An 85 year old nursing home resident was transferred to the hospital with anorexia, malnutrition, and
probable aspiration pneumonia. On admission, his WBC was 14K, creatinine was 1.3. Which of the
following nutrition plans would be most appropriate for this patient?
a. start the patient on a regular oral diet with supplements
b. establish central access with a PICC line and initiate parenteral feedings
c. establish peripheral access and initiate peripheral nutrition until enteral feedings can be established
d. determine the most appropriate enteral feeding route and establish tube feeding - Answer -d.
determine the most appropriate enteral feeding route and establish tube feeding
Which of the following is least likely to cause diarrhea in a tube fed patient?
a. clindamycin
b. kayexalate
c. codeine
d. magnesium oxide - Answer -c. codeine
Which of the following is NOT appropriate to tell a family regarding nutrition at end of life?
a. dying patients rarely feel hungry or thirsty
b. fewer calories are needed at the end of life
c. the experience of eating remains unchanged at the end of life
d. patients should not be made to feel guilty if they do not wish to eat - Answer -c. the experience of
eating remains unchanged at the end of life
, The decision to terminate enteral feeding in a patient in a persistent vegetative state whose wishes have
been made known through advance directive is based on the ethical principle of
a. justice
b. autonomy
c. beneficence
d. nonmalfeasance - Answer -b. autonomy
Which of the following best reflects the use of specialized nutrition support in patients with a Do Not
Resuscitate status?
a. the DNR status is a contraindication to the provision of SNS
b. the DNR status should not preclude the initiation of SNS if the indications exist
c. the provision of SNS to a patient with a DNR status is based on individual state laws
d. SNS cannot be withheld or withdrawn in a patient with a DNR order, even if all agree that SNS is no
longer meeting the desired goal - Answer -b. the DNR status should not preclude the initiation of SNS if
the indications exist
Which of the following best describes the use of artificial nutrition and hydration (ANH) in terminally ill
patients?
a. those who receive ANH have a more comfortable death
b. those who have dysphagia survive longer with ANH
c. those who receive ANH have a decrease in abnormal electrolytes
d. those who receive no ANH survive as long or longer than those who do - Answer -d. those who
receive no ANH survive as long or longer than those who do
A patient has an advanced directive stating a desire to forego medical technology, including nutrition
and hydration, in order to prolong life. The patient is now incompetent and in an irreversible vegetative
state. In deciding whether to continue nutrition and hydration by medical means, the patient's surrogate
decision-maker must
a. consult with a lawyer
b. have a psychiatric evaluation to be declared competent to make any decisions in the patient's care
c. honor the patient's expressed wish to withdraw nutrition and hydration by medical means
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