Deck 22: Metabolic Stress and the Critically Ill

Question 1

If a patient in the ICU experiences dysfunction of 2 or more organs whereby homeostasis is not maintained, this complication is termed:

A)SIRS.
B)septic shock.
C)MODS.
D)CARS.

Answer 1

C

Question 2

Generally speaking, patients who are under metabolic stress will have _____ caloric and _____ protein needs

A)increased, decreased
B)increased, increased
C)decreased, increased
D)decreased, decreased

Answer 2

B

Question 3

Which of the following statements is true about patients with burns?

A)They are at high nutritional risk.
B)They may be at high nutritional risk.
C)Nutritional risk is dependent on comorbidities.
D)Nutritional risk is based on the degree of the burn.

Answer 3

A

Question 4

During the ebb phase, what is the etiology of the subsequent decrease in cardiac and urinary output?

A)decreased respiratory rate
B)decreased consciousness
C)hypovolemia
D)hypermetabolism

Question 5

For a patient who has undergone major surgery, had complications, and is now in complete recovery, you would expect a gradual rise in which laboratory value?

A)albumin
B)glucose
C)C-reactive protein
D)BUN

Question 6

The transition from the ebb phase to the flow phase starts with:

A)the patient becoming hemodynamically stable.
B)acute resuscitation.
C)ceasing of hemorrhaging.
D)anabolism.

Question 7

The period 4 hours post trauma where the patient is in shock and there is hypoperfusion to the tissues is called:

A)flow.
B)recovery.
C)resolution.
D)ebb.

Question 8

Nitrogen losses per day are highest in which type of patient?

A)major surgery
B)burn
C)sepsis
D)MVA

Question 9

Initial treatment of a major burn focuses on:

A)starting enteral feedings.
B)maintaining normal blood pressure.
C)calculating BSA.
D)fluid resuscitation.

Question 10

The body normally uses _____ as a fuel source, in contrast to periods of stress, when the body utilizes _____ as a major fuel source

A)carbohydrate, protein
B)a mixture of macronutrients, protein
C)protein, a mixture of macronutrients
D)fat, protein

Question 11

Free fatty acid mobilization during metabolic stress can be attributed to all of the following hormones except:

A)cortisol
B)epinephrine
C)norepinephrine
D)insulin

Question 12

Which of the following statements is true about a critically ill patient who is post stress injury?

A)This patient will have low levels of glucagon circulating.
B)Alanine and glutamic acid needs are decreased.
C)Body fat is the primary substrate for gluconeogenesis.
D)This patient would benefit from tight glycemic control to reduce catabolism.

Question 13

Which of the following is not a measure of severity of illness?

A)APACHE
B)GCS
C)SGA
D)ISS

Question 14

The cascade of events that occur with sepsis involves an initial release of TNF and IL, a(n) _____ response, and then a shift to a(n) _____ response

A)inflammatory, anti-inflammatory
B)cytokine, inflammatory
C)anti-inflammatory, inflammatory
D)immune, anti-inflammatory

Question 15

All of the following are examples of metabolic stress except:

A)hypoxia.
B)fasting.
C)closed head injury.
D)MVA.

Question 16

You would observe low levels of which protein in a stressed patient?

A)C-reactive protein
B)ceruloplasmin
C)prealbumin
D)UUN

Question 17

The nutritional needs of a post-op CABG patient would include:

A)high amounts of vitamin C for wounds.
B)kcalorie restriction.
C)moderate fluids.
D)increased protein.

Question 18

All of the following contribute to hyperglycemia during the stress response except:

A)insulin.
B)glucagon.
C)cortisol.
D)insulin resistance.

Question 19

The most important difference between starvation and stress is:

A)adaptation.
B)recovery.
C)intake.
D)injury.

Question 20

Elevated acute-phase proteins, increased WBC, and increased heart rate and respirations are initial major signs of which complication?

A)SIRS
B)septic shock
C)MODS
D)CARS

Question 21

Case Study Multiple Choice
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2 WT: 124# UBW: 118#
Alb: 2.0
If her BMI was >30, what would you estimate her protein needs to be?

A)112 g
B)90 g
C)109 g
D)150 g

Question 22

A patient has undergone a colectomy for colon cancer The MD has kept the patient NPO for 4 days post op What is the likely cause of this order?

A)bowel rest
B)optimal bowel adaptation
C)patient reports pain
D)post-operative ileus

Question 23

BM is a 35 yo firefighter who has sustained major burns and smoke inhalation.He is taken to the burn unit and a consult with the registered dietitian has been ordered.
HT: 6'1" WT: 180#
What is the best way to estimate his caloric needs?

A)Harris-Benedict equation
B)Curreri equation
C)Fick equation
D)indirect calorimetry

Question 24

BM is a 35 yo firefighter who has sustained major burns and smoke inhalation.He is taken to the burn unit and a consult with the registered dietitian has been ordered.
HT: 6'1" WT: 180#
What are his protein requirements?

A)0.8-1.0 g/kg of body weight
B)1.0-1.2 g/kg of body weight
C)1.0-1.5 g/kg of body weight
D)1.5-2.0 g/kg of body weight

Question 25

Which of the following has the most profound impact on nutritional status in a burn patient?

A)fluid resuscitation
B)skin grafting
C)major protein loss at injury
D)low albumin

Question 26

BM is a 35 yo firefighter who has sustained major burns and smoke inhalation.He is taken to the burn unit and a consult with the registered dietitian has been ordered.
HT: 6'1" WT: 180#
What would be the best way to feed him?

A)PN
B)small bowel feeding tube
C)gastric feeding tube
D)keep him NPO

Question 27

Case Study Multiple Choice
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2 WT: 124# UBW: 118#
Alb: 2.0
If DF's usual body weight was much greater, so that her BMI was >30, what would her estimated caloric needs be?

A)1410-1750 kcal
B)1000-1115 kcal
C)1240-1409 kcal
D)1200-1364 kcal

Question 28

Case Study Multiple Choice
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2 WT: 124# UBW: 118#
Alb: 2.0
What is the likely cause of her change in weight?

A)fluid shifts
B)inaccurate measure
C)unhealthy eating habits
D)change in energy expenditure

Question 29

Case Study Multiple Choice
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2 WT: 124# UBW: 118#
Alb: 2.0
Her albumin is low due to?

A)malnutrition
B)acute-phase response
C)dehydration
D)her albumin is not low

Question 30

BM is a 35 yo firefighter who has sustained major burns and smoke inhalation.He is taken to the burn unit and a consult with the registered dietitian has been ordered.
HT: 6'1" WT: 180#
The dietitian would supplement with what amino acid to stimulate the GI tract?

A)alanine
B)arginine
C)glutamine
D)lysine

Question 31

Prescription treatments for burn patients include all of the following except:

A)vitamin C and Zn.
B)megace.
C)oxandrolone.
D)silver nitrate.

Question 32

Case Study Multiple Choice
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2 WT: 124# UBW: 118#
Alb: 2.0
To ensure that her nutrition support is providing enough kcalories and protein, what would you recommend?

A)nitrogen balance study
B)CRP
C)albumin
D)recalculating her needs

Question 33

The nutritional goal for surgical patients is:

A)to resume optimal intake.
B)to achieve normal albumin levels.
C)pain management.
D)normal bowel sounds.

Question 34

Regarding enteral nutrition and the burn patient, which of the following statements is true?

A)Small bowel feedings may be favored due to the presence of ileus.
B)If the patient can tolerate an oral diet, EN is not indicated.
C)Formula should be initiated at a very low rate due to hemodynamic instability.
D)There are no benefits to early initiation of EN.

Question 35

Case Study Multiple Choice
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2 WT: 124# UBW: 118#
Alb: 2.0
Which of the following equations would best estimate her caloric needs?

A)Harris-Benedict
B)Curreri
C)Fick
D)Penn State

Question 36

BM is a 35 yo firefighter who has sustained major burns and smoke inhalation.He is taken to the burn unit and a consult with the registered dietitian has been ordered.
HT: 6'1" WT: 180#
What medication should the registered dietitian recommend as part of her plan?

A)diuretics
B)oxandrolone
C)megace
D)vitamin A

Question 37

BM is a 35 yo firefighter who has sustained major burns and smoke inhalation.He is taken to the burn unit and a consult with the registered dietitian has been ordered.
HT: 6'1" WT: 180#
The dietitian should look for a formula that contains which of the following to induce an anti-inflammatory response?

A)omega-3 fatty acids
B)omega-6 fatty acids
C)arginine
D)probiotics