CNSC Exam With Latest Updated
Questions And Answers 2024
NGT .size .- .correct .answer.8 .- .16 .french
36 .inches
Nasoenteric .tube .size .- .correct .answer.8 .- .12 .french
Duodenal: .43 .inches
Jejunal: .60 .inches
Gastrostomy .tube .size .- .correct .answer.12 .- .28 .french
G-J .tube .size .- .correct .answer.6 .- .12 .french
Most .common .complication .s/p .enterostomy .tube .placement .- .correct .answer.peristomal
.infection
Buried .bumper .syndrome .- .correct .answer.results .from .growth .of .gastric .mucosa .over .the
.internal .bumper
risk .factors: .excessive .tension .between .internal/external .bumpers, .poor .wound .healing,
.significant .weight .gain
Decreasing .risk .of .aspiration .PNA .- .correct .answer.recent .data .suggests .jejunal .feeding
.may .be .associated .with .decreased .risk .of .asp .PNA
Diarrhea .- .correct .answer.>500mL .stool/24hr .(weigh .stool .= .1gm/1mL) .or .>3 .stools .for .at
.least .2 .consecutive .days
Drug-induced .diarrhea .- .correct .answer.magnesium, .sorbital, .PPI, .prokinetics, .ABX
Hang .time .for .reconstituted .formula .- .correct .answer.4hr
Hang .time .for .prepared .formulas .- .correct .answer.depends .on .manufacturer; .generally .4-
12hr
Dehydration .- .correct .answer.dry .mouth, .dry .tongue, .thirst, .light-headedness, .HA,
.fatigue, .loss .of .appetite, .flushed .skin ., .dark .urine, .orthostatic .hypotension, .elevated .HR,
,.poor .skin .turgor, .sunken .eyes, .muscle .cramps, .delirium, .elevated .BUN .(BUN:Cr .ratio
.>20:1)(note: .protein .intake, .renal .function, .muscle .mass .can .affect .this .ratio), .elevated
.plasma .osmolality
Normal .urine .output .- .correct .answer.Minimum .output .~700mL/d
Typical .range .0.5 .- .2 .mL/kg/hr
Hepatic .steatosis .- .correct .answer.Hepatic .steatosis .generally .occurs .in .adults .and
.presents .with .mild .elevations .in .aminotransferases, .serum .alkaline .phosphatase, .and
.bilirubin .concentrations. .This .particular .type .of .hepatobiliary .disorder .is .most .often .a
.complication .of .overfeeding.
Cholestasis .- .correct .answer.Cholestasis, .occurring .primarily .in .children, .is .characterized
.by .impaired .biliary .secretion. .Elevated .conjugated .bilirubin .levels .are .the .most .common
.laboratory .manifestation .in .this .population. .
Elevations .of .alkaline .phosphatase, .gamma .glutamyltransferase .and .conjugated .(direct)
.bilirubin .most .likely .represent .cholestasis .or .biliary .obstruction. .Elevated .serum
.conjugated .bilirubin, .typically .defined .as .>2 .mg/dL, .is .considered .a .prime .indicator .of
.cholestasis
Gallbladder .sludge .- .correct .answer.Gallbladder .sludging .or .stones .is .thought .to .result
.from .the .lack .of .enteral .stimulation .in .the .GI .tract .and .occurs .with .long-term .PN .use.
Preferred .site .of .CVC .placement .in .adults .- .correct .answer.subclavian
Mural .thrombus .- .correct .answer.develops .when .fibrin .builds .up .inside .the .vein .which
.may .cause .the .vascular .access .device .to .adhere .to .the .vessel .wall
Fibrin .sheath .- .correct .answer.The .aggregation .of .fibrin .resulting .from .the .presence .of .a
.venous .access .device .in .the .vein .often .develops .as .a .fibrin .layer .(fibrin .sheath) .that .forms
.around .the .outside .of .the .catheter
Fibrin .tail .- .correct .answer.In .some .cases, .the .fibrin .sheath .can .grow .over .the .tip .of .the
.catheter, .or .may .accumulate .exclusively .at .the .distal .tip .of .the .catheter .creating .a ."fibrin
.tail."Cannot .aspirate
Intraluminal .thrombus .- .correct .answer.An .intraluminal .thrombus .occurs .as .fibrin .or .blood
.products .build .up .inside .the .catheter .lumen, .creating .a .partial .or .total .occlusion. .Cannot
.infuse .or .aspirate
Effective .solvent .for .dissolving .calcium .phosphate .- .correct .answer.The .use .of .0.1N
.hydrochloric .acid .has .been .reported .effective .in .clearing .catheters .with .crystalline
.occlusions .because .its .acidic .pH .is .favorable .for .calcium .and .phosphate .solubility.
.Clinicians .should .be .aware, .however, .that .direct .infusion .of .hydrochloric .acid .into .the
.venous .system .can .be .associated .with .fever, .phlebitis, .and .sepsis.
,Effective .solvent .for .dissolving .lipid .residue .- .correct .answer.70 .percent .ethanol .is .the
.most .effective .solvent .to .dissolve .lipid .residue
Decreasing .the .risk .of .metabolic .bone .disease .- .correct .answer.The .most .important
.contributor .to .metabolic .bone .disease .is .a .negative .calcium .balance. .Hypocalcemia
.occurs .as .a .result .of .decreased .calcium .intake .and/or .increased .calcium .urinary
.excretion. .Factors .that .cause .hypercalciuria .include: .excessive .calcium .and .inadequate
.phosphorus .supplementation, .excessive .protein .in .PN .solutions, .cyclic .PN .infusions, .and
.chronic .metabolic .acidosis.
Causes .of .metabolic .alkalosis .with .PN .- .correct .answer.An .elevated .serum .bicarbonate
.level .is .one .of .the .markers .of .metabolic .alkalosis. .Metabolic .alkalosis .may .be .caused .by
.nasogastric .suctioning, .volume .depletion .and .diuretic .use. .In .a .PN .patient, .excess .use .of
.acetate, .which .is .metabolized .to .bicarbonate, .may .precipitate .a .metabolic .alkalosis.
Causes .of .metabolic .acidosis .with .PN .- .correct .answer.Excess .chloride, .diarrhea .and
.acute .renal .failure .(ARF) .are .common .causes .of .metabolic .acidosis.
Normal .pH .- .correct .answer.7.35 .- .7.45`
Normal .PaCO2 .- .correct .answer.35 .- .45mmHg
Normal .serum .bicarbonate .- .correct .answer.23 .- .30mEq/L
Goshung .PICC .- .correct .answer.A .Groshong .PICC .has .a .pressure .sensitive .three-way
.valve .at .the .IV .tip .of .the .catheter .that .prevents .reflux .of .blood .into .the .catheter .which
.should .decrease .the .risk .of .occlusion. .Since .blood .cannot .reflux .into .the .catheter, .the
.Groshong .catheter .need .only .be .flushed .with .saline. .Flushing .with .heparin .is .not
.necessary .to .maintain .patency. .Although .additional .features .of .Groshong .catheters
.include .soft .medical .grade .tubing, .presence .of .antimicrobial .cuff .and .large .lumen .size,
.none .of .these .contribute .to .a .decreased .incidence .of .catheter .occlusion. .Groshong
.catheters .are .not .coated .with .heparin.
Treatment .for .CVAD .occlusion .- .correct .answer.Alteplase .is .the .only .FDA-approved
.thrombolytic .agent .for .CVAD .occlusions.
Management .of .catheter .exit .site .infection .- .correct .answer.Management .of .catheter .exit
.site .infection .includes .culture .of .any .drainage .from .the .catheter .exit .site .in .addition .to
.blood .cultures.Topical .antimicrobial .agent .can .be .used .if .there .is .no .purulence .from .the
.catheter .exit .site .and .no .clinical .signs .of .sepsis. .Systemic .antimicrobial .treatment .is .used
.in .the .presence .of .purulent .drainage .from .the .catheter .exit .site .or .if .topical .treatment .is
.unsuccessful. .The .catheter .should .be .removed .if .systemic .antimicrobial .treatment .fails .or
.if .the .patient .has .clinical .signs .of .sepsis.
, Nonthrombotic .catheter .occlusion .- .correct .answer.Nonthrombotic .catheter .occlusions
.can .result .from .mechanical .obstructions, .drug .or .mineral .precipitates, .or .lipid .deposits.
.Mechanical .obstruction .may .reflect .catheter .migration .or .malposition .that .occurs .during
.insertion .or .use. .Precipitates .that .form .due .to .drug .crystallization, .drug-drug
.incompatibilities, .or .drug-solution .incompatibilities .can .produce .catheter .occlusion.
Thrombotic .catheter .occlusion .- .correct .answer.A .fibrin .sheath, .or .fibrin .sleeve, .is .a
.thrombotic .catheter .occlusion .and .develops .when .fibrin .adheres .to .the .external .surfaces
.of .the .catheter.
Interventions .for .reducing .CVC-related .infections .- .correct .answer.(1) .using .maximal
.barrier .technique .during .catheter .insertion, .(2) .cleansing .insertion .sites .with .2%
.chlorhexidine .preparation, .and .(3) .education .and .training .of .health .care .personnel.
.Administering .antibiotics .prior .to .inserting .central .venous .catheters .has .not .been .shown
.to .be .effective .in .reducing .the .rates .of .central .venous .catheter-related .infections.
Microorganism .causing .CVC-related .blood-stream .infections .- .correct
.answer.Malassezia .furfur .is .classically .associated .with .superficial .infections .of .the .skin
.and .associated .structures. .This .yeast .has .been .reported .as .a .cause .of .catheter-related
.blood .stream .infections. .This .occurs .most .commonly .in .premature .infants .and .patients
.receiving .PN .containing .IVFE. .The .IVFE .presumably .provides .growth .factors .required .for
.replication .of .the .organism. .Appropriate .treatment .of .patients .requires .administration .of
.antifungal .therapy, .discontinuation .of .IVFE, .and .removal .of .the .intravascular .catheter,
.especially .with .nontunneled .catheter .infections.
s/s .of .catheter-related .central .venous .thrombosis .- .correct .answer.Central .venous
.catheters .cause .endothelial .trauma .and .inflammation .which .can .lead .to .venous
.thrombosis. .Inflammation .of .the .vessel .wall .can .cause .pain .and .tenderness .along .the
.course .of .the .vein. .Obstruction .of .blood .flow .may .cause .collateral .vein .congestion .and
.edema .on .the .affected .side. .Arm, .shoulder, .or .neck .swelling, .limb, .jaw, .or .ear .pain, .and
.dilated .collateral .veins .over .the .arm, .neck .or .chest .are .hallmark .symptoms .of .catheter
.related .central .venous .thrombosis ..
Thiamine .repletion .- .correct .answer.Thiamine .is .a .water-soluble .vitamin .and .body .stores
.can .be .easily .depleted .by .malnutrition, .weight .loss .and .chronic .alcoholism. .Dextrose
.infusion .places .additional .demand .on .thiamine .as .it .is .an .essential .coenzyme .in
.carbohydrate .metabolism. .Thiamine .requirements .are .increased .in .patients .with
.malnutrition, .weight .loss .and .chronic .alcoholism, .and .additional .supplementation .(50-100
.mg/day .IV .or .at .least .100 .mg/day .PO .for .5-7 .days) .is .suggested .for .patients .at .risk .for
.deficiency. .Supplementation .with .a .multi-vitamin .and .additional .folic .acid .at .1 .mg/day,
.may .be .indicated.
Treatment .of .hypertonic .hyponatremia .2/2 .hyperglycemia .- .correct .answer.correct
.glucose .levels/underlying .issue