Deck 38: Medical Nutrition Therapy in Critical Care

Question 1

What type of nutrition should be avoided in a SIRS patient?

A)Soluble fiber
B)Insoluble fiber
C)Omega-3 fat
D)Polymeric

Answer 1

B
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

A)in starvation-related malnutrition.
B)in patients with MODS and SIRS.
C)in chronic disease-related malnutrition.
D)after GI surgery.

Answer 2

B
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?

A)Injury or disruption of the gut barrier function allows bacterial translocation to occur.
B)Active feeding of the gut promotes the migration of gut-associated lymphoid tissue.
C)Bypassing feeding of the gut via parenteral nutrition promotes infection through open access to the blood system.
D)Foodborne illness promotes absorption of foodborne pathogens, increasing infection.

Answer 3

A
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?

A)Promote weight gain.
B)Increase lean body mass and strength.
C)Establish fluid and electrolyte balance.
D)Promote a positive nitrogen balance.

Question 5

Multiple organ dysfunction syndrome (MODS) generally begins with

A)coagulopathy.
B)lung failure.
C)liver failure.
D)intestinal failure.

Question 6

Which of the following occurs during the ebb phase of injury?

A)Hypovolemic shock
B)Release of catecholamines
C)Increased metabolic rate
D)Hyperglycemia

Question 7

Which of the following statements is NOT true about cortisol?

A)It is released from the adrenal cortex.
B)It accelerates skeletal muscle catabolism.
C)It promotes acute-phase protein synthesis.
D)It promotes hypoglycemia.

Question 8

The preferred method for estimating energy needs in a hypermetabolic patient is

A)25 to 30 kcal/kg.
B)indirect calorimetry.
C)the DRIs.
D)nitrogen balance.

Question 9

A patient would be given enteral nutrition if the patient had

A)a high-output fistula.
B)intractable vomiting.
C)high doses of catecholamine agents.
D)acute pancreatitis.

Question 10

Which mineral may be lost and need replacement in burn patients being treated with silver nitrate soaks?

A)Calcium
B)Phosphorus
C)Magnesium
D)Zinc

Question 11

In surgical patients, what factor is the strongest predictor of postoperative mortality?

A)Extent of the primary disease and operation performed
B)Serum albumin
C)BMI
D)Age

Question 12

How deep is a second-degree burn?

A)Muscle
B)Epidermis
C)Dermis
D)Subcutaneous tissue

Question 13

Which of the following is a criterion in the diagnosis of SIRS?

A)Shock
B)Ileus
C)Bandemia
D)Multiple trauma

Question 14

Which hormone promotes the synthesis of acute-phase proteins?

A)Glucagon
B)Cortisol
C)Epinephrine
D)ACTH

Question 15

In contrast to stress, which of the following is a characteristic of starvation?

A)Increased resting energy expenditure
B)Decreased energy expenditure
C)Increased gluconeogenesis
D)Increased nitrogen excretion

Question 16

The adequacy of energy and protein intake after burn injury is best evaluated by

A)monitoring weight.
B)using indirect calorimetry.
C)monitoring wound healing and graft take.
D)monitoring albumin level.

Question 17

What are interleukin-1, interleukin-6, and tumor necrosis factor examples of?

A)Catecholamines
B)Acute phase proteins
C)Cytokines
D)Antiinflammatory proteins

Question 18

In critically ill patients, what is the recommended range for maintaining serum glucose?

A)120 to 150 mg/dl
B)150 to 200 mg/dl
C)80 to 110 mg/dl
D)150 to 180 mg/dl

Question 19

Low albumin in a critically ill patient is caused by

A)inadequate protein intake.
B)illness, injury, and inflammation.
C)inadequate calorie intake.
D)inadequate fluid intake.

Question 20

Which of the following may have a role in supporting tight junctions between the intraepithelial cells in the gut?

A)Parenteral nutrition
B)Positive nitrogen balance
C)Gut rest
D)Enteral feedings