Deck 17: Metabolic Stress

Question 1

Foods allowed on a clear liquid diet include:

A) broth.
B) cream soup.
C) milk.
D) pudding.

Answer 1

A

Question 2

The ideal method for estimating energy needs is:

A) Harris-Benedict equations.
B) 20 to 30 kcal/kg ideal body weight per day.
C) daily weight measurements.
D) indirect calorimetry.

Answer 2

D

Question 3

When a client has the most radical form of total gastrectomy (Billroth II), the stomach is excised and the esophagus is joined to the:

A) ileum.
B) duodenum.
C) jejunum.
D) rectum.

Answer 3

C

Question 4

Before general surgical procedures, oral food and fluids are withheld from patients for at least:

A) 4 to 6 hours.
B) 6 to 8 hours.
C) 8 to 12 hours.
D) 12 to 24 hours.

Question 5

Clients who have undergone radical neck or facial surgery are often fed using:

A) a straw.
B) a nasogastric tube.
C) a percutaneous endoscopic gastrostomy (PEG) tube.
D) parenteral nutrition.

Question 6

The use of a low-residue diet may be recommended preoperatively for clients:

A) scheduled for gastrointestinal surgery.
B) greater than 65 years of age.
C) who are overweight.
D) scheduled for any type of surgery.

Question 7

Immune-enhancing enteral formulas may be enriched with:

A) vitamin C and zinc.
B) omega-3 fatty acids and arginine.
C) essential amino acids and medium-chain triglycerides (MCTs).
D) iron, folic acid, and vitamin B₁₂.

Question 8

During the postoperative period, the primary source of energy should be:

A) protein.
B) carbohydrates.
C) fat.
D) specially developed formulas.

Question 9

In the first few weeks after a gastrectomy, the recommended diet is:

A) parenteral nutrition until the stomach has healed.
B) small, frequent meals that can be easily digested.
C) clear liquids served at room temperature.
D) full liquids served cold.

Question 10

An important function of carbohydrates in the postoperative period is to:

A) contribute to tissue repair.
B) provide a source of vitamins.
C) spare protein for tissue synthesis.
D) protect adipose fat reserves.

Question 11

Foods allowed on a full-liquid diet include:

A) chicken salad.
B) strawberries.
C) chili.
D) pudding.

Question 12

Postsurgical patients should resume oral feedings as soon as possible to:

A) prevent dehydration.
B) prevent permanent damage to the gastrointestinal tract.
C) provide adequate nutrition.
D) support optimal kidney function.

Question 13

Protein is important in the postoperative recovery period for tissue synthesis and:

A) good immune function.
B) maintaining insulin levels.
C) metabolism of antibiotics.
D) sparing glycogen stores.

Question 14

Preoperative or postoperative blood losses may result in a deficiency of:

A) calcium.
B) vitamin
C) iron.
D) zinc.

Question 15

Postoperatively, intravenous (IV) fluids provide:

A) energy and protein.
B) fluids and some energy.
C) fluids, electrolytes, and micronutrients.
D) all nutrient needs.

Question 16

If a client has had surgery of the head, neck, or throat and can only swallow a limited amount of food, his or her oral diet should include:

A) clear liquids only.
B) full liquids only.
C) energy- and protein-dense soft foods.
D) low-residue foods.

Question 17

After surgery, protein intake may be limited if the patient has impaired:

A) kidney function.
B) absorption.
C) pancreatic function.
D) ability to chew.

Question 18

The physiologic basis for symptoms associated with dumping syndrome is that:

A) concentrated hyperosmolar intestinal contents are absorbed too quickly.
B) ingested foods remain in the stomach too long and cause excessive bloating.
C) only the intestinal water is being absorbed, resulting in hemodilution and increased blood volume.
D) concentrated hyperosmolar fluids draw water into the intestine, decreasing blood volume.

Question 19

A good guideline for evaluating fluid balance is:

A) daily weights.
B) serum electrolyte levels.
C) measuring input and output.
D) urine volume and concentration.

Question 20

Food present in the gastrointestinal tract at the time of general surgery will increase the client's risk for:

A) gastrointestinal infection.
B) aspiration or vomiting.
C) postoperative constipation.
D) fluid and electrolyte imbalances.

Question 21

Oral intake is generally adequate in adults who have burns covering less than:

A) 10% of the total body surface area.
B) 15% of the total body surface area.
C) 25% of the total body surface area.
D) 50% of the total body surface area.

Question 22

For patients in the flow phase of metabolic stress, hyperglycemia should be treated by:

A) administration of normal saline without dextrose.
B) use of complex carbohydrates.
C) administration of specialized formulas.
D) use of exogenous insulin.

Question 23

If more than 50% of the small intestine is removed, patients may develop:

A) dumping syndrome.
B) an ileostomy.
C) short-bowel syndrome.
D) anemia.

Question 24

The surgical procedure in which a portion of the colon is attached to an opening in the abdominal wall is called a(n):

A) cholecystectomy.
B) ileostomy.
C) colostomy.
D) jejunostomy.

Question 25

The preferred type of enteral feeding for burn patients is:

A) nasogastric.
B) gastrostomy.
C) nasoenteric.
D) jejunal.

Question 26

In the first 24 to 48 hours after the burn injury, patients with second- or third-degree burns that cover 15% to 20% or more of their total body surface usually require:

A) enteral nutrition.
B) total parenteral nutrition.
C) small frequent meals.
D) IV fluid and electrolytes.

Question 27

During the ebb phase following thermal injury, overall metabolism is:

A) unchanged.
B) low.
C) high.
D) unpredictable.

Question 28

Dietary recommendations for patients with chylous ascites or chylothorax include:

A) replacement of long-chain triglycerides (LCTs) with MCTs.
B) high energy and protein intakes.
C) use of immune-enhancing formulas.
D) normal diet.

Question 29

For patients with burns covering more than 20% of total body surface area, resting energy expenditure (REE) exceeds that calculated using the Harris-Benedict equations by about:

A) 20% to 30%.
B) 30% to 50%.
C) 50% to 60%.
D) 80% to 100%.

Question 30

Nutrients lost in the initial period following a major burn injury are:

A) fluids and electrolytes.
B) electrolytes and protein.
C) protein and fluids.
D) fluids, electrolytes, and protein.

Question 31

The flow phase following thermal injury is characterized by:

A) decreased oxygen consumption.
B) increased nitrogen excretion.
C) decreased insulin production.
D) hypoglycemia.

Question 32

Symptoms of dumping syndrome are most likely to occur after patients consume:

A) protein.
B) fat.
C) simple carbohydrates.
D) complex carbohydrates.

Question 33

Nutritional strategies that are helpful for management of dumping syndrome include:

A) drinking iced beverages with meals.
B) limiting fluids to once a day.
C) avoiding caffeinated or carbonated beverages.
D) offering fluids between rather than with meals.

Question 34

The recommended diet for patients with dumping syndrome is low in:

A) sugar.
B) fat.
C) protein.
D) sodium.

Question 35

The name of the surgical procedure in which the ileum is attached to an opening in the abdominal wall is called a(n):

A) colostomy.
B) ileostomy.
C) jejunostomy.
D) cholecystectomy.

Question 36

The recommended diet for most patients with ostomies is:

A) normal.
B) high protein.
C) low fiber.
D) soft.

Question 37

Gastric bypass is recommended only for patients who need to lose more than:

A) 20 lb.
B) 50 lb.
C) 100 lb.
D) 150 lb.

Question 38

The IV solution administered during the initial stage of a severe burn injury to prevent hypovolemia is:

A) lactated Ringer's.
B) 5% dextrose.
C) normal saline.
D) 10% dextrose.

Question 39

Fat intake in patients who have experienced burns or multiple trauma should be:

A) 5% to 10% of total kilocalories (kcalories or kcal).
B) 12% to 15% of total kilocalories (kcalories or kcal).
C) 15% to 18% of total kilocalories (kcalories or kcal).
D) 20% to 30% of total kilocalories (kcalories or kcal).

Question 40

A burn that causes reddening and blistering with cell death in the dermis is classified as a:

A) first-degree burn.
B) second-degree burn.
C) third-degree burn.
D) fourth-degree burn.

Question 41

Conditionally essential amino acids include:

A) L-lysine and L-threonine.
B) L-arginine and L-glutamine.
C) L-cysteine and L-methionine.
D) L-phenylalanine and L-tyramine.

Question 42

After extensive surgery or burns, protein needs are usually:

A) 1.0 to 1.2 g/kg body weight per day.
B) 1.2 to 1.5 g/kg body weight per day.
C) 1.5 to 2.0 g/kg body weight per day.
D) 2.0 to 3.0 g/kg body weight per day.

Question 43

Omega-3 fatty acids may be important during periods of metabolic stress because they:

A) spare amino acids for tissue repair.
B) blunt the body's metabolic response to stress.
C) enhance immune function and reduce inflammation.
D) help stimulate appetite so that patients achieve adequate oral intake.