Nutrition Assessment

MULTIPLE CHOICE

     1.   What gas is required for optimum production of adenosine triphosphate (ATP)?

a.
Argon
b.
Carbon dioxide
c.
Nitrous oxide
d.
Oxygen

ANS:  D

The use of food for energy at the cellular level requires oxygen to support a controlled combustion process that produces energy molecules of ATP, which are used in all body processes for energy (see Figure 18-2).

REF:   pg. 412           OBJ:   1 | 2 | 8

     2.   Which of the following is an indicator of the energy requirements of the patient?

a.
PaO2 to PaO2 ratio
b.
Minute ventilation
c.
Oxygen uptake per minute
d.
Vital capacity

ANS:  C

The metabolic rates of tissues dictate the amount of oxygen that must be picked up within the lungs. Oxygen uptake (O2) is a respiratory factor that can be measured in the laboratory or at the bedside. Nutritionally speaking, it is this measure that indicates the patient’s energy requirement. If O2 is measured while a person is in a resting, nonstressed state, the basal metabolic rate (BMR) or basal energy expenditure (BEE) can be calculated.

REF:   pgs. 413-414                                  OBJ:   2 | 3

     3.   Measuring the patient’s energy expenditure with the use of oxygen consumption is referred to as _____ calorimetry.

a.
direct
b.
indirect
c.
simple
d.
complex

ANS:  B

Indirect calorimetry measures respiratory parameters (O2 and CO2) to determine the energy consumed by the body. Because oxygen is not stored in the body, measuring oxygen uptake (O2) correlates directly with energy (ATP) creation and use. Metabolism resting energy expenditure (REE) then can be measured by oxygen consumption and is related directly to the energy (calories) used.

REF:   pg. 415           OBJ:   2 | 3

     4.   What element must be stored in sufficient quantities to meet the metabolic demands of the diaphragm?

a.
Arginine
b.
Glycogen
c.
2,3-DPG (diphosphoglycerate)
d.
Fat

ANS:  B

Blood sugar levels are maintained from liver glycogen (carbohydrate) stores between meals and during fasting. The liver’s glycogen stores come from the carbohydrates (starches and sugars) that are eaten in the diet. However, liver glycogen will be depleted within 12 to 16 hours unless sufficient carbohydrate is ingested again.

REF:   pg. 416           OBJ:   4 | 5

     5.   Which of the following is a pulmonary effect of starvation?

a.
Increased diffusing capacity of the lung for carbon monoxide (DLCO)
b.
Increased forced expiratory volume in 1 second (FEV1)
c.
Increased risk of pneumonia
d.
Increased functional residual capacity (FRC)

ANS:  C

Because our immune antibodies are composed of proteins, persistent low calorie and low protein intake will compromise the immune system, thereby limiting the body’s ability to fight pneumonia and other infections.

REF:   pg. 416           OBJ:   5

     6.   Which of the following might hinder attempts at nutritional repletion in patients with respiratory disease?

1. The use of bronchodilators

2. Simple oxygen therapy

3. Intubation

4. Deep breathing and cough exercises

a.
1, 2, 3
b.
1, 3
c.
2, 4
d.
1, 2, 3, 4

ANS:  A

Nutritional repletion in respiratory patients often is hindered by necessary therapeutic actions. Bronchodilators may produce nausea; oxygen by nasal cannula disturbs the sense of smell and, therefore, taste because 70% of the taste of food is contributed by the sense of smell. Medications that patients are taking may interact with nutrients and render them less available for absorption or even may inhibit specific metabolic enzymes. An intubated patient really complicates the process of eating.

REF:   pg. 417           OBJ:   6

     7.   Which of the following is true about anaerobic metabolism?

1. It can cause metabolic acidosis.

2. It results in excess lactate production.

3. It results in excess production of carbon dioxide.

4. It is a very inefficient method of producing ATP.

a.
1, 2, 3
b.
1, 3
c.
2, 4
d.
1, 2, 3, 4

ANS:  D

In anaerobic metabolism, pyruvate produces lactate (lactic acid) rather than acetyl coenzyme A (CoA). The greater the energy production without sufficient oxygen, the more lactic acid is produced. This can result in lactic acidosis. If this occurs, the acid must be buffered with bicarbonate (), and carbon dioxide is produced in the process. This requires increased minute ventilation to eliminate the carbon dioxide generated. This is a short-term solution only. In the absence of oxygen, inefficient anaerobic metabolism will rapidly result in death.

REF:   pg. 419           OBJ:   7

     8.   What is the RQ value of a patient eating a pure carbohydrate diet?

a.
0.60
b.
0.70
c.
0.85
d.
1.00

ANS:  D

Pure fat metabolism has an RQ of 0.7 (more oxygen is used than the carbon dioxide produced), protein has a value of 0.85, and carbohydrate has a value of 1 (an even ratio, where one carbon dioxide (CO2) molecule is produced for each molecule of oxygen (O2) used).

REF:   pg. 420           OBJ:   9

     9.   Of which of the following components should the majority of dietary intake be made up?

a.
Fat
b.
Carbohydrate
c.
Protein
d.
None of the above

ANS:  B

The food component that should constitute the largest amount of the dietary intake is carbohydrate.

REF:   pg. 421           OBJ:   10

   10.   Which of the following may be more difficult with a high-carbohydrate diet?

a.
Oxygenation
b.
Cellular gas exchange
c.
Oxygen transport
d.
Weaning from mechanical ventilation

ANS:  D

The major problem that has arisen with carbohydrate intake in patients with respiratory disorders occurs when glucose has been given in excess. The increased CO2 (a result of both the high RQ of glucose metabolism and its conversion to fat) has induced respiratory difficulty in patients who are being weaned from mechanical ventilators. This has been observed primarily when glucose has been administered by the parenteral (IV) route.

REF:   pg. 421           OBJ:   10 | 11

   11.   What dietary adjustment might be best for patients with more severe chronic obstructive pulmonary disease (COPD)?

a.
Increased carbohydrates
b.
Increased fats
c.
Increased proteins
d.
Increased salt intake

ANS:  B

Patients with more severe COPD often do better with a higher fat content in the diet and less carbohydrate because carbon dioxide production is reduced. However, this does not lessen the importance of carbohydrates. Various carbohydrate and dietary fat percentages should be tried until the best combination is found for each patient.

REF:   pg. 422           OBJ:   6 | 10

   12.   What is nitrogen balance useful in determining?

a.
The adequacy of protein intake
b.
The adequacy of carbohydrate intake
c.
The need for vitamin supplementation
d.
Fluid and electrolyte balance

ANS:  A

Nitrogen values often are referred to in discussion of protein requirements because nitrogen is found only in the amino acids that make up proteins. Measuring nitrogen, which is a simple laboratory measure, is the easiest way to measure protein intake or excretion.

REF:   pg. 422           OBJ:   12

   13.   Which of the following is associated with a low-protein diet?

a.
Increased work of breathing
b.
Increased fixed acid load
c.
Immune compromise
d.
Increased stress on the kidneys

ANS:  C

Too little protein compromises the immune system, promotes edema and ascites, produces generalized wasting of muscle tissue, and retards growth and proper development in children.

REF:   pg. 422           OBJ:   13

   14.   Which of the following is not associated with a high-fat diet?

a.
Increased risk of heart disease
b.
Decreased tissue oxygenation
c.
Decreased DLCO
d.
Increased carbon dioxide production

ANS:  D

As the fat content of the diet increases, there is a measurable decrease in CO2. For many patients with COPD, this results in less dyspnea and improved function.

REF:   pg. 423           OBJ:   14

   15.   What mineral plays a very important role in oxygen transport?

a.
Calcium
b.
Iron
c.
Zinc
d.
Magnesium

ANS:  B

The role of iron in oxygen transport and its use in hemoglobin and myoglobin and within the respiratory transport chain make it necessary to maintain iron at normal levels.

REF:   pg. 424           OBJ:   15

   16.   What method of nutritional delivery is considered the least efficient?

a.
By mouth
b.
By nasogastric tube
c.
By arterial line
d.
By IV line

ANS:  D

Total parenteral nutrition (TPN) is the feeding of patients by direct infusion of nutrients into a peripheral or central vein. There is a reluctance to feed patients by TPN because this route is not as efficient as the enteral route, it is expensive, and risks of complications such as infection are increased.

REF:   pg. 425           OBJ:   16

   17.   Which of the following are associated with increased metabolism?

1. Severe burns

2. Severe infection

3. Multiple traumas

4. Hyperthyroidism

a.
1, 2, 3
b.
1, 3
c.
2, 4
d.
1, 2, 3, 4

ANS:  D

Conditions that increase a patient’s metabolic rate or caloric and other nutrient requirements are multiple surgical or nonsurgical traumas; fever; infection; burns; long bone fractures; hyperthyroidism; and prolonged corticosteroid therapy.

REF:   pg. 426           OBJ:   17

   18.   Which of the following might indicate poor nutritional status?

a.
Low BMI
b.
Positive nitrogen balance
c.
Positive response to skin antigen testing
d.
High serum albumin level

ANS:  A

BMIs below 19 are associated with malnutrition problems and more prevalent pneumonia infection.

REF:   pg. 427           OBJ:   17

   19.   What test is most useful for screening a patient for protein malnutrition?

a.
Serum albumin level
b.
Triceps skinfold
c.
Creatinine–height index
d.
BMI

ANS:  A

Measurement of serum albumin levels provides a useful screening tool for detecting protein energy malnutrition.

REF:   pg. 429           OBJ:   18

   20.   How does the cachectic patient appear physically?

a.
Central obesity only
b.
Very thin and malnourished
c.
Edematous around the face
d.
Very short of breath

ANS:  B

One should note the effects of body mass on breathing efficiency. Cachectic (nutritionally depleted) patients have readily outlined bony structures with depression of the intercostal spaces. Accessory muscles of respiration often are visible in these patients.

REF:   pg. 430           OBJ:   17 | 18

   21.   Which of the following findings during inspection would suggest that the patient is malnourished?

a.
Generalized obesity
b.
Use of accessory muscles
c.
Presence of wheezes
d.
Weak cough

ANS:  D

During inspection of the patient, the amount of effort that can be generated during coughing should be observed. Muscle weakness accompanies poor nutrition.

REF:   pg. 430           OBJ:   18