Name: ____________________________
Fall 2003
NUTR 427: MNT Exam 2
Directions: For each multiple choice question choose the best correct answer and circle the
corresponding letter. For non-multiple choice questions folow the directions given for each.
1. After swallowing, in what order does food pass through the GI tract?
a.
b.
c.
d.
e.
2.
jejunum, duodenum, colon, ileum, rectum
jejunum, ileum, duodenum, rectum, colon
stomach, jejunum, duodenum, ileum, colon
stomach, jejunum, duodenum, colon, ileum
stomach, duodenum, jejunum, ileum, colon
Adenosine Triphosphate (ATP) is made by which cellular component?
a. cytoplasm
b. lysosome
c. mitochondrion
d. golgi apparatus
e. ribosomes
3. What structure controls the passage of material from the stomach to the small intestine?
a.
b.
c.
d.
e.
upper esophageal sphincter
ileocecal valve
colonic sphincter
jejunal sphincter
lower esophageal sphincter
4. Which mechanism works to restore homeostasis by correcting a deficit within the system?
a.
b.
c.
d.
e.
peristaltic inhibitory
negative feedback
positive feedback
all of the above
b. and c.
5. Radiation is what type of cellular injury?
a.
b.
c.
d.
e.
toxic
infectious
physical
deficit
endogenous
5. Fermentation of CHO to produce short-chain fatty acids takes place in the
a.
b.
c.
d.
e.
small intestine
large intestine
stomach
esophagus
spleen
6. Which of the following hormones increases the resting pressure of the lower esophageal
sphincter?
a.
b.
c.
d.
e.
secretin
insulin
gastrin
cholecystokinin (CCK)
gastric-inhibitory polypeptide (GIP)
7. Which of the following hormones opposes the action & secretion of gastrin and is released from
the duodenal wall in response to acidic chyme?
a.
b.
c.
d.
e.
antigastrin
motilin
insulin
glucagon
secretin
8. Which hormone is released in response to alkalinity of the duodenum?
a.
b.
c.
d.
e.
gastrin
secretin
insulin
glucagon
motilin
10-13. Mark True or False:
____ Peristalsis is an involuntary process which moves food from the esophagus into the
stomach.
____ Due to the unusually high metabolic activity & requirements of the GI tract, it is less
susceptible to micronutrient deficiencies.
____ Passive diffusion is the process by which nutrients pass, with the aid of a carrier protein,
through the intestinal mucosal cells into the blood stream.
____ Bicarbonate ions increase the acidity of chyme.
14. Vitamin B-12 is absorbed in which part(s) of the GI tract?
a.
b.
c.
d.
e.
stomach
duodenum
ileum
colon
a. and c.
15. All of the following are parameters to monitor parenteral nutrition EXCEPT
a.
b.
c.
d.
e.
labs
weight
gastric residuals
I/O
a. and d. only
16. A polymeric formula contains
a.
b.
c.
d.
e.
intact proteins
amino acids
dipeptides
tripeptides
c. and d. only
17. Enteral nutrition is preferred to TPN for which of the following reasons?
a.
b.
c.
d.
e.
prevention of bacterial translocation
less costly
maintains GI mucosal barrier
all of the above
a. and b. only
18. Osmotic diarrhea is caused by all of the following except
a.
b.
c.
d.
e.
poorly absorbed solutes in the colon
maldigestion of CHO
sorbitol
bacterial infections
lactulous
19. Peripheral Parenteral Nutrition (PPN) relies on what concentrated, isotonic and less irritating ( to
peripheral veins) source of kcals?
a. IV dextrose
b. IV lipid
c. amino acids
d. glucose
e. all of the above
20-24. Match the following:
a. cyclic TPN
____ must be placed by an M.D.
b. PICC line
____ osmolality not to exceed 900 mOsm/kg
c. central line
____ inserted into peripheral vein & threaded up into subclavian vein
d. continuous TPN
____ preferred TPN administration in fluid restricted/glucose intolerant patients
e. PPN
____ allows mobilization of fat stores for energy
Answer questions 25-30 based on the following TF example: (show all work on calculations)
TF order: Fibersource HN @ 80cc/hr + 90cc water flush Q6h via GT
(Fibersource HN provides: 1.2 cal/cc, 53 gm prot/L, 81.4%free water, 1165cc to meet 100% RDI)
25. What is the total (formula & flushes) volume given in 24 hours?
a.
b.
c.
d.
e.
1920 cc
2280 cc
2520cc
1963 cc
360 cc
26. How many calories will be provided in 24 hours?
a.
b.
c.
d.
e.
1920
2016
2080
2304
2280
27. How many grams of protein will be provided in 24 hours?
a.
b.
c.
d.
e.
80
115
102
53
37
28. How many cc of free water will be provided in the formula alone?
a.
b.
c.
d.
e.
810
1563
1920
2280
1361
29. How many total cc's of free water (TF+water flushes) will be provided in 24 hours?
a.
b.
c.
d.
e.
1920
1210
2280
1761
1923
30. What is the %RDI provided in 24 hours?
a.
b.
c.
d.
e.
81.4%
165%
202%
60%
50%
Circle the correct answer for the following parenteral nutrition questions.
31. How many grams of protein are in 1100cc of an 8%AA solution?
a.
b.
c.
d.
e.
15
150
88
10
125
32. How many CHO calories are in 1700cc of 50% Dextrose solution?
a.
b.
c.
d.
e.
450
3400
850
2890
1700
33. How many calories are in a 20% IL solution running @ 20cc/hr for 24 hrs?
a.
b.
c.
d.
e.
528
960
264
480
432
34. What is the GUR for a patient who weighs 180# and is receiving
D15%A8% @ 80cc/hr
a.
b.
c.
d.
e.
3.2 mg/kg/min
4.1 mg/kg/min
3.1 mg/kg/min
2.9 mg/kg/min
2.4 mg/kg/min
35. How many grams of fat are provided in 370cc of a 10%IL solution?
a.
b.
c.
d.
e.
240
37
41
96
74
CASE STUDY
**Show all work for the following calculations**
MG is a 42 YOWFadmitted with esophageal CA and had a PEG placed for tube feedings.
Ht: 5'6” Wt: 125# UBW: 145#
1. Calculate MG’s REE using the HB formula
HB: REE = 655 + [9.56 x wt in kg] + [1.85x ht in cm] – [4.68 x age in years]
2. What is MG’s %IBW?
3. What is MG’s %weight change (loss)?
TF order: Jevity Plus 420cc followed by 100cc water flush TID + 2 scoops Promod TID
(Jevity Plus =1.2 cal/cc, 55.5 gm prot/L, 81% free water; Promod=28 cal/scoop, 5 gm prot/scoop)
Calculate the following:
4. Volume of formula
5. Total volume (formula + water flushes)
6. Total calories
7. Total grams of protein
MG developed a small bowel obstruction and needed to be changed to TPN for nutritional support.
TPN Order: TPN @ 70cc/hr
D50%
A10%
IL 20%
350 cc
500 cc
150 cc
Calculate the following:
8. Total calories
9.
GUR
10. %fat from calories
Extra Credit: What is the motto for using Enteral Nutrition vs. TPN? One sentence only! (2pts)
Name the 6 stages of disease (1/2 pt each):