Deck 22: Metabolic and Respiratory Stress

Question 1

Which of the following is the precursor for the eicosanoids?

A)Amino acids
B)Fatty acids
C)Thiamin
D)Vitamin D

Answer 1

B

Question 2

The metabolic effects of hormones released during the stress response include which of the following?

A)Glycogenesis
B)Gluconeogenesis
C)Lipogenesis
D)Protein synthesis

Answer 2

B

Question 3

Which of the following hormones promote glucose production from amino acids during severe stress?

A)Aldosterone, glucagon, and norepinephrine
B)Cortisol, insulin, and epinephrine
C)Norepinephrine, cortisol, and glucagon
D)Epinephrine, aldosterone, and insulin

Answer 3

C

Question 4

What is the significance of the hormones released during the stress response?

A)Their actions are opposite those of insulin.
B)Their actions are similar to those of insulin.
C)They promote the release of nutrients from storage.
D)a and c
E)b and c

Question 5

Betty is a 45-year-old woman who has recently been involved in an automobile accident.Her injuries include a broken leg and two broken ribs.What clinical finding would you expect for this patient?

A)Hyperglycemia
B)Elevated cortisol levels
C)Increased fluid and sodium retention
D)All of the above

Question 6

Louis is a 35- year-old man who has broken his arm and left leg in an automobile accident.In response to his injuries, what hormone-related changes do you expect Louis will experience?

A)Increase in metabolic rate
B)Increase in water retention
C)Decrease in cortisol production
D)a and b
E)b and c

Question 7

Which of the following hormones increase(s) water reabsorption by the kidneys?

A)Antidiuretic hormone
B)Aldosterone
C)a and b
D)None of the above

Question 8

As a result of immune and inflammatory responses to stress, all of the following changes occur except

A)swelling at the injury site.
B)reduced respiratory rate.
C)heat from the influx of warm arterial blood.
D)pain at the injury site.

Question 9

Ryan takes ibuprofen to decrease the pain and swelling in his knee due to an injury in a basketball game.What is the action of the ibuprofen in decreasing the swelling?

A)Assists with the activities of antibodies
B)Reduces the effects of histamine
C)Blocks the synthesis of eicosanoids
D)Regulates immune cell activity

Question 10

Which of the following hormones promote glycogen breakdown?

A)Catecholamines and antidiuretic hormone
B)Catecholamines and glucagon
C)Cortisol and aldosterone
D)Aldosterone and catecholamines

Question 11

After a patient sustains trauma from a car accident, his heart rate, respiratory rate, and blood pressure increase.What is happening?

A)Respiratory stress
B)Metabolic stress
C)Acute-phase response
D)Bacterial translocation

Question 12

A disruption to the body's chemical environment that threatens its normal and healthy functioning is called

A)metabolic stress.
B)severe stress.
C)physiological stress.
D)none of the above

Question 13

Effects of prolonged elevated cortisol levels include:

A)impaired wound healing.
B)increased protein synthesis.
C)increased risk of hypoglycemia.
D)improved immune response.

Question 14

Which of the following is an example of a condition that cannot lead to metabolic stress?

A)Deep wounds
B)Burns
C)Infection
D)Hypothyroidism

Question 15

What is derived from omega-6 fatty acids?

A)Cytokines
B)Eicosanoids
C)Histamines
D)Complementary proteins

Question 16

Metabolic stress results in a decrease in _____.

A)blood pressure
B)heart rate
C)blood glucose
D)growth

Question 17

Ryan's knee was injured in a basketball game.When he gets home he notices swelling, redness, heat and pain in his knee.What is causing the redness?

A)Accumulation of fluid at the site of the injury
B)Dilation of small blood vessels in the injured area
C)Influx of warm arterial blood
D)Edema within the damaged tissues

Question 18

Randall is a 54-year-old man who has recently been involved in an accident.His injuries include multiple open wounds and two broken ribs.Inflammatory responses at the injury site would include all of the following except

A)accumulation of fluid.
B)dilation of small blood vessels.
C)decreased capillary permeability.
D)increased flow of immune factors to the site.

Question 19

In response to metabolic and respiratory stress the body experiences

A)hypometabolism.
B)breakdown of muscle mass.
C)a decrease in carbon dioxide in the blood.
D)only minor complications.

Question 20

Cytokines are proteins that help regulate _____ development and activity.

A)immune system
B)inflammatory
C)hormonal
D)GI tract

Question 21

Fish oils are rich in

A)omega-3 fatty acids.
B)omega-6 fatty acids.
C)linolenic acids.
D)stearic acid.

Question 22

Timothy is a studying to be a physician.He should expect C-reactive protein to be elevated in patients with:

A)cardiovascular disease.
B)diabetes.
C)the acute-phase response.
D)all of the above

Question 23

Brenda has been diagnosed with sepsis.What is a quick method to determine her energy needs?

A)15-20 kcal/kg
B)20-25 kcal/kg
C)25-30 kcal/kg
D)30-35 kcal/kg

Question 24

A whole-body response to inflammation that persists for more than a few days and remains unresolved is called

A)systemic inflammatory response syndrome.
B)the stress response.
C)the immune response.
D)multiple organ dysfunction syndrome.

Question 25

Which of the following can raise the energy needs of a critically ill patient?

A)Being bedridden
B)Mechanical ventilation
C)Wasting
D)Electrolyte imbalances

Question 26

During metabolic stress, which of the following metabolic changes would be expected?

A)Hypoglycemia
B)Hypometabolism
C)Negative nitrogen balance
D)a and c

Question 27

What is a dietary change that can help to suppress inflammation?

A)Increase intake of fish oils rich in omega-3 fatty acids
B)Increase intake of vegetable oils rich in omega-6 fatty acids
C)Increase intake of vitamin C
D)Increase intake of zinc

Question 28

_____ is the change in body chemistry resulting from infection, inflammation, or injury; it is characterized by alterations in plasma proteins.

A)The inflammatory response
B)Systemic inflammatory response syndrome
C)The acute-phase response
D)Bacterial translocation

Question 29

Which of the following is not among the principal nutritional goals for treating acute stress?

A)Preserve lean tissue content
B)Maintain immune defenses
C)Promote healing
D)Reduce inflammation

Question 30

Which of the following is not characteristic of shock?

A)Reduced blood pressure
B)Rapid heart rate
C)Decreased respiration
D)Muscle weakness

Question 31

Which of these statements is false?

A)The Ireton-Jones equation is considered to be inaccurate when used with obese patients.
B)The amounts of protein and energy to provide during acute illness are controversial and still under investigation.
C)Energy needs of acutely stressed patients are often estimated by multiplying the RMR by a stress factor appropriate to the condition.
D)Protein recommendations for stressed patients are higher than the DRI.

Question 32

Why is the assessment of nutritional needs during acute stress not always straightforward?

A)Equations for estimating energy needs of individuals experiencing stress have not been developed.
B)Laboratory data may reflect the metabolic alterations of illness rather than the person's nutritional status.
C)Hypoglycemia can be common.
D)Fluid retention may obscure weight gain in the patient.

Question 33

The Ireton-Jones equation can be used to

A)estimate fat expenditure.
B)estimate basal energy expenditure.
C)estimate protein requirements.
D)estimate fat requirements.

Question 34

The immediate medical concerns during severe stress are the:

A)restoration of lost fluids and electrolytes.
B)correction of nutrient deficiencies.
C)removal of underlying stressors.
D)a and c
E)b and c

Question 35

Which of the following symptoms is not characteristic of sepsis?

A)Elevated heart rate
B)Elevated respiratory rate
C)Elevated red blood cell counts
D)Elevated body temperature

Question 36

Complications that result from refeeding syndrome include

A)hyperglycemia.
B)translocation and hypermetabolism.
C)negative nitrogen balance.
D)all of the above

Question 37

Shock is initiated by a sudden drop in

A)fluid retention.
B)blood flow.
C)heart rate.
D)respiratory rate.

Question 38

The initial task for the health care team for a client under major stress is to

A)institute total parenteral nutrition to prevent negative nitrogen balance.
B)place a nasogastric tube to begin enteral nutrition.
C)restore fluid and electrolyte balance.
D)determine calorie needs via indirect calorimetry.

Question 39

An estimate of the kcalorie needs of a 70-kg man who has sepsis would be

A)1525-1700 kcalories.
B)1750-2100 kcalories.
C)2450-2800 kcalories.
D)2950-3175 kcalories.

Question 40

The complication that results when adequate nutrition is reintroduced rapidly is

A)hypotension.
B)refeeding syndrome.
C)ketoacidosis.
D)tachycardia.

Question 41

Which of these statements is true?

A)For the vast majority of critically ill patients, nutrient needs are easily met through oral intake of a regular diet.
B)Current research studies support that in the stressed patient, parenteral nutrition should not be used in combination with enteral nutrition.
C)A high-kcalorie, high-protein diet is inappropriate for patients recovering from acute stress because of the risk of refeeding syndrome.
D)Enteral formulas developed specifically for promotion of wound healing have high nutrient density and may contain extra zinc, vitamin A, arginine, or glutamine.

Question 42

Which of the following micronutrients are important for tissue repair?

A)Thiamin and riboflavin
B)Folic acid and pyridoxine
C)Vitamin C and zinc
D)Iron and magnesium

Question 43

Which of these statements is false?

A)High-energy enteral supplements are especially useful for COPD patients because they reduce satiety and enhance appetite.
B)Clinical studies have not confirmed that low-carbohydrate formulas reduce respiratory stress in patients with COPD.
C)Some pulmonary enteral formulas have a different macronutrient distribution than standard formulas, with more energy from fat and less from carbohydrate.
D)The ratio of carbon dioxide production to oxygen consumption in cells is lower when fat is consumed than when carbohydrate is consumed.

Question 44

Which of the following can cause respiratory failure?

A)An obstruction of the airway
B)Aspiration of stomach contents
C)Severe trauma or infection
D)All of the above

Question 45

Burn size in adults is often estimated by dividing the body into 11 parts, each part representing about _____ of the total body surface area (TBSA).

A)9%
B)12%
C)15%
D)19%

Question 46

Maggie, newly diagnosed with COPD, is experiencing a loss of appetite.All of the following, related to her diagnosis of COPD, could explain a decrease in Maggie's appetite except:

A)medications.
B)change in chewing ability.
C)diaphragm changes.
D)dyspnea.

Question 47

Barbara is an overweight 64-year-old woman diagnosed with COPD.Which of the following is true?

A)She should not lose weight, as COPD causes wasting.
B)Barbara should not exercise, as her lungs will weaken further.
C)Barbara will benefit from weight loss to decrease respiratory strain.
D)She should consume a high-kcalorie, high-protein diet.

Question 48

Consequences of respiratory failure include all of the following except:

A)hypoxemia.
B)hypercapnia.
C)hyperoxemia.
D)hypoxia.

Question 49

Which classification of burns involves both the epidermis and dermis; are wet, red and blistery; and are extremely painful because the nerve endings are exposed?

A)1st degree
B)2nd degree
C)3rd degree
D)4th degree

Question 50

What are the current findings of research on glutamine supplementation?

A)It may increase the number of infections
B)It may reverse suppressed catecholamine release
C)It may reduce mortality rates in critically ill patients
D)All of the above

Question 51

Dave has 2nd degree burns on his back torso, left arm, and left leg.This represents about _____% of his total body surface area (TBSA).

A)27
B)36
C)45
D)72

Question 52

Which of the following are nonessential amino acids that are sometimes supplemented in patients undergoing metabolic stress?

A)Aspartic acid and arginine
B)Arginine and glutamine
C)Glycine and glutamine
D)Alanine and glycine

Question 53

Maggie has been diagnosed with COPD.Which of the following might her physician advise her to do?

A)Quit smoking
B)Get influenza and pneumonia vaccinations
C)Utilize bronchodilators
D)Start an exercise training program
E)All of the above

Question 54

Risk factors for the development of COPD do not include which of the following?

A)Elevated serum alpha-1 antitrypsin
B)Occupational exposure to dusts or chemicals
C)Respiratory infections
D)Genetic susceptibility

Question 55

Maggie, newly diagnosed with COPD, might benefit from which of the following recommendations to help her increase her food intake?

A)Eat large meals
B)Consume liquids with meals rather than between meals
C)Eat quickly
D)Use oxygen at meal times

Question 56

For critically ill patients, _____ provide the majority of energy.

A)carbohydrate and protein
B)protein and fat
C)fat and carbohydrate
D)fiber and fat

Question 57

Protein intake should average _____ percent of total calories for clients with burns greater than 10% TBSA.

A)10
B)15
C)25
D)30

Question 58

Although specific requirements have not been determined, acutely stressed patients may have increased micronutrient needs for all of the following except:

A)zinc.
B)vitamin A.
C)vitamin D.
D)selenium.

Question 59

During the immediate post-burn period, the treatment of an extensive burn focuses on

A)calculating the protein loss.
B)providing IV dextrose for caloric support.
C)replacing lost fluids and electrolytes.
D)providing supplemental lipids.

Question 60

The objectives of nutrition care for burns include all of the following except:

A)achieving nitrogen balance.
B)minimizing tissue loss.
C)maintaining immune defenses.
D)ensuring adequate fluid output.

Question 61

The registered dietitian is completing her initial assessment for Mr.Delgado.When estimating his energy needs she selects _____ for his stress factor.

A)1.7
B)1.8
C)1.9
D)2.0

Question 62

Margaret is prescribed _____ to improve airflow.

A)bronchodilators
B)corticosteroids
C)oxygen
D)an influenza vaccine

Question 63

The physician makes several recommendations for Margaret.Which of the following would not be among these recommendations?

A)High-energy supplements
B)High-kcalorie/high-protein diet
C)Exercise
D)Smoking

Question 64

Organ failure seems to occur sequentially and often follows this similar pattern among patients:

A)first the kidneys, followed by the lungs, and finally the liver or heart.
B)first the liver, followed by the lungs, and finally the kidneys or heart.
C)first the lungs, followed by the liver, and finally the kidneys, GI tract, or heart.
D)first the lungs, followed by the kidneys or GI tract, and finally the liver.

Question 65

Which of the following is true regarding patients with diseases of the respiratory system?

A)All patients need to increase fluids to decrease mucus secretions
B)Most patients need to be on a fluid restriction to prevent edema in lung tissue
C)Pulmonary formulas are the best to meet fluid needs
D)Diuretic therapy is sometimes employed and may cause dehydration

Question 66

To decrease the risk of aspiration in patients with respiratory failure who need nutrition support:

A)utilize gastric feeding.
B)utilize intestinal feeding.
C)decrease the amount of free water in the tube feeding.
D)select a formula enriched with vitamins A, C, and E.

Question 67

Blood transfusions might cause which of the following to occur?

A)Acute lung injury
B)Allergic reactions
C)White blood cell hemolysis
D)a and b
E)a, b, and c

Question 68

Mr.Ferell has ARDS.His nurse notices an increase in body weight and edema.The dietitian is consulted.She recommends:

A)a change to parenteral nutrition support.
B)a change to a nutrient-dense formula.
C)that they continue the current nutrition care plan.
D)a change to bolus feedings.

Question 69

Many of the medications used to treat COPD can cause gastrointestinal effects such as:

A)reflux.
B)ulcers.
C)diarrhea.
D)constipation.

Question 70

Ms.Caba is on a mechanical ventilator with acute ling injuries.To decrease inflammation and promote healing, the registered dietitian recommends:

A)starting parenteral nutrition.
B)changing the enteral formula to one fortified with omega-3 fatty acids and antioxidants.
C)beginning a nutrient-dense formula.
D)using an isotonic formula.

Question 71

Multiple organ failure is most frequently associated with which organ(s)?

A)Lungs
B)Liver
C)Kidneys
D)a and b
E)a, b, and c

Question 72

Which symptom is associated with systemic inflammatory response syndrome (SIRS)?

A)Fever
B)Reduced heart and respiratory rates
C)Abnormal red blood cell counts
D)Impaired inflammatory response

Question 73

Margaret is diagnosed with COPD.What is the primary cause?

A)Osteoporosis
B)Bronchitis
C)Emphysema
D)Sinusitis

Question 74

The nurse orders a nutrition consult due to Joseph's poor intake.All of the following are likely contributing to his low intake, except for:

A)pain.
B)sedation.
C)feeding problems.
D)positive nitrogen balance.

Question 75

Having burns increases Joseph's risk for all of the following except:

A)infection.
B)intestinal ileus or gastrointestinal malfunction.
C)bronchitis.
D)dehydration.
Margaret Chen is a 73-year-old widow and mother of 3 adult children.She visits her physician due to decreased appetite, lethargy, weight loss, and a productive cough for the past 2 weeks.Her past medical history includes osteoporosis, sinusitis, respiratory infections, and smoking.

Question 76

In the treatment of respiratory failure, medications may be needed to:

A)treat infections.
B)keep airways open.
C)decrease fluid output.
D)a and b
E)b and c

Question 77

All of the following may decrease Margaret's appetite except for:

A)taste perception changes.
B)dyspnea.
C)depression.
D)corticosteroids.

Question 78

Energy needs range from _____ kilocalories per kilogram for patients with respiratory failure due to the risk of excess carbon dioxide production.

A)15-20
B)20-25
C)25-35
D)30-40

Question 79

How are MODS and sepsis related?

A)Sepsis is present in all cases of multiple organ failure.
B)Sepsis can progress to shock, which can then initiate organ failure.
C)When infection is present in a patient with MODS, it can be assumed that the infection served to trigger MODS.
D)The symptoms of sepsis are identical to those of MODS.