Test Bank for Priorities in Critical Care Nursing 7th Edition Urden – Stacy – Lough

Nutritional Alterations Test Bank MULTIPLE CHOICE 1. A patient with poorly controlled diabetes mellitus is to be started on enteral tube feeding. What type of formula would be most appropriate? a. Whole proteins and glucose polymers b. Concentrated in calories c. Low sodium d. High fat, low carbohydrate ANS: D Individuals with diabetes mellitus whose blood sugar is poorly controlled with standard formulas should be given a glucose intolerance formula that is high in fat and low in carbohydrate. High protein is associated with polymeric formulas. Concentrated calories is associated with renal failure. Low sodium is associated with hepatic failure. 2. Most of the energy produced from carbohydrate metabolism is used to form what substance? a. Galactose b. Glycogen c. Adenosine triphosphate d. Antibodies ANS: C Most of the energy produced from carbohydrate metabolism is used to form adenosine triphosphate (ATP), the principal form of immediately available energy within all body cells. One gram of carbohydrate provides approximately 4 kcal of energy. Through the process of digestion, carbohydrates are broken down into glucose, fructose, and galactose. Antibodies are produced through the immune system. 3. A patient has a new order for intermittent nasogastric feedings every 4 hours. The nasogastric tube is placed by the nurse. The best method for confirming the placement of the tube before feeding would be to a. obtain radiography of the abdomen. b. check the pH of fluid aspirated from the tube. c. auscultate the left upper quadrant of the abdomen while injecting air into the tube. d. auscultate the right upper quadrant of the abdomen while injecting air into the tube. ANS: A After the tube has been placed, correct location must be confirmed before feedings are started and regularly throughout the course of enteral feedings. Radiographs are the most accurate way of assessing tube placement. 4. A person with a BMI of 28 would be considered a. obese. b. overweight or pre-obese. c. of normal weight. d. underweight. ANS: B A body mass index between 25 and 30 is considered overweight or pre-obese. The other BMIs are underweight = 2; normal = 18.5 to 24.99 kg/m2; overweight = ?5=25 kg/m2; pre-obese = 25 to 29.99 kg/m2; obese class I = 30 to 34.99 kg/m2; obese class II = 35 to 39.99 kg/m2; and obese class III = ?5=40 kg/m2. 5. Diet therapy for a person with hypertension 1 day after a myocardial infarction would include a. three meals a day with two snacks. b. a low-protein diet. c. a low-salt, low-cholesterol diet. d. a high-carbohydrate diet. ANS: C Because fluid accompanies sodium, limitation of sodium is necessary to reduce fluid retention. Specific interventions include limiting salt intake, usually to 2 g a day or less, and limiting fluid intake because appropriate meal size, caffeine intake, and food temperatures are some of the dietary factors that are of concern. Small, frequent snacks are preferable to larger meals for patients with severe myocardial compromise or postprandial angina. 6. Two types of protein-caloric malnutrition are kwashiorkor and marasmus. Kwashiorkor results in a. weight loss and muscle wasting. b. low levels of serum proteins, low lymphocyte count, and hair loss. c. elevated serum albumin and increased creatinine excretion in the urine. d. hyperpigmentation and a hard, easily palpated liver margin. ANS: B Kwashiorkor results in low levels of serum proteins, low lymphocyte count, low immunity and edema from low plasma oncotic pressure, and hair loss. Marasmus is recognizable by weight loss, loss of subcutaneous fat, and muscle wasting. 7. The patient history plays an important role in assessing the patient’s nutritional status. Significant laboratory and clinical findings in the patient with cardiovascular disease include a. low levels of high-density lipoprotein (HDL) cholesterol and transferrin. b. elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat. c. elevated sodium levels and a soft, fatty liver on palpation. d. normal triglyceride levels and the presence of S3 on auscultation. ANS: B Laboratory and clinical findings in patients with cardiovascular disease include elevated total cholesterol and triglycerides as well as cardiac cachexia (muscle and subcutaneous fat wasting). 8. Proteins serve the function of a. maintaining osmotic pressure. b. providing minerals in the body. c. maintaining blood glucose. d. providing a stored source of energy. ANS: A Proteins are the basis for lean body mass and are important for chemical reactions, transportation of other substances, preservation of immune function, and maintenance of osmotic pressure (albumin) and blood neutrality (buffers) in the body. Carbohydrates help with maintaining osmotic pressure, gluconeogenesis, and providing minerals to the body. Lipids provide source of energy. 9. The loss of exocrine function of pancreatitis results in a. anorexia. b. obesity. c. malabsorption. d. hyperglycemia. ANS: C The loss of exocrine function leads to malabsorption and steatorrhea. In chronic pancreatitis, the loss of endocrine function results in impaired glucose intolerance. Anorexia is the result of an inability to eat or not eating. Obesity would result from consuming more than the RDA of calories based on one’s body type. 10. Obtaining height and weight measurements for the critically ill patient a. should be deferred until the medical condition stabilizes. b. should be measured rather than obtained through patient or family report. c. requires consistent weights in pounds. d. requires weight, but height can be deferred. ANS: B Height and current weight are essential anthropometric measurements that should be measured rather than obtained through patient or family report. The most important reason for obtaining anthropometric measurements is to detect changes in the measurements over time (e.g., response to nutritional therapy). Weight is measured in kilograms and height in meters. BMI values are independent of age and gender and are used for assessing health risk. 11. A patient on mechanical ventilation is receiving total parenteral nutrition (TPN). Which of the following is true? a. Excessive calorie intake can cause an increase in PaCO2. b. The patient’s head should remain elevated at 45 degrees to avoid aspiration. c. Lipid intake should be maintained at greater than 2 g/kg/day. d. TPN is preferred over the use of enteral feeding to avoid the complication of aspiration. ANS: A Excessive calorie intake can raise PaCO2 sufficiently to make it difficult to wean a patient from the ventilator. A balanced regimen with both lipids and carbohydrates providing the nonprotein calories is optimal for patients with respiratory compromise, and these patients need to be reassessed continually to ensure that caloric intake is not excessive. 12. A primary nutritional intervention for hypertension is a. decreasing carbohydrates. b. limiting salt. c. increasing protein. d. increasing fluids. ANS: B For hypertensive cardiac disease, sodium chloride restriction is recommended. Some individuals are more salt sensitive than others, and this salt sensitivity contributes to hypertension. 13. Patients with coronary artery disease should be taught about cholesterol. Which situation is most desirable? a. Low levels of HDL cholesterol b. Low levels of LDL cholesterol c. Hypocholesterolemia d. Low levels of both HDL and LDL cholesterol ANS: B Interventions for patients with coronary artery disease are geared toward lowering the LDL cholesterol to desirable levels. 14. An effect of malnutrition on respiratory function is a. decreased surfactant. b. increased vital capacity. c. decreased PaCO2. d. tachypnea. ANS: A Malnutrition has extremely adverse effects on respiratory function, decreasing both surfactant production and vital capacity. Excessive lipid intake can impair capillary gas exchange in the lungs, although this is not usually sufficient to produce an increase in PaCO2 or decrease in PaO2; this results in decreased respiratory function. 15. What is the rationale for careful intake and output for patients with pulmonary alterations? a. Fluid retention occurs with tachypnea. b. Hemodilution may cause deleterious hypernatremia. c. Fluid volume excess can lead to right-sided heart failure. d. Excessive fluid losses may lead to dehydration and hypovolemic shock. ANS: C Pulmonary edema and failure of the right side of the heart may result from fluid volume excess, which can further worsen the status of patients with respiratory compromise. 16. A patient who has sustained a head injury has increased nutritional needs related to the a. decrease in metabolism as a result of coma. b. decrease in blood sugar from a lack of dietary supplementation. c. anabolism and wound healing. d. hypermetabolism and catabolism associated with the injury.