NR228 - FINAL EXAM REVIEW EXAM
2025/2026 QUESTIONS AND ANSWERS
100% PASS
SIGNIFICANT NUTRITIONAL RISK
associated with rapid weight loss in a short amount of time
a patient who experiences rapid weight loss should plan for increased nutritional intake 2
weeks prior to any planned surgery
NUTRIENTS THAT SUPPORT WOUND HEALING
vitamin A
vitamin C
zinc
MOST STRESSFUL PHYSICAL TRAUMA
serious burns
result in significant increase in metabolic rate
GLYCOGEN STORES AND FASTING
glycogen stores are depleted after 24 hours of starvation
in order to meet glucose needs, the body would need to deaminate amino acids and produce
glucose via gluconeogenesis
MALNOURISHED PATIENT - PRIORITY INTERVENTION
1 @COPYRIGHT 2025/2026.
,recommend several small meals/snacks each day
promotes adequate intake without fatigue
PORTION SIZES - FOLLOWING GASTRIC BYPASS SURGERY
after bariatric surgery, the total volume of food eaten at a meal should not exceed 1 cup
including no more than 2 oz of meat
example
half of a small chicken breast and ½ cup of green beans
METABOLIC CHANGES DURING STARVATION
the body conserves energy during starvation by decreasing metabolic rate
body temp drops - body feels colder
mental acuity decreases due to low blood glucose
STARVATIONS VS. STRESS - METABOLIC RATE
DECREASES DURING STARVATION because the body is trying to conserve energy
INCREASES DURING STRESS because the body uses energy to heal the injury
INITIAL INJURY (EBB) PHASE - CHARACTERISTICS
↓ oxygen consumption
↓ cardiac output
↓ plasma volume
hypothermia
this phase lasts 36 to 48 hours
RECOVERY (FLOW) PHASE - CHARACTERISTICS
↑ oxygen consumption
↑ cardiac output
↑ plasma volume
hyperthermia
2 @COPYRIGHT 2025/2026.
, this phase begins after 48 hours
STARVATION/FASTING - BODY PULLS ENERGY FROM...
fat
during starvation, the body conserves protein and glycogen stores as much as possible
all body tissues other than the brain, nerves, and red blood cells derive most of their energy
from fat
FLUID NEEDS DURING HYPERMETABOLIC STRESS
35-40 mL/kg
example
a patient who weighs 60 kg should have 2100-2400 mL of fluid
GLUTAMINE
during stress, glutamine is mobilized in large quantities from skeletal muscle and the lungs to
be used directly as a fuel source by intestinal cells
also plays a significant role in maintaining intestinal immune function
enhances wound repair by supporting lymphocyte and macrophage proliferation, hepatic
gluconeogenesis, and fibroblast function
REFEEDING - LAB TO WATCH
phosphorus
overfeeding of a malnourished patient can result in dangerous hypophosphatemia as
phosphorus enters the cells from the blood.
INITIAL INJURY (EBB) PHASE - NUTRITIONAL PRIORITY
normalize fluid status/fluid resuscitation
INDIRECT CALORIMETRY
a method of estimating energy expenditure by measuring respiratory gases
MALNOURISHED PATIENT - INCREASED RISK OF PNEUMONIA
Malnourished stressed patients may use protein from their intercostal muscles for energy
weakening of chest muscles increases the likelihood of pneumonia
SEVERE BURN PATIENT - FEEDING
3 @COPYRIGHT 2025/2026.
2025/2026 QUESTIONS AND ANSWERS
100% PASS
SIGNIFICANT NUTRITIONAL RISK
associated with rapid weight loss in a short amount of time
a patient who experiences rapid weight loss should plan for increased nutritional intake 2
weeks prior to any planned surgery
NUTRIENTS THAT SUPPORT WOUND HEALING
vitamin A
vitamin C
zinc
MOST STRESSFUL PHYSICAL TRAUMA
serious burns
result in significant increase in metabolic rate
GLYCOGEN STORES AND FASTING
glycogen stores are depleted after 24 hours of starvation
in order to meet glucose needs, the body would need to deaminate amino acids and produce
glucose via gluconeogenesis
MALNOURISHED PATIENT - PRIORITY INTERVENTION
1 @COPYRIGHT 2025/2026.
,recommend several small meals/snacks each day
promotes adequate intake without fatigue
PORTION SIZES - FOLLOWING GASTRIC BYPASS SURGERY
after bariatric surgery, the total volume of food eaten at a meal should not exceed 1 cup
including no more than 2 oz of meat
example
half of a small chicken breast and ½ cup of green beans
METABOLIC CHANGES DURING STARVATION
the body conserves energy during starvation by decreasing metabolic rate
body temp drops - body feels colder
mental acuity decreases due to low blood glucose
STARVATIONS VS. STRESS - METABOLIC RATE
DECREASES DURING STARVATION because the body is trying to conserve energy
INCREASES DURING STRESS because the body uses energy to heal the injury
INITIAL INJURY (EBB) PHASE - CHARACTERISTICS
↓ oxygen consumption
↓ cardiac output
↓ plasma volume
hypothermia
this phase lasts 36 to 48 hours
RECOVERY (FLOW) PHASE - CHARACTERISTICS
↑ oxygen consumption
↑ cardiac output
↑ plasma volume
hyperthermia
2 @COPYRIGHT 2025/2026.
, this phase begins after 48 hours
STARVATION/FASTING - BODY PULLS ENERGY FROM...
fat
during starvation, the body conserves protein and glycogen stores as much as possible
all body tissues other than the brain, nerves, and red blood cells derive most of their energy
from fat
FLUID NEEDS DURING HYPERMETABOLIC STRESS
35-40 mL/kg
example
a patient who weighs 60 kg should have 2100-2400 mL of fluid
GLUTAMINE
during stress, glutamine is mobilized in large quantities from skeletal muscle and the lungs to
be used directly as a fuel source by intestinal cells
also plays a significant role in maintaining intestinal immune function
enhances wound repair by supporting lymphocyte and macrophage proliferation, hepatic
gluconeogenesis, and fibroblast function
REFEEDING - LAB TO WATCH
phosphorus
overfeeding of a malnourished patient can result in dangerous hypophosphatemia as
phosphorus enters the cells from the blood.
INITIAL INJURY (EBB) PHASE - NUTRITIONAL PRIORITY
normalize fluid status/fluid resuscitation
INDIRECT CALORIMETRY
a method of estimating energy expenditure by measuring respiratory gases
MALNOURISHED PATIENT - INCREASED RISK OF PNEUMONIA
Malnourished stressed patients may use protein from their intercostal muscles for energy
weakening of chest muscles increases the likelihood of pneumonia
SEVERE BURN PATIENT - FEEDING
3 @COPYRIGHT 2025/2026.
