Deck 22: Metabolic and Respiratory Stress

Question 1

The accumulation of pus is known as ____.

A) erysipelas
B) impetigo
C) an abscess
D) cellulitis

Answer 1

C

Question 2

The inflammatory response begins with the ____.

A) removal of cellular debris by immune cells
B) dilation of arterioles and capillaries at the site of injury
C) destruction of microorganisms by phagocytes
D) release of inflammatory mediators from damaged tissue

Answer 2

B

Question 3

What effect does an increase in the release of catecholamines have on the body?

A) sodium excretion from the kidneys
B) glycogen breakdown in the liver
C) storage of fatty acids in the adipose cells
D) water reabsorption in the kidneys

Answer 3

B

Question 4

______ is/are considered the best clinical indicator of acute-phase inflammation response

A) C-reactive protein
B) Hepcidin
C) Prealbumin
D) Eicosanoids

Question 5

Which substance is the precursor for the eicosanoids?

A) amino acids
B) fatty acids
C) thiamin
D) vitamin D

Question 6

What is a metabolic effect of hormones released during the stress response?

A) glycogenesis
B) gluconeogenesis
C) lipogenesis
D) protein synthesis

Question 7

Chemical mediators that control the inflammatory process are released from ____.

A) the central nervous system, including the brain and spinal cord
B) damaged tissues, blood vessels, and activated immune cells
C) the adrenal and pituitary glands
D) adipose and muscle tissue

Question 8

Which hormone(s) is/are referred to as the "fight-or-flight" hormone(s)?

A) catecholamines
B) glucagon
C) cortisol
D) aldosterone

Question 9

Which hormones promote glycogen breakdown in the liver?

A) catecholamines and antidiuretic hormone
B) catecholamines and glucagon
C) cortisol and aldosterone
D) aldosterone and catecholamines

Question 10

Which substance is an acute-phase protein produced by the liver?

A) glucagon
B) hepcidin
C) aldosterone
D) eicosanoids

Question 11

Long-term use of pharmaceutical forms of cortisol (cortisone, prednisone) results in ____.

A) thickening of the skin
B) dehydration
C) hypothyroidism
D) early osteoporosis

Question 12

When determining the resting metabolic rate, a patient's energy needs would generally be increased by which condition?

A) receiving intravenous fluids
B) having open wounds
C) being bedridden
D) having a nasogastric tube

Question 13

Complications that result from refeeding syndrome include ____.

A) hyperglycemia
B) weight gain
C) hypoxemia
D) hypovolemia

Question 14

Which acute-phase protein is involved in iron metabolism?

A) prothrombin
B) complement proteins
C) C-reactive protein
D) hepcidin

Question 15

The complication that results from rapid overfeeding of an acutely stressed patient is ____.

A) hypotension
B) refeeding syndrome
C) ketoacidosis
D) tachycardia

Question 16

What is a function of C-reactive protein?

A) regulating blood pressure
B) regulating iron metabolism
C) producing and releasing histamine
D) binding dead or dying cells to activate certain immune responses

Question 17

Cytokines are proteins that help regulate ____ development and activity.

A) immune system
B) oxygen
C) hormonal
D) GI tract

Question 18

Effects of elevated cortisol levels during prolonged stress include ____.

A) impaired wound healing
B) increased protein synthesis
C) increased risk of hypoglycemia
D) improved immune response

Question 19

A disruption in the body's chemical environment due to the effects of disease or injury that threatens its normal and healthy functioning is called ____ stress.

A) metabolic
B) severe
C) physiological
D) dysfunctional

Question 20

In response to metabolic and respiratory stress, the body experiences ____.

A) hypometabolism
B) a breakdown of muscle mass
C) a decrease in carbon dioxide in the blood
D) only minor complications

Question 21

What would be the stress factor for acute kidney injury in this patient?

A) 1.1
B) 1.2
C) 1.3
D) 1.4

Question 22

Which classification of burns destroys both the epidermis and dermis and may also damage underlying tissues?

A) 1st degree
B) 2nd degree
C) 3rd degree
D) 4th degree

Question 23

Using the appropriate stress factor and the RMR for this patient, determine his energy intake?

A) 1873 to 2384 kcal/day
B) 1933 to 2084 kcal/day
C) 2003 to 2230 kcal/day
D) 2430 to 2533 kcal/day

Question 24

Brandon is critically ill and is in the ICU. How many kcalories must be factored to determine Brandon's daily energy needs?

A) 15 to 20 kcal/kg body weight
B) 25 to 30 kcal/kg body weight
C) 30 to 35 kcal/kg body weight
D) 35 to 38 kcal/kg body weight

Question 25

Calculate the resting metabolic rate (RMR) for this patient (Hint: Hypocaloric feedings are recommended for critically ill obese patients)

A) 1141 to 1241 kcal/day
B) 1441 to 1834 kcal/day
C) 1821 to 1934 kcal/day
D) 1941 to 2041 kcal/day

Question 26

What is the suggested kcalorie intake for hypocaloric feedings for critically ill obese patients?

A) 5 to 8 kcal/kg actual body weight
B) 8 to 10 kcal/kg actual body weight
C) 11 to 14 kcal/kg actual body weight
D) 15 to 18 kcal/kg actual body weight

Question 27

Which nonessential amino acids are sometimes supplemented in patients undergoing metabolic stress?

A) aspartic acid and arginine
B) arginine and glutamine
C) glycine and glutamine
D) alanine and glycine

Question 28

What percentage of persons with COPD are affected by malnutrition?

A) 20
B) 40
C) 60
D) 80

Question 29

An estimate of the daily energy needs of a 70-kg man who is critically ill would be ____ kcalories.

A) 1050 to 1400
B) 1750 to 2100
C) 2450 to 2800
D) 3150 to 3500

Question 30

Which condition is characterized by persistent inflammation and excessive secretions of mucus in the main airways of the lungs?

A) asthma
B) chronic bronchitis
C) emphysema
D) pneumonia

Question 31

Protein intake should average ____ percent of total calories for clients with burns greater than 10% of TBSA.

A) 10
B) 15
C) 25
D) 30

Question 32

What best describes why weight loss and malnutrition occur in the presence of chronic respiratory diseases?

A) Damaged lung tissues use more vitamins and minerals.
B) Excessive carbon dioxide in the blood causes a person to sleep more.
C) Labored breathing raises energy needs.
D) Hypoxemia causes the body to excrete excess glycogen.

Question 33

How many grams of protein would a 120-lb woman require after major physiological stress?

A) 65 to 109 grams
B) 82 to 95 grams
C) 156 to 173 grams
D) 144 to 240 grams

Question 34

Which classification of burns involves both the epidermis and dermis and is characterized by redness, swelling, and blistering?

A) 1st degree
B) 2nd degree
C) 3rd degree
D) 4th degree

Question 35

Dave has 2nd-degree burns on his back torso, left arm, and left leg. This represents about ____ percent of his TBSA.

A) 27
B) 36
C) 45
D) 72

Question 36

When parenteral nutrition is necessary for critically ill patients, dextrose is limited to ____ milligrams per kilogram of body weight per minute to prevent hyperglycemia.

A) 3
B) 5
C) 10
D) 15

Question 37

Burn size in adults is often estimated by dividing the body into 11 parts, with each part representing about ____ percent of the total body surface area (TBSA).

A) 9
B) 12
C) 15
D) 19

Question 38

The primary risk factor for chronic obstructive pulmonary disease (COPD) is ____.

A) smoking
B) vehicle exhaust
C) genetic factors
D) pollution from coal-fired power plants

Question 39

Patients with acute respiratory distress syndrome (ARDS) may require ____ grams of protein per kilogram body weight daily.

A) 0.5 to 1.0
B) 1.0 to 1.5
C) 1.5 to 2.0
D) 2.0 to 2.5

Question 40

For acutely ill patients with a functional GI tract, enteral feedings started in the first ____ hours after hospitalizations are associated with fewer complications and shorter hospital stays.

A) 12 to 24
B) 24 to 48
C) 48 to 72
D) 72 to 96

Question 41

A patient with chronic COPD might benefit from which recommendation to help increase food intake?

A) eating large meals
B) consuming liquids with meals rather than between meals
C) eating quickly
D) using supplemental oxygen at mealtimes

Question 42

Nutrition support as part of treatment for MODS ____.

A) promotes weight gain
B) reduces obesity
C) prevents excessive wasting
D) eliminates infection

Question 43

59-63. Case Study Questions  
Forty-three-year-old Joseph Delgado is an electrician for a utility company. His medical history is unremarkable, with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20 to 30% of body surface area).
The most appropriate way to meet Joseph's nutritional needs is via ____.

A) tube feedings
B) parenteral nutrition
C) a high-kcalorie/high-protein diet with six small meals/day
D) a high-kcalorie/high-protein diet with three large meals/day

Question 44

A patient has severe respiratory failure and is unable to eat much. The nurse notices a decrease in body weight and severe generalized weakness. The dietitian recommends ____.

A) a change to parenteral nutrition support
B) a change to a nutrient-dense enteral formula
C) that they continue with the current diet order
D) a change to a carbohydrate-rich enteral formula

Question 45

In what way do blood transfusions contribute to development of MODS?

A) Blood transfusions are immunosuppressive.
B) Transfusion reactions cause severe muscle loss.
C) Blood transfusions raise the patient's temperature.
D) The transfusion process requires more energy.

Question 46

Enteral formulas specifically for patients with COPD often contain more ____ than standard formulas.

A) carbohydrates
B) potassium
C) iron
D) fat

Question 47

What effects are most commonly seen when MODS causes lung failure?

A) bacterial translocation
B) inability to maintain optimal gas exchange
C) inability to maintain electrolyte balance
D) increased oxygen saturation

Question 48

The principle infection associated with MODS is ____.

A) gastroenteritis
B) acute kidney infection
C) a pressure ulcer
D) pneumonia

Question 49

Patients who have SIRS that persists for more than ____ are more likely to develop MODS.

A) 4 hours
B) 1 day
C) 48 hours
D) 3 days

Question 50

Multiple organ dysfunction syndrome (MODS) most often affects the kidneys, lungs, and ____.

A) brain
B) heart
C) liver
D) stomach

Question 51

Shortness of breath is also referred to as ____.

A) cyanosis
B) hypercapnia
C) dyspnea
D) hypoxia

Question 52

In what way does advancing age contribute to development of MODS?

A) Older adults do not understand what measures to take to prevent MODS.
B) Older adults take more medications that can cause side effects that lead to MODS.
C) Older adults are prone to infection because of increased skin thickening.
D) Older adults are less able to deal with the stress of critical illness.

Question 53

Which symptom is associated with systemic inflammatory response syndrome (SIRS)?

A) abnormal body temperature
B) reduced heart rates
C) abnormal red blood cell counts
D) reduced respiratory rates

Question 54

59-63. Case Study Questions  
Forty-three-year-old Joseph Delgado is an electrician for a utility company. His medical history is unremarkable, with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20 to 30% of body surface area).
What is the main nutritional goal for Joseph?

A) Increase intake to 75% of meals.
B) Increase tyrosine production.
C) Promote gluconeogenesis
D) Achieve nitrogen balance and minimize tissue losses.

Question 55

To decrease the risk of aspiration in patients with respiratory failure who need nutrition support, the health care provider should ____.

A) utilize gastric feedings
B) utilize intestinal feeding
C) decrease the amount of free water in the tube feeding
D) select a formula enriched with vitamins A, C, and E

Question 56

A patient with severe respiratory failure and on fluid restrictions would require nutrient-dense enteral formulas of ____ kcal/mL.

A) 0.5 to 1.0
B) 1.0 to 1.2
C) 1.2 to 1.5
D) 1.5 to 2.0

Question 57

What metabolic effect is most commonly seen with inhaled corticosteroids?

A) altered taste sensation
B) hypokalemia
C) hyperphosphatemia
D) exacerbated muscle loss

Question 58

Support of heart and blood vessel function during treatment of MODS is characterized by ____.

A) medications to maintain normal body temperature
B) fluid resuscitation
C) central venous access to administer antibiotics
D) mechanical ventilation

Question 59

Which of the following factors does NOT influence risk of MODS?

A) malnutrition
B) severity of tissue injury
C) age under 20 years
D) obesity

Question 60

Which treatment is most often used to manage MODS?

A) surgery
B) mechanical ventilation
C) induced hypothermia
D) membrane oxygenation

Question 62

Describe the factors associated with hormonal responses to severe stress.

Question 63

Explain the need for carbohydrate and fat intakes during acute stress.

Question 64

Discuss the factors that influence the development of multiple organ failure.

Question 65

Describe the acute inflammatory process in response to an injury or illness.

Question 66

Discuss the micronutrient needs in patients with metabolic stress, including the increased need for certain nutrients and their specific role in the healing process.

Question 67

Describe nutrition care for patients with respiratory failure; include estimation of energy needs and fluids for nutrition support.

Question 68

Discuss the systemic effects of inflammation.

Question 69

List the common therapies that are used to treat multiple organ failure and the function of each therapy.

Question 70

Describe factors that decrease food intake in patients with lung disease.

Question 71

Explain how nutrition therapy is used in burn patients.

Question 72

59-63. Case Study Questions  
Forty-three-year-old Joseph Delgado is an electrician for a utility company. His medical history is unremarkable, with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20 to 30% of body surface area).
The registered dietitian is completing her initial assessment for Mr. Delgado. When estimating his energy needs she selects ____ for his stress factor.

A) 1.0
B) 1.4
C) 1.8
D) 2.2

Question 73

59-63. Case Study Questions  
Forty-three-year-old Joseph Delgado is an electrician for a utility company. His medical history is unremarkable, with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20 to 30% of body surface area).
The nurse orders a nutrition consult because of Joseph's poor intake. What is UNLIKELY to be related to his low intake?

A) pain
B) sedation
C) feeding problems
D) positive nitrogen balance

Question 74

59-63. Case Study Questions  
Forty-three-year-old Joseph Delgado is an electrician for a utility company. His medical history is unremarkable, with no problems. He is admitted to the ICU (intensive care unit) with severe electrical burns to his hands, arms, and chest (20 to 30% of body surface area).
Having burns increases Joseph's risk for what condition?

A) osteoporosis
B) intestinal ileus
C) bronchitis
D) overhydration