Deck 23: Nutrition Assessment

Question 1

In which of the following patients would indirect calorimetry be indicated?
1) Patients who are difficult to wean from mechanical ventilation
2) Patients with morbid obesity
3) Patients with a high level of stress

A)1 only
B)1 and 2 only
C)1 and 3 only
D)3 only

Answer 1

C

Question 2

What is the normal BMI for adults?

A) 15.5 to 20.6 kg/m²
B) 18.5 to 24.9 kg/m²
C) 20.6 to 25.9 kg/m²
D) 22.5 to 26.0 kg/m²

Answer 2

B
Explanation: A healthy weight may be confirmed by a BMI of between 18.5 and 24.9 kg/m² for adults or a BMI-for-age between the tenth and eighty-fifth percentiles for children.

Question 3

Your patient is reported to be cachexic. Which of the following physical findings would support this statement?

A) The patient's belly is swollen.
B) The patient has facial edema.
C) The patient's ribs protrude.
D) The patient's hair falls out easily.

Answer 3

C
Explanation: Patients with persistent malnutrition will often appear very thin to the point that their ribs and bony structures of the chest are very visible. The patient is said to be cachexic in such cases.

Question 4

Protein-energy malnutrition may be reflected in reduced values for which of the following?
1) Albumin levels
2) Lymphocyte count
3) Transferrin
4) Red blood cell count

A)1, 2, and 3 only
B)1 and 2 only
C)2 and 4 only
D)3 and 4 only

Question 5

Obesity is defined as a BMI over what value?

A) 20 kg/m²
B) 25 kg/m²
C) 30 kg/m²
D) 35 kg/m²

Question 6

What is the primary purpose of nutrition assessment?

A) To identify how much weight the patient needs to lose
B) To identify the patient's ideal body weight
C) To develop a nutrition care plan
D) To identify the proper caloric intake for the patient

Question 7

Your male patient has a creatinine excretion level of 8 mg/kg body weight/day. What does this indicate?

A) It is normal.
B) There is mild muscle wasting.
C) There is moderate muscle wasting.
D) There is severe muscle wasting.

Question 8

What procedure is used to overcome the limitations associated with estimating resting energy expenditures?

A) Measuring blood glucose before and after exercise
B) Monitoring body temperature during heavy exercise
C) Indirect calorimetry
D) The Douglas procedure

Question 9

What is the recommended measurement for nitrogen balance?

A) Blood urea nitrogen
B) Serum urea nitrogen
C) Urinary nitrogen
D) Urinary urea nitrogen

Question 10

Which of the following statements is true regarding kwashiorkor?
1) Occurs with a long-term loss of protein.
2) Often causes facial and limb edema.
3) Child often has a pot belly.
4) May occur in combination with marasmus.

A)1, 2, and 3 only
B)2 and 3 only
C)2, 3, and 4 only
D)1 and 4 only

Question 11

Which of the following is not considered part of the anthropometric assessment?

A) Body mass index
B) Activity level
C) History of weight loss
D) Triceps skin fold

Question 12

If your patient is 2 m in height and weighs 80 kg, what is his body mass index (BMI)?

A) 40 kg/m²
B) 30 kg/m²
C) 20 kg/m²
D) 15 kg/m²

Question 13

Which of the following blood tests is most useful for day-to-day monitoring of long-term trends in the nutrition status of the patient?

A) Albumin levels
B) Total white blood cell count
C) Hematocrit
D) Serum potassium levels

Question 14

Which of the following pieces of equipment is not needed to perform indirect calorimetry?

A) Oxygen analyzer
B) Tissot spirometer
C) Douglas bag
D) Nitrogen analyzer

Question 15

What is the classic measure of energy expenditure?

A) Basal oxygen consumption
B) Basal metabolic rate (BMR)
C) Resting caloric uptake
D) Resting carbon dioxide production

Question 16

When is the basal metabolic rate (BMR) best obtained?

A) After 10 hr of fasting
B) While walking on a treadmill
C) On rising in the morning
D) 1 hr after lunch

Question 17

Which of the following complications is least likely to influence creatinine excretion?

A) Sepsis
B) Trauma
C) Hypoxemia
D) Diet

Question 18

What probably represents the most significant problem while performing calorimetry on a patient being mechanically ventilated?

A) Compensating for mechanical dead space
B) Leaks in the circuit
C) Volume compression during inspiration
D) High PEEP levels

Question 19

Which of the following statements is false regarding energy needs?

A) They vary with state of health.
B) They vary with activity level.
C) They are increased with obese patients.
D) They increase with sepsis.

Question 20

What changes in lung function are associated with malnutrition?

A) Reduced VC
B) Increased TLC
C) Increased RV
D) Decreased FRC

Question 21

Which of the following diseases is/are associated with protein-energy malnutrition (PEM)?
1) Asthma
2) Emphysema
3) Cancer

A)1 only
B)1 and 2 only
C)2 and 3 only
D)3 only

Question 22

Which of the following has an RQ of 1.0?

A) Fat
B) Carbohydrates
C) Protein
D) Soy

Question 23

What tube feeding method is associated with an increased risk of aspiration?

A) Bolus
B) Intermittent
C) Continuous drip
D) Pressurized

Question 24

Which of the following is associated with primary protein-energy malnutrition (PEM)?

A) Poor diet due to living in a developing country
B) Anorexia
C) Malabsorption
D) Severe infection

Question 25

Ideally, approximately what percent of a patient's estimated calorie needs should be provided by protein?

A) 20%
B) 40%
C) 50%
D) 60%

Question 26

Which of the following metabolism issues is not associated with systemic inflammatory response syndrome (SIRS)?

A) Hypoglycemia
B) Protein catabolism
C) Increased macronutrient requirement
D) Triglyceride intolerance

Question 27

What tube feeding method must be used when the food substance is delivered beyond the pylorus?

A) Bolus
B) Intermittent
C) Continuous drip
D) Pressurized

Question 28

What are the primary goals of nutritional support during mechanical ventilation?
1) Avoid loss of lean body mass.
2) Avoid lung infection.
3) Keep muscles of breathing strong enough for weaning.

A)1 only
B)1 and 2 only
C)1 and 3 only
D)1, 2, and 3

Question 29

Which of the following illnesses are associated with acute catabolic disease?
1) Trauma
2) Sepsis
3) Burns
4) Pulmonary embolism

A)3 only
B)1, 2, and 3 only
C)2, 3, and 4 only
D)3 and 4 only

Question 30

Which of the following is not associated with magnesium deficiencies?

A) Reduced diaphragm strength
B) Neurologic abnormalities
C) Cardiac abnormalities
D) Liver enlargement

Question 31

Which of the following are reasons to use enteral feeding over parenteral?
1) Reduced incidence of stress ulcers.
2) Enteral route may avoid intestinal atrophy.
3) Enteral causes less hypoglycemia.
4) Enteral is safer and cheaper.

A)1 and 3 only
B)1, 2, and 4 only
C)2 and 3 only
D)3 and 4 only

Question 32

What effect does high carbohydrate intake have on metabolism?

A) Increases CO₂ production.
B) Reduces oxygen consumption.
C) Increases caloric needs.
D) Reduces protein catabolism.

Question 33

Which of the following abnormalities in the respiratory system is/are associated with malnutrition?
1) Reduced hypoxic drive
2) Increased airway clearance
3) Loss of lung surfactant

A)1 only
B)1 and 3 only
C)2 and 3 only
D)2 only

Question 34

Which of the following is associated with acute cardiac muscle weakness and potential cardiopulmonary failure?

A) Hyperkalemia
B) Hypophosphatemia
C) Hypernatremia
D) Low folic acid levels

Question 35

Which of the following statements is false regarding malnutrition in patients with chronic obstructive pulmonary disease (COPD)?

A) Use of a nasal cannula may contribute to the problem.
B) Depression is common and may reduce appetite.
C) A high work of breathing increases caloric needs.
D) Vitamin deficiencies increased the need for oxygen.

Question 36

What does the RQ represent?

A) Matching of respiration to perfusion
B) Ratio of the moles of CO₂ produced to O₂ consumed
C) Ratio of O₂ consumed to kilograms of ideal body weight
D) Ratio of calories consumed to CO₂ produced

Question 37

Which of the following situations is not an indication for enteral nutritional support?

A) Burns over 30% of the body surface area
B) Persistent inability to eat orally
C) Severe pancreatitis
D) Renal failure

Question 38

Why raise the head of the bed during tube feedings?

A) It reduces the time needed.
B) It improves absorption.
C) It reduces the risk of aspiration.
D) It is easier for the caregiver.

Question 39

Which of the following is not associated with zinc deficiencies?

A) Poor blood clotting
B) Impaired wound healing
C) Bronchospasm
D) Reduced immunity

Question 40

What percent of the patient's caloric intake should come from fat in most circumstances?

A) 10% to 15%
B) 20% to 30%
C) 30% to 40%
D) 40% to 50%

Question 41

Which of the following pulmonary diseases is similar to chronic obstructive pulmonary disease with regard to metabolic abnormalities?

A) Asthma
B) Cystic fibrosis
C) Pulmonary fibrosis
D) Acute respiratory distress syndrome

Question 42

Which of the following tools for nutritional assessment requires the patient to maintain a daily record of food intake for a 3- or 7-day period?

A) The 24-hr recall
B) Usual intake recall
C) Food frequency questionnaire
D) Food diary

Question 43

Which of the following is not a nutritional goal for the management of a cystic fibrosis patient?

A) Maximize nutritional intake.
B) Meet clinical and psychological needs.
C) Avoid caloric dense foods.
D) Encourage mineral and vitamin supplementation.

Question 44

Which of the following instructions must be followed to prepare a patient for indirect calorimetry?
1) Suction the patient 30 min before the test.
2) Fasting 10 hr before test.
3) Avoid physical activity 4 hr before the test.
4) 24-hr urine urea nitrogen collection.

A)1 and 2 only
B)2, 3, and 4 only
C)4 only
D)3 and 4 only

Question 45

Which of the following statements is false with regard to nutritional support of the patient with advanced chronic obstructive pulmonary disease?

A) Provide low-calorie options.
B) Provide high-protein nutrition.
C) Provide small, frequent meals.
D) Provide good patient education.

Question 46

Morbid obesity is defined as a BMI over what value?

A) 20 kg/m²
B) 25 kg/m²
C) 30 kg/m²
D) 35 kg/m²