Question 1

What type of nutrition should be avoided in a SIRS patient?&#10;A)Soluble fiber&#10;B)Insoluble fiber&#10;C)Omega-3 fat&#10;D)Polymeric

Accepted Answer

Standard polymeric enteral formulas are tolerated by most patients.While insoluble fiber should be avoided, soluble fiber may be beneficial in the hemodynamically stable ICU patient.

Question 2

Nutrition support cannot replete lean body mass&#10;A)in starvation-related malnutrition.&#10;B)in patients with MODS and SIRS.&#10;C)in chronic disease-related malnutrition.&#10;D)after GI surgery.

Accepted Answer

Adequate provision of nutrition support therapy cannot replete lean body mass in patients experiencing SIRS and MODS.The loss of fat-free mass is caused by a heightened cytokine response.

Question 3

How does the gut hypothesis explain the development of systemic inflammatory response syndrome?&#10;A)Injury or disruption of the gut barrier function allows bacterial translocation to occur.&#10;B)Active feeding of the gut promotes the migration of gut-associated lymphoid tissue.&#10;C)Bypassing feeding of the gut via parenteral nutrition promotes infection through open access to the blood system.&#10;D)Foodborne illness promotes absorption of foodborne pathogens, increasing infection.

Accepted Answer

Systemic inflammatory response syndrome (SIRS) is a widespread inflammation that can occur in response to infection, burns, trauma, or hemorrhagic shock.The gut hypothesis is one suggestion as to how SIRS develops.In the gut, injury leads to impairment of the gut barrier function.Intestinal bacteria may slip between mucosal cells or through fistulas into the bloodstream, thus promoting the systemic response.

Question 4

Which of the following should be the first emphasis of nutrition care immediately after a major burn injury?&#10;A)Promote weight gain.&#10;B)Increase lean body mass and strength.&#10;C)Establish fluid and electrolyte balance.&#10;D)Promote a positive nitrogen balance.

Accepted Answer

The first 24 to 48 hours of care for thermal injury is devoted to replenishing fluid resuscitation.Stabilization of weight and lean body mass cannot occur until the patient reaches the adaptive response of the flow phase.At this time, which may occur days or weeks after the initial injury, hormonal responses decrease, and anabolism can begin.However, enteral feedings should be started as soon as the patient is hemodynamically stable.

Question 5

Multiple organ dysfunction syndrome (MODS) generally begins with&#10;A)coagulopathy.&#10;B)lung failure.&#10;C)liver failure.&#10;D)intestinal failure.

Accepted Answer

MODS is a complication of SIRS and generally begins with lung failure.The lung failure is followed by failure, in no particular order, of the liver, intestines, and kidneys.

Question 6

Which of the following occurs during the ebb phase of injury?&#10;A)Hypovolemic shock&#10;B)Release of catecholamines&#10;C)Increased metabolic rate&#10;D)Hyperglycemia

Accepted Answer

During the ebb phase of hypermetabolic response, hypovolemia, shock, and tissue hypoxia occur immediately after injury.The acute response of the flow phase to these physiologic changes includes release of catecholamines and other hormones that promote an increase in metabolic rate and hyperglycemia.

Question 7

Which of the following statements is NOT true about cortisol?&#10;A)It is released from the adrenal cortex.&#10;B)It accelerates skeletal muscle catabolism.&#10;C)It promotes acute-phase protein synthesis.&#10;D)It promotes hypoglycemia.

Accepted Answer

Cortisol, which is released from the adrenal cortex in response to stimulation by adrenocorticotropic hormone secreted by the anterior pituitary, enhances skeletal muscle catabolism and promotes hepatic use of amino acids for gluconeogenesis, glycogenolysis, and acute-phase protein synthesis.Hyperglycemia is generally observed during stress.

Question 8

The preferred method for estimating energy needs in a hypermetabolic patient is&#10;A)25 to 30 kcal/kg.&#10;B)indirect calorimetry.&#10;C)the DRIs.&#10;D)nitrogen balance.

Accepted Answer

Indirect calorimetry provides a good estimate of energy expenditure and is the preferred method for measurement of oxygen consumption in severely injured patients.Oxygen consumption is a primary factor in the determination of energy expenditure.Indirect calorimetry is less accurate in patients with BMIs over 50 and should not be used when the patient has acidosis or is dependent on supplemental oxygen.Use of 25 to 30 kcal/kg or the DRIs depends on body weight, which may be affected by fluid imbalance, and could lead to potential underfeeding of the patient.Nitrogen balance is used to estimate protein needs.

Question 9

A patient would be given enteral nutrition if the patient had&#10;A)a high-output fistula.&#10;B)intractable vomiting.&#10;C)high doses of catecholamine agents.&#10;D)acute pancreatitis.

Accepted Answer

Enteral nutrition is generally the preferred route of nutrition support for critically ill patients.Some contraindications to enteral feeding include high-output fistulas, intractable vomiting, and patients who are hemodynamically unstable due to high doses of catecholamine agents.

Question 10

Which mineral may be lost and need replacement in burn patients being treated with silver nitrate soaks?&#10;A)Calcium&#10;B)Phosphorus&#10;C)Magnesium&#10;D)Zinc

Accepted Answer

Silver nitrate soaks are used in wound management to reduce heat losses from the body and to prevent infection.However, these soaks draw sodium and calcium out of the wound and cause loss of these minerals.Calcium supplementation may be necessary to prevent hypocalcemia.Hypophosphatemia occurs in burn patients during the refeeding syndrome.Magnesium may also be lost through the wound.Serum zinc levels have been reported as decreased in burn patients, but the evidence is not clear as to whether this is a reflection of depressed total body zinc or of hypoalbuminemia.

Question 11

In surgical patients, what factor is the strongest predictor of postoperative mortality?&#10;A)Extent of the primary disease and operation performed&#10;B)Serum albumin&#10;C)BMI&#10;D)Age

Accepted Answer

The answer of In surgical patients, what factor is the...

Question 12

How deep is a second-degree burn?&#10;A)Muscle&#10;B)Epidermis&#10;C)Dermis&#10;D)Subcutaneous tissue

Accepted Answer

The answer of How deep is a second-degree burn?&#10;A)Muscle&#10;B)Epidermis&#10;C)Dermis&#10;D)Subcutaneous tissue...

Question 13

Which of the following is a criterion in the diagnosis of SIRS?&#10;A)Shock&#10;B)Ileus&#10;C)Bandemia&#10;D)Multiple trauma

Accepted Answer

The answer of Which of the following is a criterion...

Question 14

Which hormone promotes the synthesis of acute-phase proteins?&#10;A)Glucagon&#10;B)Cortisol&#10;C)Epinephrine&#10;D)ACTH

Accepted Answer

The answer of Which hormone promotes the synthesis of acute-phase...

Question 15

In contrast to stress, which of the following is a characteristic of starvation?&#10;A)Increased resting energy expenditure&#10;B)Decreased energy expenditure&#10;C)Increased gluconeogenesis&#10;D)Increased nitrogen excretion

Accepted Answer

The answer of In contrast to stress, which of the...

Question 16

The adequacy of energy and protein intake after burn injury is best evaluated by&#10;A)monitoring weight.&#10;B)using indirect calorimetry.&#10;C)monitoring wound healing and graft take.&#10;D)monitoring albumin level.

Accepted Answer

The answer of The adequacy of energy and protein intake...

Question 17

What are interleukin-1, interleukin-6, and tumor necrosis factor examples of?&#10;A)Catecholamines&#10;B)Acute phase proteins&#10;C)Cytokines&#10;D)Antiinflammatory proteins

Accepted Answer

The answer of What are interleukin-1, interleukin-6, and tumor necrosis...

Question 18

In critically ill patients, what is the recommended range for maintaining serum glucose?&#10;A)120 to 150 mg/dl&#10;B)150 to 200 mg/dl&#10;C)80 to 110 mg/dl&#10;D)150 to 180 mg/dl

Accepted Answer

The answer of In critically ill patients, what is the...

Question 19

Low albumin in a critically ill patient is caused by&#10;A)inadequate protein intake.&#10;B)illness, injury, and inflammation.&#10;C)inadequate calorie intake.&#10;D)inadequate fluid intake.

Accepted Answer

The answer of Low albumin in a critically ill patient...

Question 20

Which of the following may have a role in supporting tight junctions between the intraepithelial cells in the gut?&#10;A)Parenteral nutrition&#10;B)Positive nitrogen balance&#10;C)Gut rest&#10;D)Enteral feedings

Accepted Answer

The answer of Which of the following may have a...

Deck 38: Medical Nutrition Therapy in Critical Care