Question 1

Elevated acute-phase proteins, increased WBC, and increased heart rate and respirations are initial major signs of which complication?

Accepted Answer

A) SIRS 
B) septic shock 
C) MODS 
D) CARS 
A) SIRS 
B) septic shock 
C) MODS 
D) CARS B

Question 2

The cascade of events that occur with sepsis involves an initial release of TNF and IL, a(n) _____ response, and then a shift to a(n) _____ response

Accepted Answer

A) inflammatory, anti-inflammatory 
B) cytokine, inflammatory 
C) anti-inflammatory, inflammatory 
D) immune, anti-inflammatory 
A) inflammatory, anti-inflammatory 
B) cytokine, inflammatory 
C) anti-inflammatory, inflammatory 
D) immune, anti-inflammatory A

Question 3

The nutritional needs of a post-op CABG patient would include:

Accepted Answer

A) high amounts of vitamin C for wounds. 
B) kcalorie restriction. 
C) moderate fluids. 
D) increased protein. 
A) high amounts of vitamin C for wounds. 
B) kcalorie restriction. 
C) moderate fluids. 
D) increased protein. D

Question 4

BM is a 35 yo 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#
-What would be the best way to feed him?

Accepted Answer

A) PN 
B) small bowel feeding tube 
C) gastric feeding tube 
D) keep him NPO 
A) PN 
B) small bowel feeding tube 
C) gastric feeding tube 
D) keep him NPO

Question 5

The nutritional goal for surgical patients is:

Accepted Answer

A) to resume optimal intake. 
B) to achieve normal albumin levels. 
C) pain management. 
D) normal bowel sounds. 
A) to resume optimal intake. 
B) to achieve normal albumin levels. 
C) pain management. 
D) normal bowel sounds.

Question 6

Which of the following has the most profound impact on nutritional status in a burn patient?

Accepted Answer

A) fluid resuscitation 
B) skin grafting 
C) major protein loss at injury 
D) low albumin 
A) fluid resuscitation 
B) skin grafting 
C) major protein loss at injury 
D) low albumin

Question 7

Case Study
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2        WT: 124#      UBW: 118#
Alb: 2.0
-What is the likely cause of her change in weight?

Accepted Answer

A) fluid shifts 
B) inaccurate measure 
C) unhealthy eating habits 
D) change in energy expenditure 
A) fluid shifts 
B) inaccurate measure 
C) unhealthy eating habits 
D) change in energy expenditure

Question 8

Case Study
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2        WT: 124#      UBW: 118#
Alb: 2.0
-If her BMI was >30, what would you estimate her protein needs to be?

Accepted Answer

A) 112 g 
B) 90 g 
C) 109 g 
D) 150 g 
A) 112 g 
B) 90 g 
C) 109 g 
D) 150 g

Question 9

You would observe low levels of which protein in a stressed patient?

Accepted Answer

A) C-reactive protein 
B) ceruloplasmin 
C) prealbumin 
D) UUN 
A) C-reactive protein 
B) ceruloplasmin 
C) prealbumin 
D) UUN

Question 10

All of the following are examples of metabolic stress except:

Accepted Answer

A) hypoxia. 
B) fasting. 
C) closed head injury. 
D) MVA. 
A) hypoxia. 
B) fasting. 
C) closed head injury. 
D) MVA.

Question 11

The most important difference between starvation and stress is:

Accepted Answer

A) adaptation. 
B) recovery. 
C) intake. 
D) injury. 
A) adaptation. 
B) recovery. 
C) intake. 
D) injury.

Question 12

Prescription treatments for burn patients include all of the following except:

Accepted Answer

A) vitamin C and Zn. 
B) megace. 
C) oxandrolone. 
D) silver nitrate. 
A) vitamin C and Zn. 
B) megace. 
C) oxandrolone. 
D) silver nitrate.

Question 13

Which of the following statements is true about a critically ill patient who is post stress injury?

Accepted Answer

A) This patient will have low levels of glucagon circulating. 
B) Alanine and glutamic acid needs are decreased. 
C) Body fat is the primary substrate for gluconeogenesis. 
D) This patient would benefit from tight glycemic control to reduce catabolism. 
A) This patient will have low levels of glucagon circulating. 
B) Alanine and glutamic acid needs are decreased. 
C) Body fat is the primary substrate for gluconeogenesis. 
D) This patient would benefit from tight glycemic control to reduce catabolism.

Question 14

All of the following contribute to hyperglycemia during the stress response except:

Accepted Answer

A) insulin. 
B) glucagon. 
C) cortisol. 
D) insulin resistance. 
A) insulin. 
B) glucagon. 
C) cortisol. 
D) insulin resistance.

Question 15

BM is a 35 yo 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#
-The dietitian would supplement with what amino acid to stimulate the GI tract?

Accepted Answer

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

Question 16

Generally speaking, patients who are under metabolic stress will have _____ caloric and _____ protein needs

Accepted Answer

A) increased, decreased 
B) increased, increased 
C) decreased, increased 
D) decreased, decreased 
A) increased, decreased 
B) increased, increased 
C) decreased, increased 
D) decreased, decreased

Question 17

Which of the following statements is true about patients with burns?

Accepted Answer

A) They are at high nutritional risk. 
B) They may be at high nutritional risk. 
C) Nutritional risk is dependent on comorbidities. 
D) Nutritional risk is based on the degree of the burn. 
A) They are at high nutritional risk. 
B) They may be at high nutritional risk. 
C) Nutritional risk is dependent on comorbidities. 
D) Nutritional risk is based on the degree of the burn.

Question 18

Which of the following is not a measure of severity of illness?

Accepted Answer

A) APACHE 
B) GCS 
C) SGA 
D) ISS 
A) APACHE 
B) GCS 
C) SGA 
D) ISS

Question 19

Case Study
DF is a 55 yo F who was brought to the trauma center following a motor vehicle accident.She sustained blunt trauma to the head, is unconscious, and is being mechanically ventilated.The MD contacts you for a consult.
HT: 5'2        WT: 124#      UBW: 118#
Alb: 2.0
-If DF's usual body weight was much greater, so that her BMI was >30, what would her estimated caloric needs be?

Accepted Answer

A) 1410-1750 kcal 
B) 1000-1115 kcal 
C) 1240-1409 kcal 
D) 1200-1364 kcal 
A) 1410-1750 kcal 
B) 1000-1115 kcal 
C) 1240-1409 kcal 
D) 1200-1364 kcal

Question 20

BM is a 35 yo 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#
-The dietitian should look for a formula that contains which of the following to induce an anti-inflammatory response?

Accepted Answer

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

Exam 22: Metabolic Stress and the Critically Ill

Elevated acute-phase proteins, increased WBC, and increased heart rate and respirations are initial major signs of which complication?

The cascade of events that occur with sepsis involves an initial release of TNF and IL, a(n) _____ response, and then a shift to a(n) _____ response

The nutritional needs of a post-op CABG patient would include:

BM is a 35 yo 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# -What would be the best way to feed him?

The nutritional goal for surgical patients is:

Which of the following has the most profound impact on nutritional status in a burn patient?

You would observe low levels of which protein in a stressed patient?

All of the following are examples of metabolic stress except:

The most important difference between starvation and stress is:

Prescription treatments for burn patients include all of the following except:

Which of the following statements is true about a critically ill patient who is post stress injury?

All of the following contribute to hyperglycemia during the stress response except:

BM is a 35 yo 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# -The dietitian would supplement with what amino acid to stimulate the GI tract?

Generally speaking, patients who are under metabolic stress will have _____ caloric and _____ protein needs

Which of the following statements is true about patients with burns?

Which of the following is not a measure of severity of illness?

Role of the Dietitian in the Health Care System

The Nutrition Care Process

Nutrition Assessment: Foundation of the Nutrition Care Process

Nutrition Intervention

Enteral and Parenteral Nutrition Support

Documentation of the Nutrition Care Process

Fluid and Electrolyte Balance

Acid-Base Balance

Cellular and Physiological Response to Injury:The Role of the Immune System

Nutritional Genomics

Pharmacology

Energy Balance and Body Weight

Diseases of the Cardiovascular System

Diseases of the Upper Gastrointestinal Tract

Diseases of the Lower Gastrointestinal Tract

Diseases of the Liver, Gallbladder, and Exocrine Pancreas

Diseases of the Endocrine System

Diseases of the Renal System

Diseases of the Hematological System

Diseases and Disorders of the Neurological System

Diseases of the Respiratory System

Neoplastic Disease

Hiv and Aids

Diseases of the Musculoskeletal System

Metabolic Disorders

Filters

The cascade of events that occur with sepsis involves an initial release of TNF and IL, a(n) _ response, and then a shift to a(n) _ response

Generally speaking, patients who are under metabolic stress will have _ caloric and _ protein needs