Week 3 Sherpath: Nutrient Status

Match the assessment findings to the corresponding diagnosis. 1. 5% weight loss over 1 month 2. Moderate fluid accumulation 3. Intake of < 50% energy requirement for > 1 month A. Moderate Chronic Illness Malnutrition B. Severe Acute Injury Malnutrition C. Severe Environmental Malnutrition

1. A 2. B 3. C

Match the location to the corresponding nutritional action. 1. Formation of triglycerides 2. Lipolysis provides fatty acids for energy production 3. Storage of fatty acids A. Inside intestinal cells B. Adipose tissue C. Outside the cell

1. A 2. C 3. B

Match the cause to the corresponding nitrogen equilibrium imbalance. 1. Positive nitrogen balance 2. Negative nitrogen balance A. Hypertension or heart failure B. Pregnancy or healing C. Trauma or surgery

1. B 2. C

Match the nutritional deficiency with its corresponding assessment finding. 1. Loss of hair pigment 2. Follicular hyperkeratosis 3. Spoon-shaped nails 4. Dysgeusia A. Vitamin B12 B. Zinc C. Protein D. Vitamin A E. Vitamin K F. Iron

1. C 2. D 3. F 4. B

Match the classification to the corresponding body mass index. 1. 23.6 2. 28.2 3. 16.4 4. 32.7 A. Preobese B. Obese Class I C. Underweight D. Normal E. Obese Class III F. Obese Class II

1. D 2. A 3. C 4. F

Match the effect on nutrition to the corresponding condition. 1. Alcohol abuse 2. Cholestyramine use 3. Peritoneal dialysis 4. Fever A. Increased nutrient losses B. Increased nutrient requirements C. Inadequate absorption D. Decreased nutrient requirements E. Increased absorption F. Inadequate intake

1. F 2. E 3. A 4. B

In which order does a nutritional assessment occur? 1. Assessment 2. Patient screening 3. Development of nutritional care plan 4. Monitoring

2, 1, 3, 4 The nutritional assessment process is dynamic and also includes several reassessment steps. However, the general process begins with admission, then a patient screening, followed by patient assessment. After the assessment, a nutritional care plan is developed and implemented. Finally, the patient is monitored and reassessed as needed.

In which order will the body respond to protein-calorie malnutrition? 1. Glucagon levels rise 2. Blood ketone levels rise 3. Glycogen levels are depleted 4. Increased energy demands due to starvation or injury 5. Glucose levels fall 6. Nitrogen excretion slows

4, 5, 1, 3, 2, 6 First, the body has an increased energy demand due to starvation or injury/illness. Due to the increased energy demand, the glucose levels fall. The fall of the glucose increases the glucagon levels, and the liver begins to release glucose from the glycogen reserves. These reserves are depleted within a few hours, so fat then becomes the primary source of fuel. The breakdown of fat causes blood ketone levels to increase. As gluconeogenesis from protein precursors decrease, protein breakdown and nitrogen excretion also slow.

Which laboratory value will assist the nurse with evaluating a patient's adequacy of renal function to handle nutrition support? Select all that apply. One, some, or all responses may be correct. A. Blood urea nitrogen B. Serum levels of electrolyte C. Blood glucose D. Creatinine E. Serum triglyceride concentration

A and D Blood urea nitrogen Blood urea nitrogen levels are evaluated because they reflect the adequacy of renal function to handle nutrition support. Creatinine Creatinine levels are monitored as they reflect the adequacy of renal function to handle nutrition support.

Which assessment finding would the nurse expect to find in a patient with severe malnutrition in the context of chronic illness? Select all that apply. One, some, or all responses may be correct. A. Energy intake < 75% of requirement for > 1 month B. Mild body fat loss C. Moderate fluid accumulation D. 6% weight loss over 3 months E. Measurably reduced grip strength

A and E Energy intake < 75% of requirement for > 1 month A patient with severe malnutrition from chronic illness is unable to meet their energy intake for 1 month or longer. Measurably reduced grip strength All forms of severe malnutrition lead to a measurable reduction in grip strength.

By which method is response to nutrition support assessed? Select all that apply. One, some, or all responses may be correct. A. Physical examination B. Biochemical evaluation C. Digital rectal examination D. Anthropometric measurements E. Magnetic resonance imaging (MRI)

A, B and D Physical examination The multidisciplinary approach to evaluating the effects of nutrition support on clinical outcomes includes physical examination. Biochemical evaluation Assessment of response to nutrition support involves biochemical (laboratory) evaluation. Anthropometric measurements Assessment of response to nutrition support is an ongoing process that involves anthropometric measurements.

Which question would the nurse ask during the nutritional assessment for a patient newly admitted to the critical care unit? Select all that apply. One, some, or all responses may be correct. A. "Have you recently lost weight without trying?" B. "Have you experienced an inability to access food regularly over the last 3 months?" C. "What type of diet do you usually eat?" D. "Do you take beta-blocker medications?" E. "Do you require treatment for any chronic diseases?"

A, B, C and E "Have you recently lost weight without trying?" Involuntary loss or gain of a significant amount of weight is a risk factor for malnutrition. "Have you experienced an inability to access food regularly over the last 3 months?" Food insecurity significantly increases the risk of malnutrition. "What type of diet do you usually eat?" Chronic use of a modified diet is a risk factor for malnutrition. "Do you require treatment for any chronic diseases?" Chronic disease increases the risk for malnutrition.

Which hormone is released during a hypermetabolic state? Select all that apply. One, some, or all responses may be correct. A. Epinephrine B. Glucagon C. Adrenocorticotropic hormone D. Cortisol E. Aldosterone

A, B, C, D and E Epinephrine The adrenal medulla releases epinephrine and norepinephrine due to activation of the sympathetic nervous system. Glucagon Glucagon is an essential component of gluconeogenesis that is released by the adrenal medulla. Adrenocorticotropic hormone Adrenocorticotropic hormone is released by the adrenal medulla during hypermetabolic states. Cortisol Cortisol is a glucocorticoid that is released during hypermetabolic states. Aldosterone Aldosterone is a mineralocorticoid that is released during hypermetabolic states.

Which measurement is used to monitor daily nutrition intake? Select all that apply. One, some, or all responses may be correct. A. Daily weight B. Serum level of calcium C. Creatinine level D. Blood urea nitrogen level E. Blood glucose level F. Serum level of magnesium

A, B, C, D, E and F Daily weight Daily weights and the maintenance of accurate intake-and-output records are critical in the evaluation of nutrition progress. Serum level of calcium Monitoring serum levels of electrolytes and calcium is necessary to assess fluid balance and tolerance to nutritional intake with refeeding syndrome. Creatinine level Creatinine level is one measurement that reflects the adequacy of renal function to handle nutrition support. Blood urea nitrogen level Blood urea nitrogen level is another measurement that reflects the adequacy of renal function to handle nutrition support. Blood glucose level Blood glucose levels are monitored because they are an indicator of the patient's tolerance of the carbohydrate. Serum level of magnesium Serum levels of phosphorus, and magnesium are monitored to assess fluid balance and tolerance to nutritional intake with refeeding syndrome.

Which factor increases the risk of malnutrition for critical care patients? Select all that apply. One, some, or all responses may be correct. A. Traumatic injury B. Lack of communication C. Limited diagnostic testing D. Certain medications E. Inadequate use of supplements

A, B, D and E Traumatic injury Illness or injury increases the risk of malnutrition, especially serious injuries or illnesses. Lack of communication Lack of communication among the nurses, dieticians, and physicians increases the risk for malnutrition. Certain medications Some medications can cause anorexia, nausea, or vomiting, which would interfere with food intake. Inadequate use of supplements Inadequate use of supplements, tube feedings, or parental nutritional can lead to malnutrition.

Which assessment findings would the nurse expect to find in a patient with a Vitamin A deficiency? Select all that apply. One, some, or all responses may be correct. A. Conjunctival dryness B. Petechiae C. Follicular hyperkeratosis D. Confabulation E. Dry, scaly skin

A, C and E Conjunctival dryness Vitamin A deficiency causes conjunctival and corneal dryness. Follicular hyperkeratosis Follicular hyperkeratosis occurs when the skin appears to have gooseflesh continuously; this assessment finding occurs with Vitamin A deficiency. Dry, scaly skin Vitamin A deficiency causes dry, scaly skin.

In which way are proteins responsible for preservation of immune function within the body? A. Development of antibodies B. Production of albumin C. Regulation of blood neutrality D. Transportation of albumin

A. Development of antibodies Proteins are responsible for the preservation of immune function through the development of antibodies.

The dietician is working to develop a nutritional plan for a patient admitted to the critical care unit. Which assessment technique would provide information on cultural and spiritual dietary preferences? A. Diet history B. Diet record C. 24-hour recall D. Intake and output

A. Diet history A diet history is a detailed interview about the patient's usual intake, along with social, familial, cultural, economic, educational, and health-related factors that may affect intake.

Which intervention best prevents nutrition-related septic complications in critically ill patients? A. Early enteral nutritional B. Malnutrition assessment C. Indirect calorimetry D. Volume resuscitation

A. Early enteral nutritional The introduction of enteral nutrition within the first 24 to 48 hours significantly reduces the risk of septic complications.

Which patient is at the highest risk for malnutrition? A. Food insecurity, takes five medications for cystic fibrosis B. History of hypertension requiring a low-salt diet C. Admitted to critical care 3 days ago after a motor vehicle accident D. History of chronic obstructive pulmonary disorder

A. Food insecurity, takes five medications for cystic fibrosis Cystic fibrosis is a chronic medication. The patient also takes more than three medications and experiences food insecurity. This patient would have three risk factors for malnutrition.

Which condition would the nurse assess for in a patient with a low albumin level? A. Inflammation B. Malnutrition C. Hypertension D. Bradycardia

A. Inflammation Albumin and prealbumin are negative acute phase reactants that are associated with inflammation.

When evaluating a patient for response to nutrition support, the nurse will exclude which type of assessment? A. Patient dietary preferences B. Anthropometric measurements C. Biochemical evaluation D. Physical examination

A. Patient dietary preferences Evaluating the dietary preferences of patients is not a meaningful way to assess response to nutrition support.

During gluconeogenesis, glucose is formed from which component? Select all that apply. One, some, or all responses may be correct. A. Vitamin C B. Lactate C. Amino acids D. Protein E. Glycerol

B, C and E Lactate Glucose can be formed from lactate, amino acids, and glycerol in a process called gluconeogenesis. Amino acids Glucose can be formed from lactate, amino acids, and glycerol in a process called gluconeogenesis. Glycerol Glucose can be formed from lactate, amino acids, and glycerol in a process called gluconeogenesis.

Malnutrition increases the risk of which complication? Select all that apply. One, some, or all responses may be correct. A. Tachycardia B. Wound dehiscence C. Infection D. Respiratory failure E. Pressure injury

B, C, D and E Wound dehiscence Protein-calorie malnutrition can cause wound dehiscence and pressure injury. Infection Malnutrition increases the risk of infection. Respiratory failure Malnutrition increases the risk of respiratory failure requiring mechanical ventilation. Pressure injury Protein-calorie malnutrition can cause wound dehiscence and pressure injury.

Which measurement can be used to estimate the height of a patient? A. Abdominal circumference B. Arm span length C. Torso length D. Knee to foot distance

B. Arm span length It is possible to estimate height using arm span length or knee height.

Which statement shows a need for additional education? A. "Nutrition support should be implemented early within the hospitalization." B. "Malnutrition increases the risk for infection and pressure injuries." C. "Patients often have only one form of nutritional deficiency." D. "Malnutrition increases length of stay and health care costs."

C. "Patients often have only one form of nutritional deficiency." Nutrition deficiencies are usually combined, with the patient lacking adequate protein, calories, and vitamins or minerals.

Which change would the nurse expect to see in the body during a period of metabolic stress? A. Decreased production of glucose B. Increased production of insulin C. Breakdown of fatty acids D. Excretion of triglycerides

C. Breakdown of fatty acids During periods of metabolic stress, the fatty acids are broken down into ketones within the liver.

The dietician would like to determine a patient's nutritional requirements. Which method would be most accurate? A. Harris-Benedict formula B. Ireton-Jones calculation C. Indirect calorimetry D. Frankenfield equation

C. Indirect calorimetry Indirect calorimetry is the most accurate method for determining caloric needs. Formulas only provide estimates.

Which finding would the nurse assess for to distinguish between the different etiology-based malnutrition categories? A. Blood pressure B. Heart rate C. Inflammation D. Potassium level

C. Inflammation The level of inflammation is used to determine the etiology-based malnutrition category. Starvation-related malnutrition causes no inflammation, chronic disease-related malnutrition causes mild to moderate inflammation, and acute disease or injury-related malnutrition is associated with a marked inflammatory response.

Which factor challenges the development of a robust evidence base for the practice of medical nutrition therapy? A. Preponderance of high-quality evidence to guide recommendations B. Homogeneous nature of the patient population C. Multiple confounding variables on meaningful outcomes D. Static state of nutrition knowledge and research

C. Multiple confounding variables on meaningful outcomes Multiple confounding variables on meaningful outcomes represent a primary challenge to developing a robust evidence base for the practice of medical nutrition therapy.

Which value would the dietician require to conduct indirect calorimetry? A. Blood pH B. Body mass index C. Oxygen consumption D. Weight

C. Oxygen consumption When performing indirect calorimetry, energy expenditure is calculated from oxygen consumption (VO2) and carbon dioxide production (VCO2).

Which number of calories per kilogram would the nurse incorporate into the nutritional plan for a patient with sepsis? A. 15 calories/kg B. 20 calories/kg C. 25 calories/kg D. 30 calories/kg

D. 30 calories/kg A patient with sepsis requires between 30 and 35 calories per kilogram.

Which practical challenge is associated with developing an evidence base for clinical nutrition practice? A. Simplicity of variables on meaningful nutrition outcomes B. Overabundance of high-quality evidence to support recommendations C. Similarities that naturally occur in the patient population D. Ability to providing well-controlled nutrition interventions in research trials

D. Ability to providing well-controlled nutrition interventions in research trials Providing well-controlled nutrition interventions in research trials is a practical challenge associated with developing an evidence base for clinical nutrition practice.

In which way does hypermetabolism cause protein-calorie malnutrition? A. Decreases the intake of nutrients B. Increases absorption of protein and energy C. Decreases the breakdown of amino acids D. Increases the metabolic rate beyond supply

D. Increases the metabolic rate beyond supply Hypermetabolism increases the metabolic rate beyond the supply of nutrients and occurs with injuries or illnesses.

Which nutritional element provides the most energy for the cell? A. Protein B. Carbohydrate C. Glucose D. Lipid

D. Lipid Lipids provide more than twice the amount of energy per gram as protein and carbohydrates.

A patient in the critical care unit is experiencing stress and malnutrition and requires a significant amount of glucose to be released into the bloodstream. Which organ would the nurse expect to provide this glucose? A. Lungs B. Intestines C. Pancreas D. Liver

D. Liver Only the liver and, to a lesser extent, the kidney are capable of producing significant amounts of glucose for release into the blood for use by other tissues.