Deck 16: Nutrition in Metabolic Stress: Burns, Trauma and Surgery

Question 1

When refeeding a malnourished patient,it is especially important to monitor blood levels of

A) phosphorus.
B) iron.
C) zinc.
D) vitamin C.

Answer 1

A
Overfeeding of a malnourished patient can result in dangerous hypophosphatemia as phosphorus enters the cells from the blood.Iron is important for immune function and zinc and vitamin C levels are important for healing,but these levels are not so critical during refeeding.

Question 2

During the initial injury (ebb)phase,the main nutritional priority is

A) normalizing blood glucose levels.
B) normalizing fluid status.
C) providing adequate protein.
D) avoiding overfeeding.

Answer 2

B
During the initial injury phase,the main priority is fluid resuscitation.At this time,the body is unable to metabolize exogenous protein and energy.Avoidance of overfeeding is important but is not the primary initial concern.

Question 3

The best way to determine energy needs of stressed patients is to use

A) indirect calorimetry.
B) the Ireton-Jones formula.
C) the Dietary Reference Intakes.
D) patient hunger and appetite cues.

Answer 3

A
Energy needs of stressed patients are highly individual;the most accurate way to measure them is using indirect calorimetry.Formulas such as Ireton-Jones are used when indirect calorimetry is not available,but their results are less accurate.The Dietary Reference Intakes provide estimates of energy needs for health populations but do not account for individual differences or for stress.Stressed patients often have very poor appetites despite high energy needs.

Question 4

If a 40-year-old,woman weighing 60 kg breaks both ankles while hiking and is hospitalized,her fluid needs would be _____ mL.

A) 1800 to 2100
B) 2100 to 2400
C) 2400 to 2700
D) 2700 to 3000

Question 5

If someone has been fasting for 36 hours,his or her body is meeting its glucose needs by breaking down

A) glycogen.
B) keto acids.
C) amino acids.
D) fatty acids.

Question 6

Four day after a major accident involving multiple broken bones,the patient would be expected to be in the _____ phase.

A) critical
B) stress
C) ebb
D) flow

Question 7

Of the following,the most stressful physical traumas would be

A) a single bone fracture.
B) a low-grade fever
C) minor surgery.
D) a large third-degree burn.

Question 8

If a student group goes on hunger strike and drinks water but does not eat any food for 4 days,they are likely to

A) feel colder than usual.
B) have increased mental acuity.
C) sleep for shorter periods of time.
D) develop fluid overload.

Question 9

If a malnourished patient undergoes an emergency appendectomy and develops pneumonia during the recovery,he or she probably

A) has a history of smoking.
B) used protein from the intercostal muscles for energy.
C) had bronchitis before undergoing surgery.
D) needs evaluation for dysphagia.

Question 10

If a 75-year-old woman needs hip replacement surgery but reports that she has lost 15 lb since her husband died 3 months ago because she has had very little appetite,the best approach would be to

A) provide enteral feedings immediately after surgery.
B) delay surgery until the patient returns to usual body weight.
C) recommend using a multivitamin or multimineral supplement.
D) ensure at least 2 weeks of good nutritional intake before surgery.

Question 11

The amino acid that plays an important role in the gastrointestinal tract during stress is

A) arginine.
B) glutamine.
C) methionine.
D) phenylalanine.

Question 12

Once patients have completely recovered from gastric bypass surgery for treatment of obesity,an appropriate meal would be

A) a large green salad with chopped turkey and vinaigrette dressing.
B) a medium vanilla shake.
C) half a small chicken breast and cup of green beans.
D) a cup of bean soup with vegetable sticks.

Question 13

If a malnourished patient has a poor appetite,the nurse's first priority should be to recommend

A) enteral feedings.
B) increasing intake of fruits and vegetables.
C) several small meals and snacks each day.
D) limiting between-meal snacks to promote hunger.

Question 14

During starvation or fasting,the body adapts so that it can obtain as much energy as possible from

A) glycogen.
B) glucose.
C) protein.
D) fat.

Question 15

A major difference between starvation and stress is that metabolic rate _____ during starvation and _____ during recovery from injury.

A) increases;decreases
B) decreases;increases
C) is unaffected;increases
D) decreases;is unaffected

Question 16

If a patient who has fallen down a flight of steps has a low body temperature,low blood pressure,and high blood glucose levels,he or she is probably

A) in the initial injury (ebb)phase.
B) in the recovery (flow)phase.
C) developing a serious infection.
D) developing multiple organ dysfunction syndrome (MODS).

Question 17

If a patient is healing more slowly than expected after surgery,he or she may benefit from

A) enteral feedings.
B) supplemental zinc and vitamins A and C.
C) supplemental iron and vitamins B₁₂ and D.
D) additional branched-chain amino acids.

Question 18

If a man who weighs 80 kg is recovering from surgery and has an average protein intake of 105 g/day,his protein intake is

A) inadequate.
B) deficient.
C) appropriate.
D) excessive.

Question 19

If a severely burned patient has been unable to eat more than a few bites each day for a week,he or she should be fed by means of

A) enteral feedings into the stomach.
B) enteral feedings into the jejunum.
C) central parenteral nutrition.
D) peripheral parenteral nutrition.

Question 20

In a critically ill patient receiving parenteral nutrition,a blood glucose level of 145 mg/dL is considered

A) too low.
B) acceptable.
C) slightly elevated.
D) seriously elevated.

Question 21

The best indicator that it is safe for a patient to begin to resume oral intake after surgery is

A) presence of bowel sounds.
B) return of appetite.
C) ability to sit upright.
D) normal blood glucose level.

Question 22

If a patient experiences a third-degree burn over 30% of the body surface area,the first priority would be

A) provision of adequate protein.
B) prevention of nausea and vomiting.
C) replacement of fluids and electrolytes.
D) provision of adequate energy.

Question 23

If a patient is seriously burned and the muscle tissue is visible,the patient has a _____ burn.

A) first-degree
B) second-degree
C) third-degree
D) nonthermal

Question 24

The staff member best equipped to determine the nutrient needs of patients with severe burns is the

A) physician.
B) registered nurse.
C) pharmacist.
D) registered dietitian.

Question 25

The factor that contributes most to development of MODS is

A) blood glucose level.
B) inflammatory response.
C) fever.
D) malnutrition.

Question 26

The factor that would have the greatest influence on the energy needs of a burned patient is the

A) patient's activity level.
B) patient's emotional stress level.
C) percentage of total body surface area burned.
D) type of burn (thermal,chemical,electrical,or radioactive).

Question 27

After surgery,once bowel sounds return,the most appropriate first meal should be

A) clear liquids.
B) soft and low in fiber.
C) chosen by the physician.
D) chosen by the patient.

Question 28

If a patient has significant fluid losses from perspiration and wound dressings that cannot be measured easily,the best way to monitor fluid balance is to

A) measure serum sodium levels.
B) weigh the patient daily.
C) use formulas to calculate losses.
D) check urine concentration.

Question 29

If a patient undergoes resection of 6 inches of the colon,they are likely to have the best outcome if they

A) gave the bowel complete rest for 7 to 14 days.
B) begin oral or enteral feedings the day after surgery.
C) follow a soft,low-fiber diet.
D) follow a high-fiber diet to promote laxation.

Question 30

Presurgical nutritional status would be most important for a(n)

A) middle-aged man undergoing open heart surgery to replace a heart valve.
B) young woman undergoing a mastectomy for treatment of breast cancer.
C) older adult undergoing cholecystectomy.
D) child undergoing tonsillectomy.