Deck 17: Metabolic Stress

Question 1

Clients who have undergone radical neck or facial surgery are often fed using:

A) a straw.
B) a nasogastric tube.
C) a percutaneous endoscopic gastrostomy (PEG) tube.
D) parenteral nutrition.

Answer 1

C

Question 2

Food present in the gastrointestinal tract at the time of general surgery will increase the client's risk for:

A) gastrointestinal infection.
B) aspiration or vomiting.
C) postoperative constipation.
D) fluid and electrolyte imbalances.

Answer 2

B

Question 3

Foods allowed on a full-liquid diet include:

A) chicken salad.
B) strawberries.
C) chili.
D) pudding.

Answer 3

D
All of these foods are fairly soft, but full-liquid diets only include foods that are smooth and fairly liquid.

Question 4

After surgery, protein intake may be limited if the patient has impaired:

A) kidney function.
B) absorption.
C) pancreatic function.
D) ability to chew.

Question 5

Postoperatively, intravenous (IV) fluids provide:

A) energy and protein.
B) fluids and some energy.
C) fluids, electrolytes, and micronutrients.
D) all nutrient needs.

Question 6

Before general surgical procedures, oral food and fluids are withheld from patients for at least:

A) 4 to 6 hours.
B) 6 to 8 hours.
C) 8 to 12 hours.
D) 12 to 24 hours.

Question 7

Foods allowed on a clear liquid diet include:

A) broth.
B) cream soup.
C) milk.
D) pudding.

Question 8

Protein is important in the postoperative recovery period for tissue synthesis and:

A) good immune function.
B) maintaining insulin levels.
C) metabolism of antibiotics.
D) sparing glycogen stores.

Question 9

If a client has had surgery of the head, neck, or throat and can only swallow a limited amount of food, his or her oral diet should include:

A) clear liquids only.
B) full liquids only.
C) energy- and protein-dense soft foods.
D) low-residue foods.

Question 10

A vitamin that is necessary for formation of scar tissue during the healing process is:

A) vitamin A.
B) vitamin C.
C) vitamin B₁₂.
D) thiamin.

Question 11

A good guideline for evaluating fluid balance is:

A) daily weights.
B) serum electrolyte levels.
C) measuring input and output.
D) urine volume and concentration.

Question 12

The amount of dextrose in 3 L of 5% dextrose solution is:

A) 50g.
B) 150g.
C) 300g.
D) 500g.

Question 13

An important function of carbohydrates in the postoperative period is to:

A) contribute to tissue repair.
B) provide a source of vitamins.
C) spare protein for tissue synthesis.
D) protect adipose fat reserves.

Question 14

The use of a low-residue diet may be recommended preoperatively for clients:

A) scheduled for gastrointestinal surgery.
B) greater than 65 years of age.
C) who are overweight.
D) scheduled for any type of surgery.

Question 15

Postsurgical patients should resume oral feedings as soon as possible to:

A) prevent dehydration.
B) prevent permanent damage to the gastrointestinal tract.
C) provide adequate nutrition.
D) support optimal kidney function.

Question 16

Preoperative or postoperative blood losses may result in a deficiency of:

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

Question 17

The minimum daily amount of carbohydrate that supports central nervous system function is about:

A) 100g.
B) 150g.
C) 200g.
D) 500g.

Question 18

During the postoperative period, the primary source of energy should be:

A) protein.
B) carbohydrates.
C) fat.
D) specially developed formulas.

Question 19

The ideal method for estimating energy needs is:

A) Harris-Benedict equations.
B) 20 to 30 kcal/kg ideal body weight per day.
C) daily weight measurements.
D) indirect calorimetry.

Question 20

Immune-enhancing enteral formulas may be enriched with:

A) vitamin C and zinc.
B) omega-3 fatty acids and arginine.
C) essential amino acids and medium-chain triglycerides (MCTs).
D) iron, folic acid, and vitamin B₁₂.

Question 21

A burn that causes reddening and blistering with cell death in the dermis is classified as a:

A) first-degree burn.
B) second-degree burn.
C) third-degree burn.
D) fourth-degree burn.

Question 22

If more than 50% of the small intestine is removed, patients may develop:

A) dumping syndrome.
B) an ileostomy.
C) short-bowel syndrome.
D) anemia.

Question 23

Dietary recommendations for patients with chylous ascites or chylothorax include:

A) replacement of long-chain triglycerides (LCTs) with MCTs.
B) high energy and protein intakes.
C) use of immune-enhancing formulas.
D) normal diet.

Question 24

The recommended diet for patients with dumping syndrome is low in:

A) sugar.
B) fat.
C) protein.
D) sodium.

Question 25

In the first few weeks after a gastrectomy, the recommended diet is:

A) parenteral nutrition until the stomach has healed.
B) small, frequent meals that can be easily digested.
C) clear liquids served at room temperature.
D) full liquids served cold.

Question 26

In the first 24 to 48 hours after the burn injury, patients with second- or third-degree burns that cover 15% to 20% or more of their total body surface usually require:

A) enteral nutrition.
B) total parenteral nutrition.
C) small frequent meals.
D) IV fluid and electrolytes.

Question 27

The physiologic basis for symptoms associated with dumping syndrome is that:

A) concentrated hyperosmolar intestinal contents are absorbed too quickly.
B) ingested foods remain in the stomach too long and cause excessive bloating.
C) only the intestinal water is being absorbed, resulting in hemodilution and increased blood volume.
D) concentrated hyperosmolar fluids draw water into the intestine, decreasing blood volume.

Question 28

Symptoms of dumping syndrome are most likely to occur after patients consume:

A) protein.
B) fat.
C) simple carbohydrates.
D) complex carbohydrates.

Question 29

When a client has the most radical form of total gastrectomy (Billroth II), the stomach is excised and the esophagus is joined to the:

A) ileum.
B) duodenum.
C) jejunum.
D) rectum.

Question 30

Gastric bypass is recommended only for patients who need to lose more than:

A) 20 lb.
B) 50 lb.
C) 100 lb.
D) 150 lb.

Question 31

During the ebb phase following thermal injury, overall metabolism is:

A) unchanged.
B) low.
C) high.
D) unpredictable.

Question 32

The flow phase following thermal injury is characterized by:

A) decreased oxygen consumption.
B) increased nitrogen excretion.
C) decreased insulin production.
D) hypoglycemia.

Question 33

The recommended diet for most patients with ostomies is:

A) normal.
B) high protein.
C) low fiber.
D) soft.

Question 34

For patients with burns covering more than 20% of total body surface area, resting energy expenditure (REE) exceeds that calculated using the Harris-Benedict equations by about:

A) 20% to 30%.
B) 30% to 50%.
C) 50% to 60%.
D) 80% to 100%.

Question 35

Nutrients lost in the initial period following a major burn injury are:

A) fluids and electrolytes.
B) electrolytes and protein.
C) protein and fluids.
D) fluids, electrolytes, and protein.

Question 36

The IV solution administered during the initial stage of a severe burn injury to prevent hypovolemia is:

A) lactated Ringer's.
B) 5% dextrose.
C) normal saline.
D) 10% dextrose.

Question 37

For patients in the flow phase of metabolic stress, hyperglycemia should be treated by:

A) administration of normal saline without dextrose.
B) use of complex carbohydrates.
C) administration of specialized formulas.
D) use of exogenous insulin.

Question 38

Nutritional strategies that are helpful for management of dumping syndrome include:

A) drinking iced beverages with meals.
B) limiting fluids to once a day.
C) avoiding caffeinated or carbonated beverages.
D) offering fluids between rather than with meals.

Question 39

The name of the surgical procedure in which the ileum is attached to an opening in the abdominal wall is called a(n):

A) colostomy.
B) ileostomy.
C) jejunostomy.
D) cholecystectomy.

Question 40

The surgical procedure in which a portion of the colon is attached to an opening in the abdominal wall is called a(n):

A) cholecystectomy.
B) ileostomy.
C) colostomy.
D) jejunostomy.

Question 41

The preferred type of enteral feeding for burn patients is:

A) nasogastric.
B) gastrostomy.
C) nasoenteric.
D) jejunal.

Question 42

Conditionally essential amino acids include:

A) L-lysine and L-threonine.
B) L-arginine and L-glutamine.
C) L-cysteine and L-methionine.
D) L-phenylalanine and L-tyramine.

Question 43

Oral intake is generally adequate in adults who have burns covering less than:

A) 10% of the total body surface area.
B) 15% of the total body surface area.
C) 25% of the total body surface area.
D) 50% of the total body surface area.

Question 44

After extensive surgery or burns, protein needs are usually:

A) 1.0 to 1.2 g/kg body weight per day.
B) 1.2 to 1.5 g/kg body weight per day.
C) 1.5 to 2.0 g/kg body weight per day.
D) 2.0 to 3.0 g/kg body weight per day.

Question 45

Omega-3 fatty acids may be important during periods of metabolic stress because they:

A) spare amino acids for tissue repair.
B) blunt the body's metabolic response to stress.
C) enhance immune function and reduce inflammation.
D) help stimulate appetite so that patients achieve adequate oral intake.

Question 46

Fat intake in patients who have experienced burns or multiple trauma should be:

A) 5% to 10% of total kilocalories (kcalories or kcal).
B) 12% to 15% of total kilocalories (kcalories or kcal).
C) 15% to 18% of total kilocalories (kcalories or kcal).
D) 20% to 30% of total kilocalories (kcalories or kcal).