Question 1

Proteins serve the function of

Accepted Answer

Proteins are the basis for lean body mass and are important for chemical reactions,transportation of other substances,preservation of immune function,and maintenance of osmotic pressure (albumin)and blood neutrality (buffers)in the body.Carbohydrates help with maintaining osmotic pressure,gluconeogenesis,and providing minerals to the body.Lipids provide a source of energy.

Question 2

The patient is receiving corticosteroid treatment for neurologic alterations.The nurse should assess the patient for episodes of

Accepted Answer

Hyperglycemia is a common complication in patients receiving corticosteroids.Needs for protein and calories are increased by infection and fever,as may occur in the patient with encephalitis or meningitis.Needs for protein,calories,zinc,and vitamin C are increased during wound healing,as occurs in trauma patients and patients with pressure ulcers.

Question 3

Which of the following nutritional interventions is a priority for the patient with renal disease who is receiving dialysis?

Accepted Answer

Proteins and amino acids are removed during peritoneal dialysis,creating a greater nutritional requirement for protein.The renal patient must receive an adequate amount of protein to prevent catabolism of body tissues to meet energy needs.Approximately 1.5 to 2.0 g protein/kg/day is required.Certain nutrients such as potassium and phosphorus are restricted because they are excreted by the kidney.The patient has no specific requirement for the fat-soluble vitamins A,E,and K because they are not removed in appreciable amounts by dialysis,and restriction generally prevents development of toxicity.

Question 4

A patient is admitted to the critical care unit with severe malnutrition as a result of hepatic failure.A triple-lumen central venous catheter is placed in the right subclavian vein,and TPN is started.For which of the following complications should the patient be evaluated immediately after insertion of the catheter?

Accepted Answer

Central vein TPN carries an increased risk of sepsis as well as potential insertion-related complications such as pneumothorax and hemothorax.Repeated traumatic catheterizations are most likely to result in thrombosis.To prevent hypoglycemia,administer oral carbohydrates or an IV bolus of dextrose.Elevate the head of the bed 30 to 45 degrees to prevent pulmonary aspiration after the infusion has begun.

Question 5

A person with a BMI of 28 would be considered

Accepted Answer

A body mass index between 25 and 30 is considered overweight or pre-obese.The other BMIs are underweight = <18.5 kg/m²; normal = 18.5 to 24.99 kg/m²; overweight = >=
25 kg/m²; pre-obese = 25 to 29.99 kg/m²; obese class I = 30 to 34.99 kg/m²; obese class II = 35 to 39.99 kg/m²; and obese class III = >=40 kg/m².

Question 6

Diet therapy for a person with hypertension 1 day after a myocardial infarction would include

Accepted Answer

Because fluid accompanies sodium,limitation of sodium is necessary to reduce fluid retention.Specific interventions include limiting salt intake,usually to 2 g a day or less,and limiting fluid intake because appropriate meal size,caffeine intake,and food temperatures are some of the dietary factors that are of concern.Small,frequent snacks are preferable to larger meals for patients with severe myocardial compromise or postprandial angina.

Question 7

A patient who has sustained a head injury has increased nutritional needs related to the

Accepted Answer

Patients with neurologic alterations have increased needs because of hypermetabolism and catabolism after head injury.Poor food intake is related to altered state of consciousness,dysphagia or other chewing or swallowing difficulties,or ileus resulting from spinal cord injury or use of pentobarbital.

Question 8

Patients with coronary artery disease should be taught about cholesterol.Which situation is most desirable?

Accepted Answer

Interventions for patients with coronary artery disease are geared toward lowering the LDL cholesterol to desirable levels.

Question 9

Two types of protein-caloric malnutrition are kwashiorkor and marasmus.Kwashiorkor results in

Accepted Answer

Kwashiorkor results in low levels of serum proteins,low lymphocyte count,low immunity and edema from low plasma oncotic pressure,and hair loss.Marasmus is recognizable by weight loss,loss of subcutaneous fat,and muscle wasting.

Question 10

The loss of exocrine function of pancreatitis results in

Accepted Answer

The loss of exocrine function leads to malabsorption and steatorrhea.In chronic pancreatitis,the loss of endocrine function results in impaired glucose intolerance.Anorexia is the result of an inability to eat or not eating.Obesity would result from consuming more than the RDA of calories based on one's body type.

Question 11

A primary nutritional intervention for hypertension is

Accepted Answer

For hypertensive cardiac disease,sodium chloride restriction is recommended.Some individuals are more salt sensitive than others,and this salt sensitivity contributes to hypertension.

Question 12

A patient on mechanical ventilation is receiving total parenteral nutrition (TPN).Which of the following is true?

Accepted Answer

Excessive calorie intake can raise PaCO₂ sufficiently to make it difficult to wean a patient from the ventilator.A balanced regimen with both lipids and carbohydrates providing the nonprotein calories is optimal for patients with respiratory compromise,and these patients need to be reassessed continually to ensure that caloric intake is not excessive.

Question 13

What is the rationale for careful intake and output for patients with pulmonary alterations?

Accepted Answer

Pulmonary edema and failure of the right side of the heart may result from fluid volume excess,which can further worsen the status of patients with respiratory compromise.

Question 14

A patient has a new order for intermittent nasogastric feedings every 4 hours.The nasogastric tube is placed by the nurse.The best method for confirming the placement of the tube before feeding would be to

Accepted Answer

After the tube has been placed,correct location must be confirmed before feedings are started and regularly throughout the course of enteral feedings.Radiographs are the most accurate way of assessing tube placement.

Question 15

Most of the energy produced from carbohydrate metabolism is used to form what substance?

Accepted Answer

Most of the energy produced from carbohydrate metabolism is used to form adenosine triphosphate (ATP),the principal form of immediately available energy within all body cells.One gram of carbohydrate provides approximately 4 kcal of energy.Through the process of digestion,carbohydrates are broken down into glucose,fructose,and galactose.Antibodies are produced through the immune system.

Question 16

Obtaining height and weight measurements for the critically ill patient

Accepted Answer

Height and current weight are essential anthropometric measurements that should be measured rather than obtained through patient or family report.The most important reason for obtaining anthropometric measurements is to detect changes in the measurements over time (e.g.,response to nutritional therapy).Weight is measured in kilograms and height in meters.BMI values are independent of age and gender and are used for assessing health risk.

Question 17

The patient history plays an important role in assessing the patient's nutritional status.Significant laboratory and clinical findings in the patient with cardiovascular disease include

Accepted Answer

Laboratory and clinical findings in patients with cardiovascular disease include elevated total cholesterol and triglycerides as well as cardiac cachexia (muscle and subcutaneous fat wasting).

Question 18

A patient with poorly controlled diabetes mellitus is to be started on enteral tube feeding.What type of formula would be most appropriate?

Accepted Answer

Individuals with diabetes mellitus whose blood sugar is poorly controlled with standard formulas should be given a glucose intolerance formula that is high in fat and low in carbohydrate.High protein is associated with polymeric formulas.Concentrated calories is associated with renal failure.Low sodium is associated with hepatic failure.

Question 19

Prevention of pulmonary aspiration is best accomplished by

Accepted Answer

To reduce the risk of pulmonary aspiration during enteral tube feeding,keep the patient's head elevated at least 30 to 45 degrees during feedings unless contraindicated.

Question 20

An effect of malnutrition on respiratory function is

Accepted Answer

Malnutrition has extremely adverse effects on respiratory function,decreasing both surfactant production and vital capacity.Excessive lipid intake can impair capillary gas exchange in the lungs,although this is not usually sufficient to produce an increase in PaCO₂ or decrease in PaO₂; this results in decreased respiratory function.

Quiz 8: Nutrition Alterations and Management