Deck 22: Metabolic and Respiratory Stress

Question 1

In response to metabolic and respiratory stress, the body experiences ____.

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

Answer 1

B

Question 2

What effect does an increase in the release of catecholamines have on the body?

A)sodium excretion from the kidneys
B)glycogen breakdown in the liver
C)storage of fatty acids in the adipose cells
D)water reabsorption in the kidneys

Answer 2

B

Question 3

Effects of prolonged elevated cortisol levels include ____.

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

Answer 3

A

Question 4

Which substance is the precursor for the eicosanoids?

A)amino acids
B)fatty acids
C)thiamin
D)vitamin D

Question 5

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)the release of chemical mediators
D)edema within the damaged tissues

Question 6

Which hormone(s)is/are referred to as the "fight-or-flight" hormone(s)?

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

Question 7

Long-term use of pharmaceutical forms of cortisol (cortisone, prednisone)results in ____.

A)thickening of the skin
B)dehydration
C)hypothyroidism
D)early osteoporosis

Question 8

The complication that results when adequate nutrition is reintroduced rapidly is ____.

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

Question 9

Chemical mediators that control the inflammatory process are released from ____.

A)the central nervous system
B)damaged tissues
C)the adrenal glands
D)adipose tissue

Question 10

Which substance is an acute-phase protein?

A)glucagon
B)hepcidin
C)aldosterone
D)eicosanoids

Question 11

Complications that result from refeeding syndrome include ____.

A)hyperglycemia
B)weight gain
C)hypoxemia
D)hypovolemia

Question 12

What is a function of C-reactive protein?

A)regulating blood pressure
B)regulating iron metabolism
C)producing and releasing histamine
D)binding dead or dying cells to activate certain immune responses

Question 13

The accumulation of pus is known as ____.

A)erysipelas
B)impetigo
C)an abscess
D)cellulitis

Question 14

Shock is characterized by ____.

A)increased blood pressure
B)decreased heart rate
C)increased oxygenation
D)increased respiratory rate

Question 15

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

A)metabolic
B)severe
C)physiological
D)dysfunctional

Question 16

What is a metabolic effect of hormones released during the stress response?

A)glycogenesis
B)gluconeogenesis
C)lipogenesis
D)protein synthesis

Question 17

When determining resting metabolic rate, a patient's energy needs would generally be increased by which condition?

A)receiving intravenous fluids
B)having open wounds
C)being bedridden
D)having a nasogastric tube

Question 18

Which hormones promote glycogen breakdown?

A)catecholamines and antidiuretic hormone
B)catecholamines and glucagon
C)cortisol and aldosterone
D)aldosterone and catecholamines

Question 19

The inflammatory response begins with ____.

A)removal of cellular debris
B)dilation of arterioles and capillaries
C)destruction of microorganisms
D)release of inflammatory mediators

Question 20

Cytokines are proteins that help regulate ____ development and activity.

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

Question 21

What metabolic effect is most commonly seen with inhaled corticosteroids?

A)altered taste sensation
B)hypokalemia
C)hyperphosphatemia
D)low bone density

Question 22

Which classification of burns involves both the epidermis and dermis and is characterized by a wet, red, and blistery appearance?

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

Question 23

Brandon is critically ill and is in the ICU. How many kcalories can be factored to determine Brandon's daily energy needs?

A)15-20 kcal/kg body weight
B)25-30 kcal/kg body weight
C)30-35 kcal/kg body weight
D)35-38 kcal/kg body weight

Question 24

When parenteral nutrition is necessary for critically ill patients, dextrose is limited to ____ milligrams per kilogram of body weight per minute to prevent hyperglycemia.

A)3
B)5
C)10
D)15

Question 25

How many grams of protein would a 120-lb. woman require after major physiological stress?

A)65 - 109 grams
B)82 - 109 grams
C)156 - 173 grams
D)144 - 240 grams

Question 26

What percentage of persons with COPD is affected by malnutrition?

A)20
B)40
C)60
D)80

Question 27

Which classification of burns destroys both the epidermis and dermis and may also damage underlying tissues?

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

Question 28

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

A)eating large meals
B)consuming liquids with meals rather than between meals
C)eating quickly
D)using oxygen at meal times

Question 29

Which condition is characterized by persistent inflammation and excessive secretions of mucus in the main airways of the lungs?

A)asthma
B)chronic bronchitis
C)emphysema
D)pneumonia

Question 30

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

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

Question 31

Shortness of breath is also called ____.

A)cyanosis
B)hypercapnia
C)dyspnea
D)hypoxia

Question 32

An estimate of the energy needs of a 70-kg man who is critically ill would be ____ kcalories.

A)1050 to 1400
B)1750 to 2100
C)2450 to 2800
D)3150 to 3500

Question 33

For acutely ill patients with a functional GI tract, enteral feedings started in the first ____ hours after hospitalizations are associated with fewer complications and shorter hospital stays.

A)12-24
B)24-48
C)48-72
D)72-96

Question 34

Which substances 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 35

What best describes why weight loss and malnutrition occurs in the presence of chronic respiratory diseases?

A)Damaged lung tissues use more vitamins and minerals.
B)Excessive carbon dioxide in the blood causes a person to sleep more.
C)Labored breathing requires more energy.
D)Hypoxemia causes the body to excrete excess glycogen.

Question 36

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

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

Question 37

Patients with ARDS may require ____ grams of protein per kilogram body weight daily.

A)0.5 to 1.0
B)1.0 to 1.5
C)1.5  to  2.0
D)2.0  to  2.5

Question 38

The primary risk factor for COPD is ____.

A)smoking
B)vehicle exhaust
C)genetic factors
D)pollution from coal-fired power plants

Question 39

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

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

Question 40

What is the suggested kcalorie intake for hypocaloric feedings for obese patients who are critically ill?

A)5-8 kcal/kg actual body weight
B)8-10 kcal/kg actual body weight
C)11-14 kcal/kg actual body weight
D)15-18 kcal/kg actual body weight

Question 41

A patient with respiratory failure and fluid restrictions would require nutrient-dense formulas of ____ kcal/mL.

A)0.5 to 1.0
B)1.0 to 1.2
C)1.2 to 1.5
D)1.5 to 2.0

Question 42

What effects are most commonly seen when MODS causes lung failure?

A)hemoptysis
B)poor gas exchange
C)chronic cough
D)increased oxygen saturations

Question 43

Multiple organ dysfunction syndrome most often affects the kidneys, lungs, and ____.

A)brain
B)heart
C)liver
D)stomach

Question 44

Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit)with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area). What is the main nutritional goal for Joseph?

A)Increase intake to 75 percent of meals.
B)Increase arginine production.
C)Increase arginine intake.
D)Achieve nitrogen balance and minimize tissue losses.

Question 45

To decrease the risk of aspiration in patients with respiratory failure who need nutrition support, the healthcare provider should ____.

A)utilize gastric feedings
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 46

Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit)with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area). The registered dietitian is completing her initial assessment for Mr. Delgado. When estimating his energy needs she selects ____ for his stress factor.

A)1.0
B)1.4
C)1.8
D)2.2

Question 47

Which treatment is most often used to manage MODS?

A)surgery
B)mechanical ventilation
C)induced hypothermia
D)extra-corporeal membrane oxygenation

Question 48

In what way does advancing age contribute to development of MODS?

A)Older adults do not understand what measures to take to prevent MODS.
B)Older adults take more medications that can cause side effects that lead to MODS.
C)Older adults are prone to infection because of increased skin thickening.
D)Older adults' bodies are less able to deal with the stress of critical illness.

Question 49

The principle infection associated with MODS is ____.

A)gastroenteritis
B)acute kidney infection
C)a pressure ulcer
D)pneumonia

Question 50

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 51

Enteral formulas specifically for patients with COPD often contain more ____ than standard formulas.

A)carbohydrates
B)potassium
C)iron
D)fat

Question 52

In what way do blood transfusions contribute to development of MODS? ​

A)​B lood transfusions are immunosuppressive.
B)​T ransfusion reactions cause systemic sepsis.
C)B lood transfusions raise the patient's temperature.
D)​T he transfusion process requires more energy.

Question 53

Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit)with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area). Having burns increases Joseph's risk for what condition?

A)osteoporosis
B)intestinal ileus or gastrointestinal malfunction
C)bronchitis
D)overhydration

Question 54

Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit)with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area). The nurse orders a nutrition consult due to Joseph's poor intake. What is unlikely to be related to his low intake?

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

Question 55

Forty-three-year-old Joseph Delgado is an electrician for a utility company. His past medical history is unremarkable with no problems. He is admitted to the ICU (intensive care unit)with severe electrical burns to his hands, arms, and chest (20-30 percent body surface area). The most appropriate way to meet Joseph's nutritional needs is via ____.

A)tube feedings
B)TPN
C)a high-kcalorie/high-protein diet with six small meals/day
D)a high-kcalorie/high-protein diet with three large meals/day

Question 56

Support of heart and blood vessel function during treatment of MODS is characterized by ____. ​

A)medications to maintain blood pressure
B)surgery to remove excess atherosclerosis
C)central venous access to administer antibiotics
D)medications to dissolve blood clots

Question 57

Signs of sepsis include ____. ​

A)increased blood pressure
B)bradycardia
C)abnormal body temperature
D)abnormal red blood cell count

Question 58

Patients who have SIRS that persists for more than ____ are more likely to develop MODS. ​

A)4 hours
B)1 day
C)48 hours
D)3 days

Question 59

Nutrition support as part of treatment for MODS ____. ​

A)promotes weight gain
B)reduces obesity
C)prevents wasting
D)eliminates infection

Question 60

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

A)abnormal body temperature
B)reduced heart and respiratory rates
C)abnormal red blood cell counts
D)impaired inflammatory response

Question 61

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

A)osteoporosis
B)smoking
C)poor appetite
D)sinusitis

Question 68

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

A)dry mouth
B)ulcers
C)diarrhea
D)constipation

Question 72

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. The physician makes several recommendations for Margaret. What would be among these recommendations?

A)high-energy supplements
B)low-protein diet
C)extremely limited exercise
D)reduced fiber intake

Question 77

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. What is an example of a corticosteroid that may be prescribed for Margaret?

A)albuterol
B)ipratropium
C)salmeterol
D)fluticasone

Question 80

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. Margaret is prescribed ____ to improve airflow.

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