Deck 16: Nutrition in Metabolic and Respiratory Stress

Question 1

Complications associated with SIRS or sepsis include all of the following except:

A)tissue edema.
B)low blood pressure.
C)hypertriglyceridemia.
D)impaired blood flow.

Answer 1

C

Question 2

Which of the following should be used to estimate the energy needs of a critically ill woman who is 5'4" and 190 pounds?

A)22-25 kcal/kg actual body weight
B)25-30 kcal/kg ideal body weight
C)11-14 kcal/kg actual body weight
D)30-35 kcal/kg ideal body weight

Answer 2

C

Question 3

Smoking is the primary risk factor in most cases of COPD.

Answer 3

True

Question 4

Overfeeding an acutely stressed patient improves nitrogen balance and decreases lean tissue losses.

Question 5

The symptoms associated with the initial inflammatory response are collectively called the systemic inflammatory response syndrome.

Question 6

The adverse effects of cortisol in prolonged stress include all of the following except:

A)muscle wasting.
B)bone loss.
C)impaired wound healing.
D)hypoglycemia.

Question 7

Which of the following compounds is produced by white blood cells and participates in the inflammatory process?

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

Question 8

The high nutrient requirements of acutely stressed patients often require a patient to be fed via the enteral or parenteral route to meet his or her nutritional needs.

Question 9

The energy expenditure of acutely stressed patients may be raised due to all of the following except:

A)fever.
B)mechanical ventilation.
C)presence of open wounds.
D)inactivity.

Question 10

Excessive energy intake in patients with ARDS can worsen respiratory function.

Question 11

The increase in basal metabolic rate as a part of the stress response can be attributed to:

A)catecholamines.
B)cortisol.
C)eicosanoids.
D)cytokines.

Question 12

Clinical findings typical of patients undergoing metabolic stress include all of the following except:

A)hyperglycemia.
B)hypermetabolism.
C)insulin resistance.
D)positive nitrogen balance.

Question 13

Recovery from an injury or illness can be hastened by hypermetabolism and positive nitrogen balance.

Question 14

Which of the following substances is derived from fatty acids?

A)cortisol
B)eicosanoids
C)antihistamines
D)cytokines

Question 15

Nutrition care for patients in acute respiratory failure is aimed at providing a low-fat, high-carbohydrate diet.

Question 16

Metabolic stress can result from uncontrolled infection or extensive tissue injury.

Question 17

One of the initial concerns for the medical team for patients hospitalized with acute stress is to:

A)maintain immune function.
B)achieve positive nitrogen balance.
C)minimize nutrient losses.
D)restore lost fluids and electrolytes.

Question 18

The inflammatory process can alter immune cell function in the body.

Question 19

An excessive response to metabolic stress can worsen illness and lead to death.

Question 20

Protein synthesis is inhibited by:

A)cortisol.
B)eicosanoids.
C)mast cells.
D)phagocytes.

Question 21

When pulmonary edema is present, a patient requires:

A)tube feeding.
B)a fluid restriction.
C)increased fluids.
D)decreased protein.
Use the following case study to answer questions 26-31.
Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident.She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition.Kati is 5'2" tall and weighs 115 pounds.

Question 22

Which of the following is not a cause of poor food intake in persons with severe COPD?

A)medications
B)dyspnea
C)lower energy needs
D)change in taste perception

Question 23

To decrease the risk of infection, it will be important to keep Kati's _____ under control while she is recovering.

A)serum albumin
B)blood glucose
C)blood pressure
D)serum prealbumin

Question 24

Which of the following methods was developed for estimating energy needs in a patient with traumatic and/or burn injuries?

A)Ireton-Jones energy equation
B)indirect calorimetry
C)Harris-Benedict equation
D)25-30 kcalories/kg body weight

Question 25

In critically ill patients, a high intake of _____ may suppress immune function and increase the risk of developing infections.

A)fat
B)dextrose
C)protein
D)zinc

Question 26

A COPD patient who complains of abdominal discomfort and dyspnea may benefit from:

A)small, frequent meals.
B)a low-fat diet.
C)a high-fiber diet.
D)consuming more liquids.

Question 27

Estimate the energy needs of a nonobese patient with sepsis who weighs 180 pounds.

A)2045-2455 kcal
B)2250-2700 kcal
C) 1980-2125 kcal
D)2365-3050 kcal

Question 28

All of the following nutrients play a critical role in immunity and wound healing except:

A)zinc.
B)vitamin A.
C)vitamin C.
D)potassium.

Question 29

Kati's protein needs will likely be calculated using a range of:

A)0.6 to 0.8 g/kg.
B)0.8 to 1.0 g/kg.
C)1.2 to 2 g/kg.
D)2 to 3 g/kg.

Question 30

Which of the following amino acids has been shown to have beneficial effects on critically ill patients?

A)leucine
B)glutamine
C)valine
D)isoleucine

Question 31

As a result of the acute-phase response, you would expect Kati's plasma concentrations of _____ to decrease.

A)glucose and cholesterol
B)sodium and potassium
C)iron and glucose
D)albumin and iron

Question 32

Medical nutrition therapy for COPD involves all of the following except:

A)promoting a healthy body weight.
B)preventing muscle loss.
C)improving food intake.
D)relieving chronic cough.

Question 33

Laura is a critically ill patient.She is 5'4" tall and weighs 150 pounds.What are Laura's protein needs?

A)34-40 grams
B)54-68 grams
C)82-136 grams
D)136-170 grams

Question 34

Estimate Kati's energy needs using the Ireton-Jones equation: 1925 + [5 * wt (kg)] - [10 * age (yr)] + (281 * sex) + (292 * trauma) + (851 * burn).

A)2288
B)2828
C)3420
D)3240

Question 35

A parenteral feeding should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute.

A)2
B)3
C)4
D)5

Question 36

Increased energy metabolism in hypermetabolic patients is associated with the need for increased amounts of:

A)vitamin C.
B)zinc.
C)B vitamins.
D)vitamin E.

Question 37

Adequate fluid intake will help the person with COPD by:

A)decreasing carbon dioxide output.
B)preventing the secretion of overly thick mucus.
C)aiding in weight loss.
D)improving oxygen consumption.

Question 38

When she arrived in the ER, the most immediate nutrition concern for Kati was:

A)restoring fluid and electrolyte balance.
B)starting parenteral nutrition.
C)estimating her energy needs.
D)assessing her swallowing ability.

Question 39

Which amino acid may have beneficial effects on the immune response of postoperative patients?

A)tryptophan
B)tyrosine
C)arginine
D)phenylalanine

Question 40

Excessive kcalorie intake in COPD patients may:

A)increase respiratory distress.
B)alter taste perception.
C)interfere with drug therapy.
D)increase gas formation.

Question 41

Nutrition support plays a role in the therapy for MODS in all of the following ways except:

A)to provide nutrients.
B)to prevent excessive wasting.
C)to promote recovery.
D)to maintain blood pressure.
Nursing Exam Review Multiple Choice

Question 42

A patient is admitted to the ER with multiple gunshot wounds.The nurse understands that the initial treatment includes:

A)initiating enteral nutrition.
B)administering IV fluids.
C)initiating PPN.
D)referral to the dietitian.

Question 43

Mrs.White is in the ICU for complications following surgery.She has been diagnosed with sepsis and is on a ventilator.In order to most accurately estimate her energy needs, the nurse recognizes that the preferred method to use is:

A)the Harris-Benedict equation.
B)the Penn State equation.
C)direct calorimetry.
D)the Mifflin-St.Jeor equation.

Question 44

A patient with ARDS requires mechanical ventilation.The nurse recognizes that fluid accumulation is a potential problem and understands that this may make it difficult to assess his:

A)weight.
B)temperature.
C)kcalorie intake.
D)fluid intake.

Question 45

A frequent cause of death among older intensive care patients with multiple or severe injuries is:

A)pulmonary edema.
B)heart attack.
C)multiple organ dysfunction syndrome.
D)stroke.

Question 46

Mr.Jones, a critically ill patient, is 5'9" tall and weighs 176 pounds.The nurse recommends that he receive a minimum of _____ grams of protein daily.

A)80
B)64
C)96
D)240

Question 47

Mr.Winslett is a COPD patient who is complaining of poor appetite, abdominal discomfort, and bloating.Which of the following is the nurse's appropriate suggestion for improving his food intake?

A)"Consume larger meals."
B)"Substitute beans for meat."
C)"Drink a supplement before eating."
D)"Eat smaller, more frequent meals."

Question 48

Mark is a 23-year-old firefighter who experienced severe burns while fighting a house fire.The nurse recognizes the fact that he may benefit from supplements of _____ to reduce the risk of infection.

A)zinc, vitamin C, and vitamin A
B)iron, zinc, and calcium
C) sodium, potassium, and chloride
D)zinc, thiamin, and riboflavin

Question 49

John has been hospitalized with a severe infection in his foot.The nurse recognizes that increasing his intake of _____ may help to suppress the inflammation.

A)protein
B)omega-3 fatty acids
C)carbohydrate
D)omega 6-fatty acids

Question 50

One of the factors that increases the risk of MODS is:

A)age over 40 years.
B)length of hospital stay.
C)length of SIRS infection.
D)obesity.

Question 51

The nurse understands that the inflammatory process can cause a variety of systemic effects and monitors her patient's:

A)heart rate, respiratory rate, and temperature.
B)heart rate, appetite, and blood pressure.
C)blood pressure, temperature, and appetite.
D)blood pressure, heart rate, and weight.

Question 52

The principal infection associated with MODS is:

A)pneumonia.
B)a fungal infection.
C)herpes simplex.
D)a viral infection.

Question 53

If Kati's enteral feeding is not providing adequate energy and protein to meet her nutritional needs, she will experience:

A)a loss of lean tissue.
B)hyperglycemia.
C)pulmonary edema.
D)sepsis.

Question 54

All of the following are therapies used to manage MODS except:

A)mechanical ventilation.
B)fluid resuscitation.
C)hemofiltration or dialysis.
D)physical therapy.

Question 55

Mr.Morgan is a critically ill patient in the ICU who is on TPN.The nurse understands that monitoring his _____ can help to determine if he is being overfed.

A)glucose levels
B)cholesterol levels
C)iron levels
D)albumin levels

Question 56

A patient who is on a tube feeding gains nine pounds in three days.The nurse realizes that this may indicate:

A)adequate nutrition.
B)excess protein intake.
C)fluid imbalance.
D)nutrient imbalance.

Question 57

The first organ to fail in MODS is normally the:

A)lungs.
B)liver.
C)kidneys.
D)heart.

Question 58

A critically ill patient with ARDS is on a tube feeding and requires a fluid restriction.The nurse understands that an appropriate enteral formula will be:

A)low residue.
B)high protein.
C)nutrient dense.
D)hydrolyzed.

Question 59

Mary is a 59-year-old patient who suffered multiple broken bones in a motor vehicle accident.She weighs 138 pounds.The nurse chooses a protein factor of 1.5 g/kg to estimate her protein needs and calculates that Mary's protein requirements are approximately _____ grams per day.

A)94
B)103
C)121
D)207

Question 60

The nurse recognizes all of the following as the classic signs of inflammation except:

A)hyperglycemia.
B)swelling.
C)redness.
D)heat.

Question 61

Why are intestinal tube feedings preferred over gastric feedings for patients with acute respiratory failure?

Question 62

Explain the metabolic effects of stress hormones and how they potentially affect the nutritional status of a patient.

Question 63

What is a "stress factor"?

Question 64

Matching

Question 65

Describe the symptoms and complications associated with SIRS.

Question 66

Describe the diet-drug interactions that may be experienced by a patient using bronchodilators.

Question 67

Discuss protein requirements in a stressed patient (include specific amino acids).

Question 68

Describe three ways to estimate energy needs in a stressed patient.

Question 69

Describe the body's hormonal responses to stress.

Question 70

Explain the metabolic effects of corticosteroid drugs.