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CNSC REAL EXAM AND STUDY GUIDE 300 QUESTIONS
AND CORRECT ANSWERS 2024-2025 LATEST
VERSION//ALREADY GRADED A+
Standard for glucose checks in a patient with DM on PN - CORRECT ANSWER-Every 2-6 hours Maximum glucose infusion rate for patients with DM on PN - CORRECT ANSWER-5 mg/kg/min Estimated amount of insulin to add to PN for a diabetic - CORRECT ANSWER-0.05-0.1 unit insulin/gm dextrose, increased daily to achieve glycemic goals by adding 2/3 of previous days sliding scale insulin Patients with DM on PN have an increased risk for - CORRECT ANSWER-infection The best approach to preventing PN-induced cholelithiasis is - CORRECT ANSWER-Early initiation of enteral feeding CMS standards for coverage determination of HPN - CORRECT ANSWER-1. Disease of small intestine and/or exocrine glands that significantly impairs nutrient absorption
- Motility disorders of the GI tract which results in severe nutrient malabsorption
- Meet test of permanence (>3 months duration needed) Most common complication seen after PEG placement is - CORRECT ANSWER-Peristomal infection (~30% of patients) Third party payers are most likely to reimburse for which home enteral nutrition expenses? - CORRECT ANSWER-Enteral administration supplies Which trace element deficiency is most likely to occur in long term PN-dependent patients after 3-6 months of therapy? - CORRECT ANSWER-Iron
Iron can be added to which type of PN solution? - CORRECT ANSWER- 2 - in- 1 What form of iron can be added to PN? - CORRECT ANSWER-Iron dextran How often should serum iron and ferritin levels be monitored in patients receiving iron in PN? - CORRECT ANSWER- 1 - 3 months How does PNAC typically present? What is the prime indicator? - CORRECT ANSWER-Elevated alkaline phosphatase, gamma-glutamic transpeptidase, and conjugated (direct) bilirubin. Bilirubin of >2 mg/dL is the prime indicator. What trace elements may become elevated in patients with cholestasis? - CORRECT ANSWER- Manganese and Copper Types of VADs approved for HPN include: - CORRECT ANSWER-1. Tunneled central venous catheters
- Implanted ports
- PICCs What is the best way to determine chromium deficiency? - CORRECT ANSWER-There is no known reliable indicator of chromium status. What is the best way to treat chromium deficiency? - CORRECT ANSWER-Treat hyperglycemia patients with chromium supplementation and observe for resolution of symptoms. Symptoms of Zinc deficiency: - CORRECT ANSWER-Loss of taste, altered smell, skin rash, growth failure, alopecia, decreased muscle work capacity, gonadal hypofunction. Pica, dysgeusia, skin loss, hair lesions. What criteria must be met for home enteral nutrition (HEN) under Medicare coverage guidelines? - CORRECT ANSWER-1. A permanent no function or disease of the structures that normally permit food to reach the small bowel
- A disease of the small bowel that impairs digestion and absorption of an oral diet.
- Test of permanence met (>3 months)
Infusion rates of phosphate should not exceed - CORRECT ANSWER-7 mmol/hr Risk of thrombophlebitis increased after - CORRECT ANSWER-Day 4 What may worsen hypokalemia by stimulating insulin release and promoting intracellular shifts of K+? - CORRECT ANSWER-Dextrose solutions Metabolic acidosis presents as: - CORRECT ANSWER-Low pH, CO2, HCl, Ca High PO4, K+ Hypophosphatemia may cause - CORRECT ANSWER-Neuromuscular adverse affects such as rhabdo Which serum electrolyte level should be monitored most closely in metabolic acidosis? - CORRECT ANSWER-Potassium What should be on inpatient PN label according to ASPEN? - CORRECT ANSWER-2 patient identifiers Patient location or address Dosing weight in metric units Administration date and and time Beyond use date and time Route of administration Prescribed volume and overfill volume Infusion rate in mL/hr Duration of infusion Size of in-line filter Complete name of all ingredients Barcode Institution or Pharmacy Institution or pharmacy contact info including phone number
When should you remove the PICC line? - CORRECT ANSWER-Only when is it suspected or known to be the source of infection. What is a disadvantage of a PICC? - CORRECT ANSWER-Limited self care ability High rate of malposition or coiling More prone to occlusion What are advantages of a PICC line? - CORRECT ANSWER-No risk of pneumothorax or puncture Available in single, double, triple lumens Repeated skin puncture is not required When should PN be used in Crohn's Dz? - CORRECT ANSWER-Only after failure to tolerate EN What is most serious complication of significant hyperphosphatemia? - CORRECT ANSWER-Soft tissue and vascular complications Calcification occurs when the serum calcium level multiplied by the serum phosphorus level exceeds what number? - CORRECT ANSWER-55 mg/dL Consequences of hyperphosphatemia - CORRECT ANSWER-1. Secondary hyperparathyroidsism
- Renal osteodystrophy
- Hypocalcemia When can PN solutions be started immediately without x-ray verification? - CORRECT ANSWER-If the catheter was placed with fluoroscopy What biochemical evidence indicates essential fatty acid deficiency (EFAD)? - CORRECT ANSWER-A triene to tetraene ratio >2.0 (Holman Index)
Which vitamins are recommended to be added individually to PN for a patient with SBO during PN MVI shortages? - CORRECT ANSWER-Thiamin, folic acid, pyridoxine, vitamin C Cyclosporine or tacrolimus (used for solid-organ transplants for immune suppressions) can cause nutrient disorders such as what? - CORRECT ANSWER-Hyperkalemia Hypomagnesia Hyperglycemia Hypercholesterolemia Altered potassium homeostasis Patients taking cyclosporine or tacrolimus may require education for what kinds of diet? - CORRECT ANSWER-Low potassium- monitor K+ on a regular basis B12 deficiency symptoms include: - CORRECT ANSWER-Anemia, neurological and psychiatric symptoms including numbness, paresthesia, and memory disturbance Thiamin deficiency symptoms include: - CORRECT ANSWER-Neuropathy disorders, BeriBeri, Wernicke's encephalopathy. NOT anemia. Copper deficiency symptoms include: - CORRECT ANSWER-Anemia (microcytic, hypochromic) and neutropenia, myeloneuropathy and peripheral neuropathy. Sensory ataxia, lower extremity spasticity, parathesis in extremities, leukopenia, hypercholesterolemia, increased erythrocyte turnover, abnormal EKG patterns Overt signs of EFAD (scaly dermatitis, alopecia, thrombocytopenia, and growth failure) are uncommon in patients with what disease? - CORRECT ANSWER-Cystic Fibrosis How does EFAD preset in patients with CF? - CORRECT ANSWER-Poor growth and pulmonary status EFA profiles have been shown to improve in CF patients after what? - CORRECT ANSWER-Lung transplant
What type of diets should be recommended to patients with short bowel syndrome (SBS) with ileal resection and colon in continuity? - CORRECT ANSWER-High complex carb diet— reduces osmotic load and may exert a positive effect on the adaptation process SBS patients who have a colon in continuity should restrict/induce what nutrients in their diets? - CORRECT ANSWER-Restrict oxalate intake Consume high calcium foods or calcium citrate supplements What normally happens to dietary oxalate in the colon? - CORRECT ANSWER-Oxalate binds to calcium and is excreted in the stool What happens to oxalate in the setting of steatorrhea? - CORRECT ANSWER-Calcium binds to fatty acids allowing excess and unbound oxalate to be absorbed from the colon and filtered by the kidneys Oxalate stone formation is facilitated in the kidneys of SBS patients by what? - CORRECT ANSWER-Excess oxalate, dehydration, metabolic acidosis, and hypomagnesia How can you prevent oxalate stone formation in SBS patients? - CORRECT ANSWER-Urine output > mL/d Oral Calcium supplements of 800-1200 mg/d in divided doses not exceeding 500 mg compete with fatty acids to bind oxalate in the colon limiting dietary fat intake to 20-30% intake How much thiamin is recommended before initiating dextrose containing IVF? - CORRECT ANSWER- 100 mg How much thiamin is recommended for those at refeeding risk? - CORRECT ANSWER-100 mg/d for 5- 7 days What condition may occur in patients with SBS and small intestinal bacterial overgrowth (SIBO)? - CORRECT ANSWER-Metabolic acidosis
What nutrition tool is used to evaluate critically ill patients? - CORRECT ANSWER-NRS-2002 or NUTRIC tool Cheilosis is a physical symptom associated with a deficiency of what vitamin? - CORRECT ANSWER- Riboflavin Symptoms of riboflavin deficiency: - CORRECT ANSWER-Hypermedia and edema of pharyngeal and oral mucosa, angular stomatitis, glossitis The chemotherapeutic drug methotrexate acts by interfering with the normal intracellular metabolism of which nutrient? - CORRECT ANSWER-Folate How does methotrexate impair malignant growth? - CORRECT ANSWER-Interfering with DNA synthesis repair, and cellular replication Long term use (>3 years) of PPIs may cause a fall in what vitamin? - CORRECT ANSWER-B Additional zinc is recommended in patients with losses from what conditions? - CORRECT ANSWER- Thermal injury, excessive GI losses such as diarrhea, decubitus ulcers, and high output fistulas Lactic acidosis can can be a result of which vitamin deficiency? - CORRECT ANSWER-Thiamin Which IVF most closely resembles jejunal and ileal electrolyte content? - CORRECT ANSWER-Lactated Ringer's Electrolyte content of LR - CORRECT ANSWER-Glucose: 0 Sodium: 130 mEq/L Chloride: 109 mEq/L Potassium: 4 mEq/L Lactate: 28 mEq/L
Calcium: 2.7 mEq/L Electrolyte content of NS - CORRECT ANSWER-Sodium: 154 mEq/L Chloride: 154 mEq/L Electrolyte content of 1/2 NS - CORRECT ANSWER-Sodium: 77 mEq/L Chloride: 77 mEq/L Electrolyte content of D5 1/2 NS - CORRECT ANSWER-Glucose: 50 g/L Sodium: 77 mEq/L Chloride: 77 mEq/L Dietary fat is predominately absorbed in what part of the gastrointestinal tract? - CORRECT ANSWER- Duodenum and proximal jejunum Valproic acid has been shown to induce a deficiency in which nutrient? - CORRECT ANSWER-Carnitine What is the role of carnitine in the body? - CORRECT ANSWER-Involved in the metabolism of fatty acids and essential cofactor in the proper metabolism of valproic acid and ammonia elimination What chronic disease can be the result of lack of carnitine? - CORRECT ANSWER-Chronic fatty liver (as fatty acids cannot be metabolized) Consider carnitine replacement in which patient populations? - CORRECT ANSWER-Patients in a coma, elevated ammonia concentrations, hepatoxicity or valproic acid concentrations above 450 mcg/mL What is the primary fuel of the colonocytes? - CORRECT ANSWER-SCFAs- butyrate, acetate, propionate SCFAs may provide how many kcal/d in patients with SBS? - CORRECT ANSWER- 1000
What PN changes are appropriate for high ileostomy output? - CORRECT ANSWER-Increased fluid volume and increased fluid How much fluid per day is required to maintain fluid balance in an average healthy adult? - CORRECT ANSWER- 25 - 35 mL/kg/day Insensible fluid losses from lungs and skin can account for how much fluid loss per day? - CORRECT ANSWER-1 L What metabolic process is common in both acute illness or injury related and social or environmental related malnutrition? - CORRECT ANSWER-Lipolysis What metabolic process is common in starvation? - CORRECT ANSWER-Hypoglycemia and ketosis What metabolic process is common in stress-related malnutrition? - CORRECT ANSWER- Hypermetabolism and hyperglycemia What is the vitamin A supplementation regimen in vitamin A deficiency caused by chronic corticosteroid use? - CORRECT ANSWER- 3000 - 15000 RAE/d for 7 days What is the vitamin A supplementation regimen for enhanced wound healing with concurrent corticosteroid therapy? - CORRECT ANSWER-Oral administration of 3000-4500 RAE/d Where is iron primarily absorbed? In what form? - CORRECT ANSWER-duodenum and jejunum, ferrous state Hepatic encephalopathy is most likely improved by which trace element? - CORRECT ANSWER-Zinc Liver Dz is associated with toxicity of which mineral? - CORRECT ANSWER-Copper Copper toxicity symptoms - CORRECT ANSWER-Nausea, diarrhea, vomiting
Which amino acid is most crucial in small intestine structure and function? - CORRECT ANSWER- Glutamine Gastrectomy patients are at risk for a deficiency of which vitamin? - CORRECT ANSWER-B Fluid requirement for adults 18-55? - CORRECT ANSWER-35 mL fluid/kg/day Fluid requirement for adults 55-75? - CORRECT ANSWER-30 mL fluid/kg/day Fluid requirement for adults 75+? - CORRECT ANSWER-25 mL fluid/kg/day Which area of the GI tract has the least impact on nutrient absorption? - CORRECT ANSWER-Duodenum and proximal jejunum Arginine increases the production of what? - CORRECT ANSWER-Nitric oxide Arginine supplementation should be used most cautiously in patients with which condition? - CORRECT ANSWER-Septic shock Treatment of PKU - CORRECT ANSWER-Phenylalanine free diet and tyrosine supplementation Which predictive equation has demonstrated the greatest accuracy in estimating actual resting metabolic rate in healthy obese and non-obese adults? - CORRECT ANSWER-MSJ Equation Benefits of using an electromagnetic placement device for NGT placement? - CORRECT ANSWER-3D localization follows tip of placement relative to lower esophageal sphincter Max hang time for human breast milk? - CORRECT ANSWER-4 hours
Hang time of ready to use cans is how long? - CORRECT ANSWER-12 hours How long are powdered formulas reconstituted in advance good for? - CORRECT ANSWER-Discard within 24 hours of prep if not used; expose to room temp no longer than 4 hours Reasons for abdominal distention in enteral feeding include: - CORRECT ANSWER-Rapid administration of feeding use of hyperosmolar solution Medications that slow peristalsis Excess air in the stomach or intestines Tube migration from stomach to small intestine Infection Cold formula Inadequate fluid provision Bacterial contamination Fat, fiber, or lactose intolerance Holding enteral feedings for distention is not indicated unless abdominal girth exceeds baseline by how much? - CORRECT ANSWER- 8 - 10 cm What should appear on the label of an enteral feeding product given to a patient int he hospital? - CORRECT ANSWER-Patient ID Product name Administration method Route Access device Date and time hung Clinical presentations of refeeding syndrome include: - CORRECT ANSWER-Dyspnea Seizures
Cardiac arrhythmias sodium retention exacerbated by excessive sodium and fluid intake Excess carb administration in PN is associated with what? - CORRECT ANSWER-Hepatic steatosis Symptoms of manganese deficiency are associated most commonly with accumulation of the mineral in which organ? - CORRECT ANSWER-Brain Manganese absorption from the GI tract is normally what percent of dietary intake? - CORRECT ANSWER- 6 - 16% What percent of manganese is absorbed via PN - CORRECT ANSWER-100% What prokinetic agents are used to increase motility? - CORRECT ANSWER-Metaclopramide and Erythromycin What intervention assists with maintaining enteral access device patency in the adult patient? - CORRECT ANSWER-30 mL FWF Q4H for continuous feeds How often should short term EADs be exchanged? - CORRECT ANSWER- 4 - 6 weeks Normal pH range - CORRECT ANSWER-7.35-7. Normal PCO2 - CORRECT ANSWER- 35 - 45 mmHg Normal sodium bicarbonate - CORRECT ANSWER- 22 - 26 mEq/L What syndrome occurs when the catheter is being compressed between the first rib and the clavicle? - CORRECT ANSWER-Pinch off syndrome- relief when lifting arm
The most accurate method of diagnosing PN-associated metabolic bone Dz is to measure what? - CORRECT ANSWER-Bone mineral density What catheter occlusion allows PN to continue to infuse, but it is difficult to aspirate blood from the catheter? - CORRECT ANSWER-Fibrin sheath What type of sodium/fluid imbalance is primarily associated with hyperglycemia in a patient receiving PN? - CORRECT ANSWER-Hypertonic hyponatremia (psuedohyponatremia) Hypertonic hyponatremia is caused by what? - CORRECT ANSWER-The presence of osmotically active substances other than sodium in the ECF causing water to move from ICF to ECF in order to equilibrate osmolality For each 100 md/dL increase in blood glucose above 100 mgdL, how much is serum sodium expected to fall? - CORRECT ANSWER-1.6 mEq/L Causes of hypertonic hyponatremia - CORRECT ANSWER-hyperglycemia, mannitol, meds, hypertonic fluids with little or no sodium What feature of a Groshong CVC reduces the risk of catheter occlusion? - CORRECT ANSWER-Pressure sensitive 3 way valve What is the most effective for clearing catheter occlusions due to precipitation of calcium phosphate? - CORRECT ANSWER-0.1 N hydrochloride acid What is most effective for clearing catheter occlusions due to precipitation of lipid residue? - CORRECT ANSWER-70% ethyl alcohol What is most effective for clearing occlusions from basic medications? - CORRECT ANSWER-8.4% sodium bicarbonate or 0.1 N NaOH Qualifications to receive PPN - CORRECT ANSWER-Good peripheral access
Ability to tolerate large volumes (2.5-3L/d) Contraindication to central venous access How may a catheter related blood stream infection present? - CORRECT ANSWER-Without redness or purulence. Fevers, chills, positive blood cultures with no other apparent source. How do tunnel infections present? - CORRECT ANSWER-Tenderness, erythema, or induration from the catheter site along the subcutaneous tract of a tunneled catheter Exit site infections are characterized by what symptoms? - CORRECT ANSWER-Erythema, or induration within 2 cm of the catheter exit site, absence of concomitant blood stream infection, without purulence How is catheter related phlebitis characterized? - CORRECT ANSWER-Inflammation of the vessel wall as well as erythema and pain near catheter insertion site or alone the affected vein A rise in which lab value indicates cholestasis? - CORRECT ANSWER-Conjugated bilirubin (>2 mg/dL) AKP Gamma glutamyltransferase What is the most appropriate intervention to reduce hypercalcuria caused by PN? - CORRECT ANSWER- Decrease amino acid content of PN solution What factors cause hypercalciuria? - CORRECT ANSWER-Excessive calcium and inadequate phosphorus supplementation, excessive protein in PN solution, cyclic PN infusions, chronic metabolic acidosis What is max threshold for long term PN provision of protein? - CORRECT ANSWER-Should not exceed 1. g/kg/d Which evidence based intervention should be implemented to reduce the risk of CVAD related infections? - CORRECT ANSWER-Training of nursing staff to maintain CVAD Metabolic alkalosis is caused by what? - CORRECT ANSWER-NG suctioning
