Deck 24: Energy - and Protein - Modified Diets for Metabolic and Respiratory Stress

Question 1

The nutrition goals during stress are to provide a diet that meets all of these objectives except _____.

A) ​maintains immune defenses
B) ​promotes healing
C) ​increases hypermetabolism
D) ​preserves muscle tissue
E) ​reverses negative nitrogen balance

Answer 1

C

Question 2

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.​

Answer 2

True

Question 3

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

Answer 3

False

Question 4

All of these complications are associated with SIRS or sepsis except _____.

A) ​tissue edema
B) ​low blood pressure
C) ​hypertriglyceridemia
D) ​impaired blood flow
E) ​decreased oxygen delivery to tissue

Question 5

Excessive energy intake in patients with acute respiratory distress syndrome (ARDS) can worsen respiratory function.

Question 6

During prolonged stress, cortisol causes all of these adverse effects except _____.

A) ​muscle wasting
B) ​bone loss
C) ​impaired wound healing
D) ​hypoglycemia
E) ​skin thinning

Question 7

Clinical findings typical of patients undergoing metabolic stress include all of these factors except _____.

A) ​hyperglycemia
B) ​hypermetabolism
C) ​insulin resistance
D) ​positive nitrogen balance
E) ​protein loss

Question 8

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

Question 9

Protein synthesis is inhibited by excess production of _____.

A) ​cortisol
B) ​eicosanoids
C) ​mast cells
D) ​phagocytes
E) ​epinephrine

Question 10

Overfeeding an acutely stressed patient can lead to _____.

A) ​fever
B) ​mechanical ventilation
C) ​abscesses
D) ​inactivity
E) ​refeeding syndrome

Question 11

Which substance is derived from dietary fatty acids?

A) ​cortisol
B) ​eicosanoids
C) ​antihistamines
D) ​cytokines
E) ​epinephrine

Question 12

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

Question 13

The increase in basal metabolic rate that occurs as part of the stress response can be attributed to _____.

A) ​catecholamines
B) ​cortisol
C) ​eicosanoids
D) ​cytokines
E) ​acetylcholine

Question 14

Smoking is the primary risk factor in most cases of chronic obstructive pulmonary disease (COPD).

Question 15

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

Question 16

Which compound is produced by white blood cells and participates in the inflammatory process?

A) ​glucagon
B) ​catecholamines
C) ​cytokines
D) ​cortisol
E) ​histamine

Question 17

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

Question 18

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

Question 19

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

Question 20

One of the initial concerns 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
E) ​increase insulin levels

Question 21

An increase in _____ is needed to support the increase in energy metabolism in hypermetabolic patients.​

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

Question 22

Which nutrient plays a critical role in immunity and wound healing?

A) ​zinc
B) ​vitamin B
C) ​vitamin D
D) ​potassium
E) ​calcium

Question 23

All these therapies are used to manage MODS except ______.​

A) ​mechanical ventilation
B) ​fluid resuscitation
C) ​hemofiltration or dialysis
D) ​physical therapy
E) ​nutritional support

Question 24

Laura is an intensive care, non-obese, acute stress patient. She weighs 150 pounds. What are Laura's approximate maximum daily protein needs?

A) 20 to 40 grams
B) ​50 to 60 grams
C) ​70 to 80 grams
D) ​80 to 135 grams
E) ​150 to 200 grams

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
E) ​glucose

Question 26

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
E) ​improving ventilation

Question 27

When pulmonary edema is present, a patient requires _____.

A) ​tube feeding
B) ​fluid restriction
C) ​increased fluids
D) ​decreased protein
E) ​increased ventilation

Question 28

Which condition gives the highest stress factor for an acute illness?​

A) ​intensive care
B) ​acute kidney injury
C) ​burns
D) ​acute inflammation
E) ​acute pancreatitis

Question 29

Which factor 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
E) ​loss of sense of smell

Question 30

To prevent hyperglycemia, parenteral feedings should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute.

A) ​2
B) ​3
C) ​4
D) ​5
E) ​6

Question 31

Medical nutrition therapy for COPD is designed to meet all of these goals except _____.

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

Question 32

Which amino acid may improve infection, muscle mass, and mortality rates in critically ill patients?

A) ​leucine
B) ​glutamine
C) ​valine
D) ​isoleucine
E) ​glycine

Question 33

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

A) ​pulmonary edema
B) ​hyperosmolar hyperglycemic syndrome
C) ​multiple organ dysfunction syndrome (MODS)
D) ​stroke
E) ​neurological failure

Question 34

Which amino acid may have beneficial effects on infection rates and wound healing in postoperative patients?

A) ​glutamine
B) ​tyrosine
C) ​arginine
D) ​phenylalanine
E) ​glycine

Question 35

The first organ(s) to fail in multiple organ dysfunction syndrome (MODS) is/are normally the _____.​

A) ​lungs
B) ​liver
C) ​kidneys
D) ​heart
E) ​GI tract

Question 36

Excessive kcalorie intake in COPD patients may _____.

A) ​increase respiratory distress
B) ​alter taste perception
C) ​interfere with drug therapy
D) ​increase gas formation
E) ​decreases carbon dioxide levels

Question 37

Which method is used to measure the energy requirements for intensive care patients?

A) ​Mifflin-St. Jeor equation
B) ​indirect calorimetry
C) ​Penn State equation
D) ​estimate needs using 15-20 kcalories/kg body weight
E) ​lung function tests

Question 38

The principal infection associated with MODS is _____.

A) ​pneumonia
B) ​a fungal infection
C) ​herpes simplex
D) ​a viral infection
E) ​COPD

Question 39

One of the factors that increases the risk of MODS is _____.

A) ​age over 40 years
B) ​length of hospital stay
C) ​malnutrition
D) ​underweight
E) ​gender

Question 40

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
E) ​lying down

Question 41

The stress response is the body's _____ response to a variety of stressors.​

A) ​nonspecific
B) ​localized
C) ​cell-mediated
D) ​hypometabolic
E) ​specific

Question 42

Which action is not attributed to cortisol?

A) ​muscle degradation
B) ​raising blood levels of amino acids
C) ​raising blood levels of glucose
D) ​breakdown of triglycerides
E) ​decreased urine output

Question 43

Mr. Morgan is an acutely stressed patient in intensive care who is on total parenteral nutrition (TPN). Monitoring Mr. Morgan's blood _____ levels can help to ensure that excessive amounts of nutrients are not given intravenously.​

A) ​glucose
B) ​cholesterol
C) ​trace mineral
D) ​albumin
E) ​uric acid

Question 44

All of these factors are classic signs of inflammation except _____.​

A) ​hyperglycemia
B) ​swelling
C) ​redness
D) ​heat
E) ​pain

Question 45

Which procedure is not an initial treatment of acute stress?

A) ​administering fluids
B) ​treating infections
C) ​mechanical ventilation
D) ​repairing wounds
E) ​debridement

Question 46

Most critical care patients require between _____ kcalories per kg per day.

A) ​5-10
B) ​10-15
C) ​15-20
D) ​25-30
E) ​35-40

Question 47

Which chemical messengers are catecholamines?

A) ​acetylcholine
B) ​aldosterone and cortisol
C) ​cytokines and histamine
D) ​sodium and potassium
E) ​epinephrine and norepinephrine

Question 48

In patients with severe hyperglycemia, fat may supply up to ____ percent of kcalories.

A) ​20
B) ​30
C) ​40
D) ​50
E) ​60

Question 49

The benefits of adding _____ to the diets of acutely stressed patients is controversial.

A) ​glutamine and creatine
B) ​glycine and C-reactive peptide
C) ​serine and arginine
D) ​arginine and glutamine
E) ​alanine and glutamine

Question 50

A patient who is on a tube feeding gains nine pounds in three days. This may indicate _____.​

A) ​adequate nutrition
B) ​excess protein intake
C) ​fluid imbalance
D) ​nutrient imbalance
E) ​respiratory dysfunction

Question 51

John has been hospitalized with a severe infection in his foot. Increasing his intake of _____ may help to suppress the inflammation.

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

Question 52

Respiratory distress is characterized by _____.

A) ​C-reactive peptide action
B) ​elevated cortisol
C) ​decreased oxygen and increased carbon dioxide
D) ​histamine secretion
E) ​elevated blood pressure

Question 53

Which chemical messenger is not produced by the liver during inflammation, infection or severe injury?

A) ​C-reactive peptide
B) ​complement
C) ​cortisol
D) ​hepcidin
E) ​prothrombin

Question 54

The two main types of COPD are chronic bronchitis and _____.

A) ​pneumonia
B) ​emphysema
C) ​asthma
D) ​fibrosis
E) ​influenza

Question 55

The loss of elastic tissue and destruction of alveolar walls is characteristic of _____.

A) ​bronchitis
B) ​emphysema
C) ​asthma
D) ​fibrosis
E) ​influenza

Question 56

A patient is admitted to the ER with multiple gunshot wounds. The initial treatment includes _____.​

A) ​beginning enteral nutrition
B) ​administering intravenous (IV) fluids
C) ​beginning PPN
D) ​referral to the dietitian
E) anti-inflammatory medications

Question 57

The inflammatory process can cause a variety of systemic effects, including _____.

A) increased heart rate, respiratory rate, and temperature​
B) ​decreased heart rate and appetite, and increased blood pressure
C) ​increased blood pressure, temperature, and appetite
D) ​increased blood pressure, heart rate, and weight
E) ​decreased cardiac output and blood pressure, and increased urine production

Question 58

Nutrition support plays a role in the therapy for MODS by _____.

A) ​preventing excessive wasting
B) ​maintaining blood pressure
C) ​improving gas exchange
D) ​preventing toxic build-up
E) ​maintaining cardiac output

Question 59

Refeeding syndrome is characterized by _____.

A) ​fluid and electrolyte shifts
B) ​infections
C) ​respiration issues
D) ​sepsis
E) ​inflammation

Question 60

Patients with burns and tissue injuries may require increased_____ due to tissue losses.

A) ​glucose
B) ​trace minerals
C) ​vitamin C
D) ​fats
E) ​proteins

Question 61

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
wasting​

Question 62

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
COPD

Question 63

Which symptom is not part of the systemic inflammatory response?

A) ​fever
B) ​elevated heart rate
C) ​increased respiratory rate
D) ​elevated white blood cell count
E) ​acidosis

Question 64

In a patient with MODS, mechanical ventilation is used to support the _____.

A) ​GI tract
B) ​heart
C) ​lungs
D) ​kidney
E) ​liver

Question 65

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
SIRS

Question 66

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
metabolic stress

Question 67

Which sign of respiratory failure appears as a bluish cast in the skin on the lips, cheeks and nail beds?

A) ​acidosis
B) ​hypercapnia
C) ​hypoxia
D) ​hypoxemia
E) ​cyanosis

Question 68

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
ARDS

Question 69

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
hypermetabolism

Question 70

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
acidosis

Question 71

Which factor increases the risk for developing MODS?

A) ​patient age below 50 years old
B) ​having SIRS for less than two days
C) ​the use of invasive catheters
D) ​low body weight
E) ​having localized, acute injuries

Question 72

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
systemic effects​

Question 73

Which symptom of respiratory failure can lead to acidosis?

A) ​surfactant
B) ​hypercapnia
C) ​hypoxia
D) ​hypoxemia
E) ​cyanosis

Question 74

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
respiratory stress

Question 75

The main goal of nutrition therapy for COPD is to _____.

A) ​decrease blood glucose
B) ​increase lipid levels
C) ​decrease mucus production
D) ​prevent muscle wasting
E) ​promote gas exchange

Question 76

Persistent inflammation and excessive mucus secretion is characteristic of _____.

A) ​bronchitis
B) ​emphysema
C) ​asthma
D) ​fibrosis
E) ​influenza

Question 77

Alpha-1-antitrypsin deficiency _____.

A) ​is an inherited disorder
B) ​accounts for the majority of cases of COPD
C) ​is detrimental only if the person is also a smoker
D) ​causes the production of excess mucus
E) ​inhibits oxygen and carbon dioxide exchange

Question 78

In a patient with MODS, which organ(s) is(are) one of the last to fail?​

A) ​GI tract
B) ​heart
C) ​lungs
D) ​gallbladder
E) ​pancreas

Question 79

Matching
a. a disruption in the body's chemical environment due to the effects of disease or injury
b. abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels
c. a higher-than-normal metabolic rate
d. the breakdown of lean tissue that results from disease or malnutrition
e. relating to the entire body
f. a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature
g. acid accumulation in the body tissues
h. a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema
i. shortness of breath
j. respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation
dyspnea

Question 80

Food intake declines as COPD progresses because _____.

A) ​changes in hormonal levels lead to early satiety
B) ​high levels of carbon dioxide affects muscle function
C) ​cortisol suppresses appetite
D) ​mucus production interferes with swallowing
E) ​dyspnea may interfere with swallowing