Question 1

Nutrition support cannot replete lean body mass&#10;A)in starvation-related malnutrition.&#10;B)in patients with MODS and SIRS.&#10;C)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 2

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 emphasis of care immediately after an injury should be replenishing fluid and electrolytes while trying to eliminate the cause of the inflicting stress.Weight gain, an increase in lean body mass, and promotion of a positive nitrogen balance 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.

Question 3

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

Hypoalbuminemia reflects severe illness, injury, and inflammation; thus, serum albumin should not be used as a marker of nutritional status in critically ill patients.

Question 4

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

Surgical morbidity correlates best with the extent of the primary disease and the nature of the operation performed.A well-nourished patient usually tolerates major surgery better than a severely malnourished patient.Assessment of nutritional status before surgery should include BMI and serum proteins, but albumin results must be used with caution because they are affected by many things other than nutrition.

Question 5

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.Either direct damage can lead to fistula or prolonged injury and stress reroute circulatory support to the intestine, promoting weakening and loss of the mucosa.Intestinal bacteria may slip between mucosal cells or through fistulas into the bloodstream, thus promoting the systemic response.

Question 6

The preferred method for estimating energy needs in a hypermetabolic patient is&#10;A)25-30 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 7

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 8

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 adequacy of energy and protein intake is best evaluated by monitoring healing, graft take and some nutrition assessment parameters such as weight.The problem with using weight on its own is that it can be difficult to obtain accurate weights because of fluid shifts, edema, and wound dressings.Indirect calorimetry is used to measure energy expenditure.Serum albumin remains depressed until major burns are healed.Proteins with shorter half-lives such as prealbumin help to assess the resolution of the inflammatory response and the adequacy of nutrition support therapy.

Question 9

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

Accepted Answer

A second-degree burn causes damage down through both the epidermis and dermis.These burns tend to be painful because of the damage to nerve endings in the dermal layer.A fourth-degree burn can go as deep as the muscle or bone.First-degree burns only affect the epidermis.A third-degree burn goes as deep as the subcutaneous tissue.

Question 10

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

Accepted Answer

Cortisol is the counterregulatory hormone released in response to stimulation by adrenocorticotropic hormone (ACTH).Cortisol increases muscle catabolism and promotes hepatic use of amino acids in gluconeogenesis and acute-phase protein synthesis.Glucagon and epinephrine also stimulate gluconeogenesis and glycogenolysis to increase glucose availability during stress.

Question 11

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 12

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...

Question 13

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)Anti-inflammatory proteins

Accepted Answer

The answer of What are interleukin 1, interleukin 6, and...

Question 14

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 15

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

The answer of Multiple organ dysfunction syndrome (MODS) generally begins...

Question 16

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 17

In what type of patient should immune modulating formulas be avoided?&#10;A)Patients undergoing GI surgery&#10;B)Patients with sepsis&#10;C)Patients with diarrhea&#10;D)Burn patients

Accepted Answer

The answer of In what type of patient should immune...

Question 18

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

The answer of Which of the following statements is NOT...

Question 19

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

The answer of A patient would be given enteral nutrition...

Question 20

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

The answer of Which of the following occurs during the...

Deck 39: Medical and Nutrition Therapy for Metabolic Stress: Sepsis, Trauma, Burns, and Surgery