to nocturnal feedings

 

Julia Reynolds is a 64-year-old realtor. She has been admitted to the local medical center 6 times in the past 3 months with severe pancreatitis. Julia has been experiencing intractable vomiting and intense pain after eating. Her insurance will not cover home nutritional support. She is being transferred to a sub-acute nursing facility for therapy.

 

d      664-665 (A)          77.  Upon admission, Julia tells her nurse that she has a lot of fear in regards to nutrition support due to a “vein blowout” at a previous admission. What is the most likely cause of this incident?

  1. High glucose in the TPN
  2. Low amino acids in the TPN
  3. Low vitamin K in the PPN
  4. Osmolarity of the PPN

 

b      663-665;673 (A)  78.  The registered dietitian completing her initial assessment should expect which of the following?

  1. High albumin
  2. Weight loss
  3. High iron
  4. Low insulin

 

c      673 (A)                   79.  The nutrition support team decides to increase the kcal in Ms. Reynolds’s TPN _____ to prevent _____.

  1. slowly, hypoglycemia
  2. quickly, hypoglycemia
  3. slowly, refeeding syndrome
  4. quickly, refeeding syndrome

 

b      673 (A)                   80.  Laboratory values indicate that Julia’s blood glucose is extremely high. Which nutrient component of her TPN must be adjusted?

  1. Water
  2. Dextrose
  3. Amino acids
  4. Chromium

 

c      673-674 (A)          81.  After 6 weeks of intense nutrition support, her liver enzymes are elevated. The dietitian recommends:

  1. a low-fat diet.
  2. elemental tube feedings.
  3. cyclic TPN.
  4. continuous TPN.

 

 

Matching

 

D     665                         01. Type of nutrition support in which the nutrient concentrations do not need to be limited.

G     667                         02. Administration of a second solution using a separate port in an intravenous catheter.

J      672                         03.  Continuous administration of parenteral solution over 24 hours.

F      664                         04.  Refers to the concentration of solutes per kilogram of water.

A     664                         05.  Small-diameter veins that carry blood from the arms and legs.

B     664                         06. Large-diameter veins close to the heart.

H     668                         07.  Parenteral solution that contains dextrose, amino acids, and lipids.

O     679                         08.  Written statement that specifies the medical procedures desired or not desired in the event that a person is unable to communicate or is incapacitated.

K     672                         09.  Administration of a parenteral solution over an 8- to 16-hour period.

C     664                         10.  Type of nutrition support that usually has a maximum of 900 mOsm/L.

I      668                         11.  Parenteral solution that contains dextrose and amino acids, and excludes lipids.

E     664                         12.  Refers to the concentration of solutes per liter of solution.

L     673                         13.  Exhibited by severely malnourished patients who are fed aggressively; characterized by fluid and electrolyte imbalances.

M    679                         14.  Legal document that gives legal authority to another to make medical decisions in the event of incapacitation.

N     679                         15.  Written or oral instruction regarding one’s preferences for medical treatment to be used in the event that a person becomes incapacitated.

 

 

 

  1. Peripheral veins
  2. Central veins
  3. Peripheral parenteral nutrition
  4. Total parenteral nutrition
  5. Osmolarity
  6. Osmolality
  7. Piggyback
  8. Total nutrient admixture
  9. 2-in-1 solution
  10. Continuous parenteral nutrition
  11. Cyclic parenteral nutrition
  12. Refeeding syndrome
  13. Durable power of attorney
  14. Advance directive
  15. Living will

 

 

 

Essay

 

Page(s)

 

662-667                                 01.  Why is enteral nutrition preferred over parenteral nutrition if the GI tract is functional? Explain the difference in the form of nutrients delivered in each of these types of nutrition support.

 

662-665                                 02.  Compare PPN solutions and TPN solutions. Give examples of conditions or situations where each intravenous feeding method would be appropriate.

 

670-674                                 03.  How are clients receiving parenteral nutrition monitored?

 

672-673                                 04. Describe how patients are tapered off of TPN solutions and how enteral feedings are started.

 

673                                         05.  Define refeeding syndrome. Why does it occur, and how can it be prevented?

 

673-674                                 06. Discuss possible metabolic complications associated with intravenous nutrition and possible corrections of these complications.

 

674-676                                 07.  Discuss how home enteral and parenteral programs are developed and give examples of candidates who would benefit from such programs.

 

676                                         08.  Discuss the quality of life issues that need to be addressed with patients receiving long-term nutrition support at home.

 

679-681                                 09.  Discuss the ways in which a health care professional must balance his or her obligation to provide appropriate care with the need to follow ethical principles.