Deck 16: Nutrition in Metabolic and Respiratory Stress

Question 1

To maintain lean tissue, the protein intakes recommended during acute stress are higher than DRI values.

Answer 1

True

Question 2

Nutrition care for patients in acute respiratory failure is aimed at providing a low-fat, high-carbohydrate diet.

Answer 2

False

Question 3

Smoking is the primary risk factor in most cases of COPD.

Answer 3

True

Question 4

The inflammatory process can alter immune cell function in the body.

Question 5

The increase in metabolic rate as a part of the stress response can be attributed to:

A) catecholamines.
B) cortisol.
C) eicosanoids.
D) cytokines.
E) hepcidin.

Question 6

If the reduction in blood flow from inflammation is severe enough to deprive the body's tissues of oxygen and nutrients, SIRS can result.

Question 7

Excessive energy intake in patients with ARDS can worsen respiratory function.

Question 8

The symptoms associated with the initial inflammatory response are collectively called the systemic inflammatory response syndrome.

Question 9

Weight loss and wasting are common in the advanced stages of COPD and may result from hypermetabolism, poor food intake, and the actions of various inflammatory proteins.

Question 10

Recovery from an injury or illness can be hastened by hypermetabolism and positive nitrogen balance.

Question 11

Protein synthesis is inhibited by:

A) cortisol.
B) eicosanoids.
C) mast cells.
D) phagocytes.
E) aldosterone.

Question 12

If stress continues for a long period, growth retardation and illness can occur.

Question 13

A patient with lung disease would most likely prevent or reverse loss of muscle mass by decreasing activity levels and incorporating more rest.

Question 14

The major precursor to eicosanoids in the inflammatory process is:

A) cortisol.
B) arachidonic acid.
C) epinephrine.
D) glucagon.
E) norepinephrine.

Question 15

An excessive response to metabolic stress can worsen illness and lead to death.

Question 16

The high nutrient requirements of acutely stressed patients often require a patient to be fed via the enteral or parenteral route to meet his or her nutritional needs.

Question 17

Underfeeding an acutely stressed patient improves nitrogen balance and decreases lean tissue losses.

Question 18

Patients under 55 years old are several times more likely to develop MODS than are older patients.

Question 19

What compound is produced by white blood cells and participates in the inflammatory process?

A) glucagon
B) catecholamines
C) cytokines
D) cortisol
E) aldosterone

Question 20

During the inflammatory response, mast cells release _____, which causes vasodilation and capillary permeability.

A) erythropoietin
B) cortisol
C) anti-diuretic hormone
D) cytokine
E) histamine

Question 21

In critically ill patients, a high intake of _____ may suppress immune function and increase the risk of developing infections.

A) fat
B) dextrose
C) protein
D) zinc
E) vitamin A

Question 22

Nutrition therapy for management of COPD involves:

A) promoting weight gain.
B) supporting wound healing.
C) improving food intake.
D) relieving chronic cough.
E) decreasing supplemental oxygen needs.

Question 23

A parenteral feeding should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute to prevent hyperglycemia in critically ill patients .

A) 1
B) 2
C) 3
D) 4
E) 5

Question 24

Which amino acid has been shown to have beneficial effects on critically ill patients?

A) leucine
B) glutamine
C) valine
D) isoleucine
E) phenylalanine

Question 25

Emphysema associated with COPD is most often diagnosed by:

A) serial chest x-rays.
B) clinical signs and lung function tests.
C) oxygen saturation readings.
D) 24-hour halter monitoring.
E) culture and sensitivity of mucus samples.

Question 26

Adequate fluid intake will help the person with COPD by:

A) decreasing carbon dioxide output .
B) preventing the secretion of overly thick mucus.
C) aiding in weight loss.
D) improving oxygen consumption.
E) reducing abdominal distention.

Question 27

Excessive kcalorie intake in COPD patients may:

A) interfere with catabolic processes.
B) alter taste perception.
C) interfere with drug therapy.
D) increase gas formation.
E) increase respiratory stress.

Question 28

Which amino acid may have beneficial effects on surgical healing of postoperative patients?

A) tryptophan
B) tyrosine
C) arginine
D) phenylalanine
E) leucine

Question 29

What method was developed for estimating energy needs in a patient with traumatic injuries?

A) Parkland formula
B) Jackson/Pollock method
C) Harris-Benedict equation
D) Lund-Browder formula
E) Ireton-Jones energy equation

Question 30

A 25-year-old woman is critically ill after surviving a motor vehicle accident. The patient is 5'4" and weighs 120 pounds. This patient's energy needs would require how many kcalories for energy?

A) 15-20 kcal/kg body weight per day
B) 22-25 kcal/kg body weight per day
C) 25-30 kcal/kg body weight per day
D) 30-35 kcal/kg body weight per day
E) 38-40 kcal/kg body weight per day

Question 31

Once patients can tolerate oral feedings, what type of diet is often prescribed?

A) high fiber
B) low sodium
C) high-kcalorie, high-protein
D) low fat
E) low carbohydrate

Question 32

Laura is a critically ill patient. She is 5'4" tall and weighs 150 pounds. What are Laura's protein needs?

A) 34-40 g
B) 54-68 g
C) 82-136 g
D) 136-158 g
E) 160-184 g

Question 33

What complication is most closely associated with severe cases of SIRS or sepsis?

A) hypertension
B) fluid retention
C) hypertriglyceridemia
D) poor glucose control
E) intestinal bleeding

Question 34

The protein needs of a non-obese critically ill patient would be:

A) 0.8-1.0 g/kg body weight per day.
B) 1.0-1.2 g/kg body weight per day.
C) 1.2-2.0 g/kg body weight per day.
D) 2.0-2.5 g/kg body weight per day.
E) 2.5-3.0 g/kg body weight per day.

Question 35

What micronutrient plays a role in immunity and wound healing?

A) z inc
B) c holine
C) s elenium
D) v itamin K
E) i ron

Question 36

The most common risk factor associated with development of COPD is:

A) alpha-1 anti-trypsin deficiency.
B) environmental exposure to pollutants.
C) lung cancer.
D) cigarette smoking.
E) cystic fibrosis.

Question 37

A COPD patient who complains of abdominal discomfort and dyspnea may benefit from:

A) small, frequent meals.
B) a low-fat diet.
C) a high-fiber diet.
D) consuming more liquids.
E) increased energy consumption.

Question 38

When caring for a patient who is suffering from acute illness and metabolic stress, how would clinicians best estimate protein and energy needs?

A) Adjust nutrient intakes according to patient responses.
B) Underfeed the patient to minimize tissue loss.
C) Maintain the patient at NPO status to promote bowel rest.
D) Overfeed the patient to prevent hypoglycemia.
E) Increase carbohydrate intake to promote weight gain and appropriate energy use.

Question 39

What describes the immediate care concerns of the clinician during a patient's time of severe stress?

A) e ducating the patient about nutrient needs
B) p roviding psychological counseling
C) d etermining the level of the patient's understanding about his condition
D) p roviding nutrition therapy
E) r estoring fluids and electrolytes

Question 40

In critically ill patients, _____ is used to measure the resting metabolic rate (RMR).

A) skinfold measurement
B) BMI
C) the stress factor equation
D) indirect calorimetry
E) a clinical body weight growth chart

Question 41

Nursing Exam Review Multiple Choice A nurse is treating a patient who is experiencing fluctuations in hormone levels as a result of stress. Based on her understanding of the metabolic effects associated with certain hormones, the nurse knows that aldosterone is responsible for:

A) increasing the patient's metabolic rate.
B) producing glucose from amino acids.
C) reabsorbing sodium in the kidneys.
D) releasing fatty acids from adipose tissue.
E) reabsorbing water in the kidneys.

Question 42

Nursing Exam Review Multiple Choice Mrs. White is in the ICU for complications following surgery. She has been diagnosed with sepsis and is on a ventilator. In order to most accurately estimate her energy needs, the nurse recognizes that the preferred method to use is:

A) the Harris-Benedict equation.
B) the Penn State equation.
C) direct calorimetry.
D) the Mifflin-St. Jeor equation.
E) the permissive protein balance method.

Question 43

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5'2" tall and weighs 115 pounds.
Kati's protein needs are estimated at 1.2 to 2 g/kg of body weight based on her condition. Based on this estimation, her daily protein intake would then be _____ g per day.

A) 36 to 58 g
B) 62 to 104 g
C) 116 to 138 g
D) 154 to 168 g
E) 180 to 200 g

Question 44

Nursing Exam Review Multiple Choice A patient who is on a tube feeding gains nine pounds in three days. The nurse realizes that this may most likely indicate:

A) inadequate nutritional intake.
B) excess protein intake.
C) a fluid imbalance.
D) low levels of vitamin D.
E) refeeding syndrome.

Question 45

The principal infection most often associated with MODS is:

A) pneumonia.
B) urinary tract infection.
C) herpes simplex virus infection.
D) meningitis.
E) hepatitis B infection.

Question 46

In what way does nutrition support play a role in treatment of MODS?

A) s upporting gas exchange
B) p reventing excessive wasting
C) p romoting excretion of waste products
D) m aintaining blood pressure
E) i ncreasing cardiac output

Question 47

The first organ to fail in MODS is often the:

A) lungs.
B) liver.
C) kidneys.
D) heart.
E) brain.

Question 48

Nursing Exam Review Multiple Choice While caring for a patient who has been injured, the nurse recognizes which sign of inflammation that accompanies altered blood flow?

A) h yperglycemia
B) s welling
C) p ale skin
D) h ypotension
E) c onfusion

Question 49

Severe hypercapnia associated with respiratory failure can cause _____ , which interferes with normal functioning of the central nervous system.

A) sepsis
B) SIRS
C) cardiac failure
D) COPD
E) acidosis

Question 50

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5'2" tall and weighs 115 pounds.
If Kati's enteral feeding is not providing adequate energy and protein to meet her nutritional needs, she will experience:

A) a loss of lean tissue.
B) hyperglycemia.
C) pulmonary edema.
D) sepsis.
E) organ failure.

Question 51

A patient who has developed MODS would most likely demonstrate what signs or symptoms associated with liver failure?

A) a bnormal bleeding
B) s epsis
C) a ltered metabolic processes
D) i mpaired gas exchange
E) l ow blood pressure

Question 52

Nursing Exam Review Multiple Choice Mr. Morgan is a critically ill patient in the ICU who is on TPN. The nurse understands that monitoring his _____ can help to determine if he is being overfed.

A) glucose levels
B) cholesterol levels
C) iron levels
D) albumin levels
E) calcium levels

Question 53

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5'2" tall and weighs 115 pounds.
Estimate Kati's energy needs using the Ireton-Jones equation: 1784+ [5 ´x wt (kg)] - [11   ´x age (yr)] + (244   x sex) + (239 x trauma) + (804  x  burn).

A) 2078
B) 2681
C) 2828
D) 3420
E) 3240

Question 54

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5'2" tall and weighs 115 pounds.
The stress of Kati's condition places her at risk of hypermetabolism. What kind of complication is most closely associated with hypermetabolism as a result of stress?

A) wasting
B) fractures
C) kidney failure
D) bone pain
E) pulmonary edema

Question 55

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5'2" tall and weighs 115 pounds.
As a result of the acute-phase inflammatory response, Kati's plasma concentrations of _____ would be expected to decrease.

A) glucose and cholesterol
B) sodium and potassium
C) iron and glucose
D) albumin and iron
E) magnesium and chloride

Question 56

Nursing Exam Review Multiple Choice John has been hospitalized with a severe infection in his foot. The nurse recognizes that increasing his intake of _____ may help to suppress the inflammation.

A) omega-3 fatty acids
B) protein
C) carbohydrate
D) omega 6-fatty acids
E) vitamin D

Question 57

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5'2" tall and weighs 115 pounds.
To decrease the risk of infection, it will be important to keep Kati's _____ under control while she is recovering.

A) serum albumin
B) blood glucose
C) blood pressure
D) serum prealbumin
E) nitrogen

Question 58

Nursing Exam Review Multiple Choice Mr. Jones, a critically ill patient, is 5'9" tall and weighs 176 pounds. The nurse recommends that he receive a minimum of _____ grams of protein daily.

A) 64
B) 80
C) 96
D) 136
E) 240

Question 59

One factor that increases the risk of a patient developing MODS is:

A) age over 40 years.
B) an increased length of hospital stay.
C) uncontrolled blood glucose.
D) obesity.
E) the severity of SIRS infection.

Question 60

Nursing Exam Review Multiple Choice Because the immediate stress response can cause a variety of systemic effects, the nurse should closely monitor her patient's:

A) heart rate, respiratory rate, and blood pressure.
B) appetite, temperature, and weight.
C) pain rating, level of consciousness, and posture.
D) abdominal girth, reflexes, and edema.
E) hearing, vision, and sense of smell.

Question 62

Explain why enteral feedings are preferred over parenteral feedings in patients with ARDS.

Question 63

Describe the symptoms and complications associated with SIRS.

Question 64

Describe the risk factors associated with development of multiple organ dysfunction syndrome (MODS).

Question 65

Explain important goals of nutrition therapy among patients undergoing metabolic stress.

Question 66

Explain the metabolic effects of corticosteroid drugs.

Question 67

Nursing Exam Review Multiple Choice A critically ill patient with ARDS is on a tube feeding and requires a fluid restriction. The nurse understands that an appropriate enteral formula would be a _____ formula.

A) low residue
B) high protein
C) nutrient dense
D) hydrolyzed
E) low fat

Question 68

Nursing Exam Review Multiple Choice Mr. Winslett is a COPD patient who is complaining of poor appetite, abdominal discomfort, and bloating. Which suggestion from the nurse is most appropriate for improving his food intake?

A) "Consume larger meals."
B) "Substitute beans for meat."
C) "Drink a supplement before eating."
D) "Eat smaller, more frequent meals."
E) "Increase fluid intake throughout the day."

Question 69

Nursing Exam Review Multiple Choice Mary is a 59-year-old patient who suffered multiple broken bones in a motor vehicle accident. She weighs 138 pounds. The nurse chooses a protein factor of 1.5 g/kg to estimate her protein needs and calculates that Mary's protein requirements are approximately _____ grams per day.

A) 94
B) 103
C) 121
D) 180
E) 208

Question 70

Nursing Exam Review Multiple Choice Mark is a 23-year-old firefighter who experienced severe burns while fighting a house fire. The nurse recognizes the fact that he may benefit from supplements of _____ to reduce the risk of infection and to counter oxidative stress .

A) zinc, vitamin C, and vitamin E
B) iron, magnesium, and calcium
C) sodium, potassium, and chloride
D) phosphorus, thiamin, and riboflavin
E) calcium, vitamin D, and vitamin K

Question 71

Nursing Exam Review Multiple Choice A patient with ARDS requires mechanical ventilation. The nurse recognizes that fluid accumulation is a potential problem that may make it difficult to assess his:

A) weight.
B) temperature.
C) kcalorie intake.
D) fluid intake.
E) heart rate.