Chapter 15 Nutrition and Metabolic Stress

1. The adverse effects of malnutrition on the gastrointestinal tract result in

a. decreased absorption of fluids and electrolytes from food.
b. increased bacterial activity inside the gastrointestinal tract.
c. decreased transit time for food passing through the GI tract.
d. increased risk of spread of bacteria from the GI tract into the rest of the body.

D

2. The adverse effects of malnutrition on the skin may result in

a. excessive sweating.
b. slow wound healing.
c. increased hair growth.
d. reddening and soreness.

B

3. One of the most stressful physical traumas is

a. a fracture in a long bone.
b. a low-grade fever (<100° F). c. minor surgery requiring a general anesthetic. d. a burn that covers >40% of body surface area.

D

4. Glycogen stores are usually depleted after an individual fasts for _____ hours.

a. 2 to 4
b. 4 to 8
c. 8 to 12
d. 12 to 18

C

5. During the first few days of starvation, the brain obtains glucose that is produced from

a. glycogen via glycolysis.
b. fatty acids via lipogenesis.
c. amino acids via gluconeogenesis.
d. branched-chain amino acids via deamination.

C

6. After several days of starvation, the body tissues obtain more of their energy from

a. glucose.
b. glycogen.
c. amino acids.
d. ketone bodies.

D

7. During starvation, the body conserves energy by

a. decreasing metabolic rate.
b. shivering to create warmth.
c. sleeping for shorter periods of time.
d. sweating to reduce body temperature.

A

8. A major difference between starvation and stress is that metabolic rate _____ during starvation and _____ during stress.

a. increases; decreases
b. decreases; increases
c. is unaffected; increases
d. decreases; is unaffected

B

9. Major hallmarks of the ebb phase of stress are

a. hypothermia and lethargy.
b. nausea, vomiting, and diarrhea.
c. increased catabolism of macronutrients.
d. hyperthermia and increased nitrogen excretion.

A

10. Seventy-two hours after a major accident involving multiple broken bones, the patient would be expected to be in the _____ phase.

a. critical
b. stress
c. ebb
d. flow

D

11. Patients with poor nutritional status before surgery are at high risk for pneumonia or wound infections after surgery because

a. they are likely to lose more blood and body fluids during surgery.
b. they are likely to already have pneumonia or infections before surgery.
c. they have an increased prevalence of nausea and vomiting after surgery.
d. their nutrient stores may be inadequate to meet increased needs during recovery.

D

12. During severe stress, such as major burns over large areas of the body, protein needs may increase to as high as _____ g/kg body weight.

a. 1.2
b. 1.5
c. 2.0
d. 2.5

C

13. As patients age, their body composition changes, and their fluid needs during recovery

a. increase.
b. decrease.
c. do not change.
d. vary with the type of metabolic stress.

B

14. The amino acid that plays an important role in the gastrointestinal tract during stress is

a. arginine.
b. glutamine.
c. methionine.
d. phenylalanine.

B

15. During stress, giving patients extra insulin does not always decrease their high blood glucose levels because

a. the ratio of glucagon to insulin is increased.
b. the extra insulin stimulates glucose production.
c. the number of insulin receptors on cells decreases.
d. high blood glucose levels help protect the body against infection.

A

16. During stress and recovery, it is especially important that patients achieve adequate intakes of

a. iron, folate, and vitamin B12.
b. vitamin C, vitamin A, and zinc.
c. potassium, thiamine, and niacin.
d. vitamin K, vitamin D, and calcium.

B

17. The best way to determine energy needs of stressed patients is to use

a. indirect calorimetry.
b. the Ireton-Jones formula.
c. the Dietary Reference Intakes.
d. patient hunger and appetite cues.

A

18. The activity factor used to estimate energy requirements for patients prescribed bed rest is

a. 1.1.
b. 1.2.
c. 1.3.
d. 1.5.

B

19. If someone has a limited food budget and becomes malnourished because they only eat one small meal a day, they would have

a. primary malnutrition.
b. secondary malnutrition.
c. anorexia nervosa.
d. iatrogenic malnutrition.

A

20. If a patient has very low levels of serum visceral proteins and poor wound healing but does not look overtly malnourished, they are likely to have

a. hyperglycemia.
b. refeeding syndrome.
c. kwashiorkor.
d. marasmus.

C

21. For individuals with marasmus, overly aggressive repletion of nutrients may cause

a. dumping syndrome.
b. refeeding syndrome.
c. nausea and vomiting.
d. rapid increases in body fat.

B

22. During refeeding of a patient with protein-energy malnutrition, it is important to provide adequate amounts of

a. iron, folate, and vitamin B12.
b. vitamin C, vitamin A, and zinc.
c. calcium, vitamin D, and vitamin K.
d. phosphorus, potassium, and magnesium.

D

23. When refeeding patients with protein-energy malnutrition, it is important to limit intake of

a. fluid.
b. sodium.
c. potassium.
d. phosphorus.

B

24. Multiple organ dysfunction syndrome (MODS) usually results in

a. a hypermetabolic state.
b. a hypometabolic state.
c. marasmus.
d. kwashiorkor.

A

25. Patients with multiple organ dysfunction syndrome (MODS) benefit most from _____ feedings.

a. oral
b. enteral
c. central parenteral
d. peripheral parenteral

B

26. After surgery, patients may resume oral intake when

a. they have bowel sounds.
b. their appetite returns.
c. they are able to sit upright.
d. their blood glucose level is normal.

A

27. Optimal recovery from surgery is promoted by

a. use of enteral tube feedings to supplement oral intake.
b. initiation of parenteral nutrition support immediately after surgery.
c. use of a clear liquid diet for at least 24 to 48 hours to reduce intestinal stress.
d. progression of the diet from liquids to solid foods as quickly as is reasonable.

D

28. A burn that destroys the entire epidermis, dermis, and underlying subcutaneous tissue is classified as a _____ burn.

a. first-degree
b. second-degree
c. third-degree
d. nonthermal

C

29. During the first 24 to 48 hours after a major burn, the focus of nutrition care is

a. provision of adequate protein.
b. prevention of nausea and vomiting.
c. replacement of fluids and electrolytes.
d. education concerning nutrient needs.

C

30. Energy needs of burned patients are influenced by the

a. patient’s activity level.
b. patient’s emotional stress level.
c. percentage of total body surface area (TBSA) burned.
d. type of burn: thermal, chemical, electrical, or radioactive.

C

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