Deck 38: Medical Nutrition Therapy in Critical Care

Question 1

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.

Answer 1

D
Explanation: Cortisol, which is released from the adrenal cortex in response to stimulation by adrenocorticotropic hormone secreted by the anterior pituitary, enhances skeletal muscle catabolism and promotes hepatic use of amino acids for gluconeogenesis, glycogenolysis, and acute-phase protein synthesis. Hyperglycemia is generally observed during stress.

Question 2

How deep is a second-degree burn?

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

Answer 2

C
Explanation: 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 3

Which hormone promotes the synthesis of acute-phase proteins?

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

Answer 3

B
Explanation: 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 4

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

Question 5

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

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

Question 6

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 7

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.

Question 8

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 9

Multiple organ dysfunction syndrome (MODS) generally begins with

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

Question 10

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 11

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

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

Question 12

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 13

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 14

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 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

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

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

Question 17

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 18

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 19

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.

Question 20

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