Deck 24: Energy- and Protein-Modified Diets for Metabolic and Respiratory Stress

Question 1

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. ​

Answer 1

True

Question 2

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

Answer 2

True

Question 3

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

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

Answer 3

A

Question 4

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

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

Question 5

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

Question 6

One of the initial concerns for patients hospitalized with acute stress is to:

A)maintain immune function.
B)achieve positive nitrogen balance.
C)minimize nutrient losses.
D)restore lost fluids and electrolytes.
E)increase insulin levels.

Question 7

Metabolic stress can result from uncontrolled infection or extensive tissue injury.

Question 8

Overfeeding an acutely stressed patient can lead to:

A)fever.
B)mechanical ventilation.
C)abscesses.
D)inactivity.
E)refeeding syndrome.

Question 9

All of these complications are associated with SIRS or sepsis EXCEPT:

A)tissue edema.
B)low blood pressure.
C)hypertriglyceridemia.
D)impaired blood flow.
E)decreased oxygen delivery to tissue.

Question 10

Smoking is the primary risk factor in most cases of chronic obstructive pulmonary disease (COPD).

Question 11

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

Question 12

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

Question 13

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

Question 14

During prolonged stress, cortisol causes all of these adverse effects EXCEPT:

A)muscle wasting.
B)bone loss.
C)impaired wound healing.
D)hypoglycemia.
E)skin thinning.

Question 15

Excessive energy intake in patients with acute respiratory distress syndrome (ARDS)can worsen respiratory function.

Question 16

The nutrition goals during stress are to provide a diet that meets all of these objectives EXCEPT:

A)maintains immune defenses.
B)promotes healing.
C)increases hypermetabolism.
D)preserves muscle tissue.
E)reverses negative nitrogen balance.

Question 17

Clinical findings typical of patients undergoing metabolic stress include all of these factors EXCEPT:

A)hyperglycemia.
B)hypermetabolism.
C)insulin resistance.
D)positive nitrogen balance.
E)protein loss.

Question 18

Which substance is derived from dietary fatty acids?

A)cortisol
B)eicosanoids
C)antihistamines
D)cytokines
E)epinephrine

Question 19

The symptoms associated with the whole-body inflammatory response to severe illness are collectively called the systemic inflammatory response syndrome (SIRS).

Question 20

Protein synthesis is inhibited by excess production of:

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

Question 21

Medical nutrition therapy for COPD is designed to meet all of these goals EXCEPT:

A)promoting a healthy body weight.
B)preventing muscle loss.
C)improving food intake.
D)relieving chronic cough.
E)preventing malnutrition.

Question 22

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)glucose

Question 23

Which nutrient plays a critical role in immunity and wound healing?

A)zinc
B)vitamin B
C)vitamin D
D)potassium
E)calcium

Question 24

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)lying down.

Question 25

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)improving ventilation.

Question 26

One of the factors that increases the risk of MODS is:

A)age over 40 years.
B)length of hospital stay.
C)malnutrition.
D)underweight.
E)gender.

Question 27

Laura is an intensive care, non-obese, acute stress patient. She weighs 150 pounds. What are Laura's approximate maximum daily protein needs?

A)20 to 40 grams
B)50 to 60 grams
C)70 to 80 grams
D)80 to 135 grams
E)150 to 200 grams

Question 28

The first organ(s)to fail in multiple organ dysfunction syndrome (MODS)is/are normally the:

A)lungs.
B)liver.
C)kidneys.
D)heart.
E)GI tract.

Question 29

A frequent cause of death among older intensive care patients with multiple or severe injuries is:

A)pulmonary edema.
B)hyperosmolar hyperglycemic syndrome.
C)multiple organ dysfunction syndrome (MODS).
D)stroke.
E)neurological failure.

Question 30

Which condition gives the highest stress factor for an acute illness? ​

A)intensive care
B)acute kidney injury
C)burns
D)acute inflammation
E)acute pancreatitis

Question 31

Which method is used to measure the energy requirements for intensive care patients?

A)Mifflin-St. Jeor equation
B)indirect calorimetry
C)Penn State equation
D)estimate needs using 15-20 kcalories/kg body weight
E)lung function tests

Question 32

The principal infection associated with MODS is:

A)pneumonia.
B)a fungal infection.
C)herpes simplex.
D)a viral infection.
E)COPD.

Question 33

Which factor is not a cause of poor food intake in persons with severe COPD?

A)medications
B)dyspnea
C)lower energy needs
D)change in taste perception
E)loss of sense of smell

Question 34

An increase in _____ is needed to support the increase in energy metabolism in hypermetabolic patients. ​

A)vitamin C
B)zinc
C)B vitamins
D)vitamin E
E)vitamin D

Question 35

To prevent hyperglycemia, parenteral feedings should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute.

A)​2
B)​3
C)​4
D)​5
E)​6

Question 36

When pulmonary edema is present, a patient requires:

A)tube feeding.
B)fluid restriction.
C)increased fluids.
D)decreased protein.
E)increased ventilation.

Question 37

Excessive kcalorie intake in COPD patients may:

A)increase respiratory distress.
B)alter taste perception.
C)interfere with drug therapy.
D)increase gas formation.
E)decreases carbon dioxide levels.

Question 38

Which amino acid may have beneficial effects on infection rates and wound healing in postoperative patients?

A)glutamine
B)tyrosine
C)arginine
D)phenylalanine
E)glycine

Question 39

Which amino acid may improve infection, muscle mass, and mortality rates in critically ill patients?

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

Question 40

All these therapies are used to manage MODS EXCEPT:

A)mechanical ventilation.
B)fluid resuscitation.
C)hemofiltration or dialysis.
D)physical therapy.
E)nutritional support.

Question 41

Respiratory distress is characterized by:

A)C-reactive peptide action.
B)elevated cortisol.
C)decreased oxygen and increased carbon dioxide.
D)histamine secretion.
E)elevated blood pressure.

Question 42

The benefits of adding _____ to the diets of acutely stressed patients is controversial.

A)glutamine and creatine
B)glycine and C-reactive peptide
C)serine and arginine
D)arginine and glutamine
E)alanine and glutamine

Question 43

Patients with burns and tissue injuries may require increased_____ due to tissue losses.

A)glucose
B)trace minerals
C)vitamin C
D)fats
E)proteins

Question 44

A patient who is on a tube feeding gains nine pounds in three days. This may indicate:

A)adequate nutrition.
B)excess protein intake.
C)fluid imbalance.
D)nutrient imbalance.
E)respiratory dysfunction.

Question 45

A patient is admitted to the ER with multiple gunshot wounds. The initial treatment includes:

A)beginning enteral nutrition.
B)administering intravenous (IV)fluids.
C)beginning PPN.
D)referral to the dietitian.
E)anti-inflammatory medications.

Question 46

The two main types of COPD are chronic bronchitis and:

A)pneumonia.
B)emphysema.
C)asthma.
D)fibrosis.
E)influenza.

Question 47

Nutrition support plays a role in the therapy for MODS by:

A)preventing excessive wasting.
B)maintaining blood pressure.
C)improving gas exchange.
D)preventing toxic build-up.
E)maintaining cardiac output.

Question 48

The loss of elastic tissue and destruction of alveolar walls is characteristic of:

A)bronchitis.
B)emphysema.
C)asthma.
D)fibrosis.
E)influenza.

Question 49

Which action is not attributed to cortisol?

A)muscle degradation
B)raising blood levels of amino acids
C)raising blood levels of glucose
D)breakdown of triglycerides
E)decreased urine output

Question 50

Which chemical messenger is not produced by the liver during inflammation, infection or severe injury?

A)C-reactive peptide
B)complement
C)cortisol
D)hepcidin
E)prothrombin

Question 51

Mr. Morgan is an acutely stressed patient in intensive care who is on total parenteral nutrition (TPN). Monitoring Mr. Morgan's _____ levels can help to ensure that excessive amounts of nutrients are not given intravenously.

A)glucose
B)cholesterol
C)trace mineral
D)albumin
E)uric acid

Question 52

All of these factors are classic signs of inflammation EXCEPT:

A)hyperglycemia.
B)swelling.
C)redness.
D)heat.
E)pain.

Question 53

In patients with severe hyperglycemia, fat may supply up to ____ percent of kcalories.

A)20
B)30
C)40
D)50
E)60

Question 54

Which chemical messengers are catecholamines?

A)acetylcholine
B)aldosterone and cortisol
C)cytokines and histamine
D)sodium and potassium
E)epinephrine and norepinephrine

Question 55

The inflammatory process can cause a variety of systemic effects, including:

A)increased heart rate, respiratory rate, and temperature .
B)decreased heart rate and appetite, and increased blood pressure.
C)increased blood pressure, temperature, and appetite.
D)increased blood pressure, heart rate, and weight.
E)decreased cardiac output and blood pressure, and increased urine production.

Question 56

Which procedure is not an initial treatment of acute stress?

A)administering fluids
B)treating infections
C)mechanical ventilation
D)repairing wounds
E)debridement

Question 57

John has been hospitalized with a severe infection in his foot. Increasing his intake of _____ may help to suppress the inflammation.

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

Question 58

The stress response is the body's _____ response to a variety of stressors. ​

A)nonspecific
B)localized
C)cell-mediated
D)hypometabolic
E)specific

Question 59

Refeeding syndrome is characterized by:

A)fluid and electrolyte shifts.
B)infections.
C)respiration issues.
D)sepsis.
E)inflammation.

Question 60

Most critical care patients require between _____ kcalories per kg per day.

A)5-10
B)10-15
C)15-20
D)25-30
E)35-40

Question 61

In a patient with MODS, which organ(s)is(are)one of the last to fail? ​

A)GI tract
B)heart
C)lungs
D)gallbladder
E)pancreas

Question 66

Alpha-1-antitrypsin deficiency:

A)is an inherited disorder.
B)accounts for the majority of cases of COPD.
C)is detrimental only if the person is also a smoker.
D)causes the production of excess mucus.
E)inhibits oxygen and carbon dioxide exchange.

Question 67

Which symptom of respiratory failure can lead to acidosis?

A)surfactant
B)hypercapnia
C)hypoxia
D)hypoxemia
E)cyanosis

Question 68

The main goal of nutrition therapy for COPD is to:

A)decrease blood glucose.
B)increase lipid levels.
C)decrease mucus production.
D)prevent muscle wasting.
E)promote gas exchange.

Question 70

Food intake declines as COPD progresses because:

A)changes in hormonal levels lead to early satiety.
B)high levels of carbon dioxide affects muscle function.
C)cortisol suppresses appetite.
D)mucus production interferes with swallowing.
E)dyspnea may interfere with swallowing.

Question 72

Persistent inflammation and excessive mucus secretion is characteristic of:

A)bronchitis.
B)emphysema.
C)asthma.
D)fibrosis.
E)influenza.

Question 73

Which symptom is not part of the systemic inflammatory response?

A)fever
B)elevated heart rate
C)increased respiratory rate
D)elevated white blood cell count
E)acidosis

Question 74

In a patient with MODS, mechanical ventilation is used to support the:

A)GI tract.
B)heart.
C)lungs.
D)kidney.
E)liver.

Question 77

Which factor increases the risk for developing MODS?

A)patient age below 50 years old
B)having SIRS for less than two days
C)the use of invasive catheters
D)low body weight
E)having localized, acute injuries

Question 78

Which sign of respiratory failure appears as a bluish cast in the skin on the lips, cheeks, and nail beds?

A)acidosis
B)hypercapnia
C)hypoxia
D)hypoxemia
E)cyanosis