Deck 22: Metabolic Stress and the Critically Ill

Question 1

What is the term for reduced blood flow?

A) hypotension
B) cyanosis
C) alkalosis
D) hypoperfusion
E) vasoconstriction

Answer 1

D

Question 2

Interleukin 6 (IL-6) increases the production of _____ during metabolic stress.

A) albumin
B) C-reactive protein
C) prealbumin
D) acetylcholine
E) histamine

Answer 2

B

Question 3

Which amino acid supplement is strongly recommended for burn, trauma, and ICU patients?

A) arginine
B) lysine
C) cysteine
D) tyrosine
E) glutamine

Answer 3

E

Question 4

During metabolic stress, what supplies the substrate used for gluconeogenesis?

A) breakdown of muscle tissue
B) breakdown of body fat
C) breakdown of connective tissue
D) breakdown of bone minerals
E) breakdown of brain tissue

Question 5

Which amino acid is the primary substrate required for gluconeogenesis?

A) lysine
B) arginine
C) alanine
D) glutamine
E) cysteine

Question 6

Which of the following is released in response to inflammation?

A) insulin
B) cysteine
C) histamine
D) C-reactive protein
E) lipase

Question 7

Catecholamines (epinephrine, norepinephrine) increase energy availability by stimulating glycogenolysis and increasing the release of which alternative fuel source?

A) glucose
B) galactose
C) amino acids
D) polypeptides
E) fatty acids

Question 8

How long, on average, does it take for a healthy patient to progress to protein-energy malnutrition (PEM)?

A) 48 hours
B) 1 week
C) 2 weeks
D) 4 weeks
E) 8 weeks

Question 9

Which group of viruses does HIV belong to?

A) rotavirus
B) retrovirus
C) rhabdovirus
D) picornavirus
E) reovirus

Question 10

What are the three phases of the stress response?

A) ebb phase, flow phase, recovery or resolution phase
B) injury phase, healing phase, recovery phase
C) reaction phase, adjustment phase, resolution phase
D) hyperstress phase, moderation phase, reduction phase
E) inflammation phase, reaction phase, recovery or resolution phase

Question 11

Which amino acid is a precursor for nitric oxide?

A) arginine
B) lysine
C) cysteine
D) tyrosine
E) glutamine

Question 12

Which of the following is used in copper transport?

A) ceruloplasmin
B) serum amyloid A
C) VLDL
D) C-reactive protein
E) fibronectin

Question 13

For critically ill patients, when should enteral nutrition be started in the hospital?

A) within 3-4 days
B) after about 72 hours
C) after about 60 hours
D) within the first 24-48 hours
E) immediately

Question 14

Which amino acid is the primary fuel for enterocytes within the gastrointestinal tract and for T lymphocytes?

A) lysine
B) arginine
C) alanine
D) glutamine
E) cysteine

Question 15

What happens to the basal metabolic rate during starvation?

A) no change
B) increases
C) reduces
D) wildly fluctuates
E) unpredictable

Question 16

What is the key difference between the body's physiological reaction to starvation and metabolic stress?

A) Adaptation occurs during metabolic stress.
B) Adaptation occurs during starvation.
C) Starvation can lead to death.
D) Starvation leads to weight loss.
E) Metabolic stress is not related to diet.

Question 17

Which of the following conditions causes the highest excretion of nitrogen per day from the body?

A) major trauma
B) major burn
C) starvation
D) major surgery
E) sleep deprivation

Question 18

During periods of starvation, what is the primary source of fuel?

A) protein
B) glucose
C) lipids
D) amino acids
E) connective tissue

Question 19

Which of the following vitamins should be given to metabolically stressed patients while recovering?

A) vitamins A and B₆
B) vitamins B₇and C
C) vitamins C and E
D) vitamins D and E
E) vitamins D and K

Question 20

What is the metabolic pathway through which glucose is formed from non-carbohydrate sources?

A) glycolysis
B) glucogenesis
C) glycogenesis
D) glycogenolysis
E) gluconeogenesis

Question 21

Which of the following drugs is an example of nucleoside and nucleotide reverse-transcriptase inhibitors?

A) nevirapine
B) enfuvirtide
C) zidovudine
D) saquinavir
E) elvitegravir

Question 22

Which mineral supplementation does ASPEN recommend for a critically ill patient?

A) iron
B) selenium
C) boron
D) calcium
E) magnesium

Question 23

What are the daily protein requirements for burn victims?

A) 0.5-0.7 g protein/kg IBW per day
B) 0.8-1.1 g protein/kg IBW per day
C) 1.1-1.5 g protein/kg IBW per day
D) 1.5-2 g protein/kg IBW per day
E) 1.9-2.4 g protein/kg IBW per day

Question 24

Depending on the burn size and severity, how long can the hypermetabolic stress last in burn patients?

A) 4 years
B) 2 years
C) 1 year
D) 6 months
E) 3 months

Question 25

BM is a 35-year-old firefighter who has sustained major burns and smoke inhalation. He is taken to the burn unit, and a consult with the registered dietitian has been ordered.
HT: 6'1"          WT: 180 pounds (81.6  kg)  
What would be the best way to feed him while he is in the hospital and cannot eat on his own?

A) Keep him NPO (nothing-by-mouth) indefinitely.
B) parenteral nutrition
C) gastric feeding tube
D) enteral feeding to the large bowel
E) enteral feeding to the small bowel

Question 26

Which cells in the blood are markedly increased during sepsis?

A) granulocytes
B) thrombocytes
C) platelets
D) red blood cells
E) white blood cells

Question 27

When should enteral and/or parenteral feeding be initiated after surgery?

A) as soon as possible
B) 12-15 hours post-op
C) 18-24 hours post-op
D) 1-2 days post-op
E) at least 72 hours post-op

Question 28

BM is a 35-year-old firefighter who has sustained major burns and smoke inhalation. He is taken to the burn unit, and a consult with the registered dietitian has been ordered.
HT: 6'1"          WT: 180 pounds (81.6  kg)  
The dietitian should look for a formula that contains which of the following to induce an anti-inflammatory response?

A) saturated fatty acids
B) omega-3 fatty acids
C) omega-6 fatty acids
D) probiotics
E) arginine

Question 29

Parenteral nutrition should be reserved for those cases of prolonged nothing-by-mouth (NPO) status lasting how long?

A) 7 days
B) 10 days
C) 14 days
D) 21 days
E) 28 days

Question 30

What is the most common source of burn wounds?

A) chemicals
B) electricity
C) radiation
D) magnets
E) heat

Question 31

Which factor is not correlated with the severity of electrical burns?

A) temperature
B) time of exposure
C) voltage
D) location affected
E) presence of water

Question 32

BM is a 35-year-old firefighter who has sustained major burns and smoke inhalation. He is taken to the burn unit, and a consult with the registered dietitian has been ordered.
HT: 6'1"          WT: 180 pounds (81.6  kg)  
Wh ich of the following amino acid supplements does the dietitian recommend to stimulate the GI tract?

A) alanine
B) arginine
C) glutamine
D) lysine
E) cysteine

Question 33

Which of the following primarily occurs when a human body is infected by HIV?

A) reduction in CD4 cell counts
B) increase in serum bilirubin
C) increase in monocyte counts
D) reduction in RBC counts
E) increase in serum glucose

Question 34

BM is a 35-year-old firefighter who has sustained major burns and smoke inhalation. He is taken to the burn unit, and a consult with the registered dietitian has been ordered.
HT: 6'1"          WT: 180 pounds (81.6  kg)  
Approximately how many grams of protein does BM require while he is in the hospital?

A) 123 g
B) 150 g
C) 65 g
D) 94 g
E) 87 g

Question 35

Enteral nutrition formulas for burn patients should be high in which nutrients?

A) saturated fat and sucrose
B) monounsaturated fat and glucose
C) essential amino acids and simple carbohydrates
D) protein and omega-6 fatty acids
E) protein and omega-3 fatty acids

Question 36

BM is a 35-year-old firefighter who has sustained major burns and smoke inhalation. He is taken to the burn unit, and a consult with the registered dietitian has been ordered.
HT: 6'1"          WT: 180 pounds (81.6  kg)  
What is the best way to estimate his caloric needs?

A) Harris-Benedict equation
B) Curreri equation
C) Fick equation
D) indirect calorimetry
E) ESPEN guidelines

Question 37

How many genes are present in the human immunodeficiency virus (HIV)?

A) 12
B) 16
C) 9
D) 6
E) 3

Question 38

Which enteral formula has the highest percentage of lipids?

A) Perative^®
B) Pivot^®
C) Crucial^®
D) Oxepa^®
E) Impact^®

Question 39

Which mineral supplements are most important for burn victims?

A) iron and calcium
B) zinc and selenium
C) calcium and magnesium
D) boron and selenium
E) zinc and iron

Question 40

What is the most common source of burn wounds?

A) chemicals
B) electricity
C) radiation
D) magnets
E) heat

Question 41

One of the most important distinctions between starvation and metabolic stress is the difference in _______________ and fuel substrate requirements.

Question 42

The increased rate of gluconeogenesis during the stress response creates reliance on protein as a source of _______________.

Question 43

Increased levels of glucagon serve to increase glucose production from amino acids-a process called _______________.

Question 44

Energy requirements are _______________ during metabolic stress and injury.

Question 45

The depth of the wound and the percentage of the body surface area (BSA) that is affected are used to classify burn injury.

Question 46

In burn patients, _______________ nutrition that is initiated within 24 hours of injury has been associated with prevention of infections, the prevention of Curling's ulcer, and the reduction of protein catabolism.

Question 47

Metabolic stress is the hypermetabolic, catabolic response to acute injury or disease.

Question 48

Compared to parenteral nutrition, _______________ is more cost-effective and is associated with reduced infectious complications, fewer surgical interventions, and fewer hospital days.

Question 49

Negative _______________ balance is a consistent marker of metabolic stress.

Question 50

For critically ill individuals, nutritional needs can normally be met by the oral route.

Question 51

For normal-weight individuals, _______________ kcal/kg of actual body weight per day is recommended during critical illness.

Question 52

Many general surgical procedures do not pose a nutritional risk.

Question 53

Indirect calorimetry is the method of choice to establish energy and protein requirements for the critically ill.

Question 54

Release of either glucagon or cortisol can result in _______________ during the stress response.

Question 55

When providing nutrition support to the critically ill, it is crucial to avoid _______________ and its subsequent metabolic complications, which include increased _______________ production and hyperglycemia.

Question 56

Once access to the GI tract has been established, the first step in developing the nutrition prescription is choosing the appropriate enteral formula.

Question 57

HIV RNA is transcribed to DNA particles using reverse-transcriptase enzymes.

Question 58

It was not until the hallmark studies of Dr. Ancel Keys that the manner in which the body responds to starvation through physiological adaptations was understood.

Question 59

Weaning from nutritional support is recommended when the patient is able to meet at least 25% of nutritional needs orally.

Question 60

The degree of metabolic stress is inversely proportionate to the seriousness of the injury.

Question 61

Describe how severe burn injuries affect the nutrition assessment.

Question 62

Inflammation results in vascular _______________, which is caused by high levels of nitric oxide.

Question 63

HIV is most typically transmitted via blood through sexual contact, blood _______________, intravenous needle sharing, and _______________ through blood or breast milk.

Question 64

Describe the effects general anesthesia can have on the GI tract and how this affects postoperative feeding recommendations.

Question 65

Sepsis is actually a(n) _______________ process that prevents an adequate response to infection.

Question 66

Explain why nutrition therapy is so important for burn injuries.

Question 67

Combination _______________ testing for both antigen and antibodies allows for earlier diagnosis of HIV infection.

Question 68

Discuss the importance of glutamine during times of metabolic stress.

Question 69

Available assays to identify early HIV infection evaluate _______________ antigen levels and titers of viral RNA or DNA

Question 70

_______________ burns destroy all layers of the skin and can involve underlying muscle, organs, and bone.

Question 71

Explain what methods are used to feed the critically ill and when weaning can occur.

Question 72

Substrates such as inulin, guar gum, and other soluble fibers are fermented in the gut to _______________ and lactate.

Question 73

Omega-3 fatty acids can serve to reduce the _______________ cytokines that are involved in systemic inflammatory conditions and metabolic stress.

Question 74

Describe the clinical manifestations of the physiological response to stress.

Question 75

General anesthesia may result in a post-operative _______________.

Question 76

Provide a comprehensive definition of sepsis.

Question 77

List the four types of external forces that can cause burns.

Question 78

Describe the main objectives of nutritional support for the critically ill.

Question 79

Patients are required to refrain from eating or drinking for at least _______________ hours before surgery.

Question 80

Describe the metabolic consequences of injury and stress.