Deck 24: Energy- and Protein-Modified Diets for 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

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.

Answer 2

D

Question 3

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

Answer 3

False

Question 4

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

Question 5

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

Question 6

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 7

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 8

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 9

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

Question 10

The nutrition objectives during stress are to provide a diet that does all of the following except:

A)maintains immune defenses.
B)promotes healing.
C)increases hypermetabolism.
D)preserves muscle tissue.

Question 11

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 12

Protein synthesis is inhibited by excess production of:

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

Question 13

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

Question 14

The symptoms associated with the whole-body inflammatory response to severe illness are collectively called the systemic inflammatory response syndrome.

Question 15

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

Question 16

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 17

Which of the following substances is derived from fatty acids?

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

Question 18

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 19

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

Question 20

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

Question 21

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 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

Case Study Questions
Use the following case study to answer questions
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.
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 24

Case Study Questions
Use the following case study to answer questions
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.
Estimate Kati's energy needs using the Ireton-Jones equation: 1925 + [5  wt (kg)] - [10  age (yr)] + (281  sex) + (292  trauma) + (851  burn).You must insert the appropriate numbers for gender, trauma, and burn.

A)2288
B)2569
C)3420
D)3240

Question 25

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 26

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 27

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 28

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 29

Case Study Questions
Use the following case study to answer questions
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.
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 30

Which of the following methods was developed for estimating energy needs in a ventilator-dependent 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 31

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 32

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 33

Case Study Questions
Use the following case study to answer questions
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.
most immediate nutrition concern for Kati is:

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

Question 34

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

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

Question 35

Case Study Questions
Use the following case study to answer questions
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.
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 36

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 37

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

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

Question 38

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

A)34-40 grams
B)54-60 grams
C)105-136 grams
D)136-204 grams

Question 39

pulmonary edema is present, a patient requires:

A)tube feeding.
B)a fluid restriction.
C)increased fluids.
D)decreased protein.

Question 40

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 41

Jones experienced a burn and is currently in a state of stress.Mr.Jones is 5'9" tall and weighs 176 pounds.The nurse recommends that he receive a minimum of _____ grams of protein per day.

A)80
B)120
C)160
D)240

Question 42

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 43

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 minerals such as _____ to reduce the risk of infection.

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

Question 44

of the following are therapies used to manage MODS except:

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

Question 45

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 46

Mr.Morgan is an acutely stressed patient in the ICU who is on TPN.The nurse understands that monitoring the patient's _____ can help to determine if the patient is being overfed.

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

Question 47

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 48

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

A)providing nutrients.
B)preventing excessive wasting.
C)promoting recovery.
D)maintaining blood pressure.

Question 49

first organ to fail in MODS is normally the:

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

Question 50

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 51

Case Study Questions
Use the following case study to answer questions
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.
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 52

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 53

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 54

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

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

Question 55

principal infection associated with MODS is:

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

Question 56

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

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

Question 57

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 58

of the factors that increases the risk of MODS is:

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

Question 59

Case Study Questions
Use the following case study to answer questions
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.
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 60

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 Ireton-Jones equation.
C)direct calorimetry.
D)the Mifflin-St.Jeor equation.

Question 61

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

Question 62

Describe the symptoms and complications associated with SIRS.

Question 63

1.Describe the body's hormonal responses to stress.

Question 64

What is a "stress factor"?

Question 65

Explain the metabolic effects of corticosteroid drugs.

Question 66

Case Study
Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling.She suffered head and chest trauma as well as multiple broken bones.Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS.She is being fed enterally.Her mother reports that she is 5'7" tall and weighs approximately 140 pounds.
What are the potential diet-drug interactions Caroline might experience?

Question 67

Case Study
Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling.She suffered head and chest trauma as well as multiple broken bones.Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS.She is being fed enterally.Her mother reports that she is 5'7" tall and weighs approximately 140 pounds.
What kind of medications might be prescribed for Caroline? Why?

Question 68

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

Question 69

Differentiate between how energy needs are estimated for a non-obese patient versus an obese patient.

Question 70

Case Study
Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling.She suffered head and chest trauma as well as multiple broken bones.Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS.She is being fed enterally.Her mother reports that she is 5'7" tall and weighs approximately 140 pounds.
Why is Caroline likely to experience negative nitrogen balance despite being provided with adequate protein?

Question 71

Case Study
Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling.She suffered head and chest trauma as well as multiple broken bones.Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS.She is being fed enterally.Her mother reports that she is 5'7" tall and weighs approximately 140 pounds.
a.Estimate Caroline's energy needs using the Ireton-Jones equation:
1925 + [5 × wt (kg)] - [10 × age (yr)] + (281 × sex) + (292 × trauma) + (851 × burn).
You must insert the appropriate numbers for gender and trauma.
b.Estimate Caroline's protein needs based on mild to moderation lung injury.

Question 72

Case Study
Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling.She suffered head and chest trauma as well as multiple broken bones.Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS.She is being fed enterally.Her mother reports that she is 5'7" tall and weighs approximately 140 pounds.
Where is Caroline's feeding tube likely located? Why?

Question 73

Case Study
Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling.She suffered head and chest trauma as well as multiple broken bones.Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS.She is being fed enterally.Her mother reports that she is 5'7" tall and weighs approximately 140 pounds.
What type of enteral formula is best for Caroline at this time?