nutrition support

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jksrd
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140676
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nutrition support
Updated:
2012-03-11 10:54:25
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nutrition support
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  1. The following statement(s) characterize recent changes in the ICU pop’n
    A – higher acuity w/ longer ICU LOS
    B – inc incidence of sepsis
    C – Heightened severity of illnesses create more difficulty for nutritional provision
    d – all of the above
    d – all of the above
  2. In addition to an elevated HR ( >90 bpm), clinical s/s of systemic inflammatory response syndrome (SIRS) include all of the following except
    A – temperature >38 or <36 C
    B – rr >20 breathes/min or PaC02 <32 mmHg
    C – urinary WBC >1000/dL
    D – serum WBC >12000/mcL or <4000mcL
    C – urinary WBC >1000/dL
    (this multiple choice question has been scrambled)
  3. Sepsis definition
    Characterized by fever, leukocytosis or leucopenia, elevated cardiac output w/ reduced systemic vascular resistance in presence of severe infection. Pro-inflammatory and anti-inflammatory mediators are present in sepsis, working to rid the body of the foreign antigens. Sepsis can result in multiple organ dysfxn syndrome
  4. s/s of SIRS includes:
    • · Body temperature less than 36°C or greater than 38°C
    • · Heart rate greater than 90 beats per minute
    • · Tachyapnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
    • · White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10% immature neutrophils (band forms)
  5. In addition to evidence of infection, the following must also be present in order to dx sepsis:
    A – Provides fuel and substrates
    B – Hypotension
    C – 2 or more of the components of SIRS
    D – temp >40C
    C – 2 or more of the components of SIRS
    (this multiple choice question has been scrambled)
  6. The first phase of the metabolic response to sepsis, the stress phase, occurring immediately after injury and lasting 24-48 hours is characterized by
    A – Hemodynamic instability, hyper metabolism, hypo catabolism
    B - Hemodynamic instability, hypo metabolism, hypo catabolism
    C – Insulin sensitivity, hyper metabolism, hyper catabolism
    D - Insulin resistance, hyper metabolism, hyper catabolism
    B - Hemodynamic instability, hypo metabolism, hypo catabolism
    (this multiple choice question has been scrambled)
  7. Which of the following has not been proposed to reduce the risk of ON associated liver dz?
    A - Omit lipids form the PN solution
    B – Infuse PN over 24 hours
    C - Supplement PN w/ choline
    D - Provide lipids less than 7 days a week
    B – Infuse PN over 24 hours
    (this multiple choice question has been scrambled)
  8. Initiation of enteral nutrition within 24/48 hours of injury or admission to the ICU can impact
    A - Serum prealb
    B – Infectious complications
    C – Mortality
    D – Bacterial translocation
    B – Infectious complications
    (this multiple choice question has been scrambled)
  9. Postpyloric enteral feedings should be considered for
    A – All critically ill pts
    B – pts w/ gastric residuals >150 mL
    C – pt who require prolonged supine positioning
    D – all trauma pt w/ head injury
    C – pt who require prolonged supine positioning
  10. The acute phase responses is associated w/ providing in all of the following benefits except:
    A – enhances antimicrobial and antioxidant activity
    b- fosters wound healing/removes damaged tissue
    c – maintain fluid balance
    d – provides fuel and substrate
    c – maintain fluid balance
  11. The catabolic phase ensues after the following stress phase and usually lasts 7-10d, and is characterized by:
    A – fever, hypercatabolism, increases lipolysis
    B - fever, hypocatabolism, increases lipogenesis
    C – hypercatabolism, lipogenesis, glycogenolysis
    D – hypocatabolism, increased lipolysis, insulin sensitivity
    A – fever, hypercatabolism, increases lipolysis
    (this multiple choice question has been scrambled)
  12. the anabolic phase can last up to several months after the catabolic phase of injury and is characterized by all of the following except:
    A – hypermetabolism
    B – hypometabolism
    C – normalization of acute phase proteins
    D – nutritional recovery
    B – hypometabolism
    (this multiple choice question has been scrambled)
  13. If SIRS continues unabated, the potential exists for this serious and immunosuppressive condition
    A – compensated attenuated reaction syndromes (CARS)
    B – counter anti-inflammatory response syndromes (CARS)
    C – super inflammatory response (SIR)
    D – Responsive inflammatory medicated response (RIMR)
    B – counter anti-inflammatory response syndromes (CARS)
    (this multiple choice question has been scrambled)
  14. Hyperglycemia d/t insulin deficiency is observed w/ all of the following conditions except:
    A – underlying DM
    B – advanced age
    C - pancreatitis
    D – excessive glycogenesis
    D – excessive glycogenesis
    (this multiple choice question has been scrambled)
  15. hyperglycemia d/t insulin resistance is observed w/:
    a – obesity
    b – corticosteroids
    c – sepsis
    d – all of the above
    d – all of the above, + uremia, catecholamine infusion, cirrhosis
  16. Besides its role in decreasing glc, insulin may offer benefits as a:
    A – regulator of kidney fxn
    B – component of multiple antioxidants
    C – mediator of phagocytosis
    D – potent anti-inflammatory agent
    D – potent anti-inflammatory agent
    (this multiple choice question has been scrambled)
  17. The following statement (s) describes the utilization of hospital resources by persons with DM:
    A – DM pts account for ~15% hospital admissions
    B – The LOS for pts w/ DM is ~30-40% lower than non-DM pts
    C – more than 3M persons w/ DM are admitted to the hospital annual, accounting for ~20% hospital costs
    D – all of the above
    D – all of the above
  18. Improved glycemic control has been shown to offer benefits in the following pop’ns
    A – post op, including cardiac surgery pts
    B – ventilated pts
    C – stroke pts
    D – all of the above
    D – all of the above
  19. According to consensus of recommendations from the American college of Endo, the goal glc level for ICU pts should be (in mg/dL)
    A – 135
    B – 110
    C – 85
    D - <155
    B – 110
    (this multiple choice question has been scrambled)
  20. In a landmark study comparing conventional glc control to intensive glc control, the pts in the intensively controlled glc group
    A – reduced rate of ICU mortality
    B – reduced rate of in hospital mortality
    C – shorter ICU LOS
    D – all of the above
    D – all of the above
  21. Parenteral dextrose infusion should not exceed this threshold in adults (in mg/kg/min)
    A – 6
    B – 4.5
    C – 7
    D – 8.5
    C – 7
    (this multiple choice question has been scrambled)
  22. Calculate the dextrose infusion rate for a 70 kg pt receiving PN containing 15% dextrose at 100 mL/hr (in mg/kg/min)
    A – 3.6
    B – 3.2
    C – 4.7
    D – 4.3
    A – 3.6
    (this multiple choice question has been scrambled)
  23. To calculate mg/kg/min
    • 1. take % PN solution delivery and multiple by length of time 9i.e. 24 hours)
    • 2. multiple total delivery x % dextrose
    • 3. Multiple that number by 1000 mg/ 1 gram
    • 4. Divide by kg wt of pt
    • 5. Divide by 24 hours
  24. In preventing and treating hyperglycemia in a pt receiving PN, all of the following are true except
    A – the initiation of nutrition support can worsen hyperglycemia
    B – macronutrient provision should be advanced when glycemic stability is achieved and maintained
    C – hyperglycemia will negate beneficial effects of nutrition support
    D – macronutrient provision should always be increased to goal as quickly as possible
    D – macronutrient provision should always be increased to goal as quickly as possible
    (this multiple choice question has been scrambled)
  25. In the setting of critical illness such as sepsis, the following statements are true:
    A – aggressive nutrition support can prevent catabolism of LBM
    B – in this subset of pts, the more nutrition support these pts receive the better the outcome
    C - aggressive nutrition support can prevent catabolism of LBM AND in this subset of pts, the more nutrition support these pts receive the better the outcome
    D – endogenous glc production will not be suppressed by aggressive nutrition support
    D – endogenous glc production will not be suppressed by aggressive nutrition support
    (this multiple choice question has been scrambled)
  26. The following statement(s) describe hypocaloric feeding
    A – hypocaloric delivery is likely to worsen nitrogen losses
    B – total kcal delivery is less than measured or estimated with generous protein provision (1.5 g/kg)
    C - total kcal delivery is less than measured or estimated with generous protein provision (1.5 g/kg) AND hypocaloric delivery is likely to worsen nitrogen losses
    D – total kcal delivery is less than measured or estimated with standard protein provision (0.8 g/kg)
    B – total kcal delivery is less than measured or estimated with generous protein provision (1.5 g/kg)
    (this multiple choice question has been scrambled)
  27. In the setting of this condition(s), short term hypocaloric nutrition support may offer some benefit
    A – high likelihood of hyperglycemia
    B – severe volume limitations
    C – severe obesity
    D – all of the above
    D – all of the above
  28. For pts w/ acute long injury or adult respiratory distress syndrome, supplementation with EPA, gamma-linolenic acid, and antioxidants may provide the following benefit(s)
    A – increase gas exchange and decrease time on ventilator
    B – reduce rate of new organ failures in ICU pt
    C – decrease pulmonary inflammation and modify systemic inflammatory response
    D – all of the above
    D – all of the above
  29. The following scoring scale is used to predict risk-adjusted mortality in ICU pts using components such as temp, HR, age, Glasgow coma scale
    A – random criteria
    B – acute care prognostician index
    C – apache II
    D – none of the above
    C – apache II
    (this multiple choice question has been scrambled)
  30. In which phase(s) of sepsis should hypocaloric feeding (~20 kcal/kg w/ 1.5 – 2 g pro/kg) be considered
    A – hemodynamically unstable pt
    B – anabolic phase
    C – catabolic phase
    D – any of the above
    C – catabolic phase
    (this multiple choice question has been scrambled)
  31. In interpreting serum protein, ___ is a negative acute phase reactant; ___ is a positive acute phase reactant.
    A – haptoglobulin, albumin
    B – CRP, prealb
    C – prealb, CRP
    D – transferrin, albumin
    C – prealb, CRP
    (this multiple choice question has been scrambled)
  32. Negative acute phase reactants
    • Assimilated during non-stressed times
    • Prealb, albumin, transferring, retinol binding protein
  33. Positive acute phase reactants
    • Elevated in times of stress
    • Haptoglobulin, CRP, ceruloplasmin, fibrinogen
  34. Anabolism would be indicated by the increase of ____ and the decrease and subsequent normalization of _________
    A – CRP, albumin
    B – transferring, retinol binding protein
    C – prealb, CRP
    D – CRP, prealb
    C – prealb, CRP
    (this multiple choice question has been scrambled)
  35. All of the following statements describe gln except for
    A – levels of gln become depleted during critical illness
    B – it is the preferred fuel for enterocytes
    C – it is a precursor to glutathione
    D – it is an essential AA
    D – it is an essential AA
    (this multiple choice question has been scrambled)
  36. The following describes gln supplementation in critical illness:
    A – parenterally administered gln may be most beneficial
    B – parenterally administered gln may be detrimental
    C - yield no benefit in mortality or critical illness
    D – clear and convincing evidence exists in support of enterally administered gln
    A – parenterally administered gln may be most beneficial
    (this multiple choice question has been scrambled)
  37. All of the following describe the benefits of n-3 FA except for:
    A - n-3 FA may increase O2 in pts with ARDS
    B - n-3 FA may reduce systemic vascular resistance
    C - n-3 FA stimulate increased cytokine production
    D – n-3 FA are less immunosuppressive than LCFA
    C - n-3 FA stimulate increased cytokine production
    (this multiple choice question has been scrambled)
  38. Arginine is important in times of severe stress b/c:
    A – arginine [] are low in times of stress and injury
    B – arginine dependent NO modulates pro synthesis and mediates endotoxin effects
    C – arginine is a mediator of collagen synthesis
    D – all of the above
    D – all of the above
  39. The following statement is true re: supplementation of arginine in septic pts
    A – arginine supplementation may be harmful in the septic population
    B – when wounds are present arginine should be supplements, whether or not the pt is septic
    C – arginine supplementation has clearly demonstrated improved outcomes
    D – none of the above
    A – arginine supplementation may be harmful in the septic population
    (this multiple choice question has been scrambled)
  40. Regarding the supplementation of antioxidants in times of stress and injury
    A – antioxidants stabilize the free radicals and help decrease pro-inflammatory metabolites
    B – antioxidant supplementation may help lower infection rate and LOS
    C – optimal dosing and timing have yet TBD
    D – all of the above
    D – all of the above
  41. Research on immune enhancing formulas in stress, sepsis and critical injury has demonstrated
    A – evidence for optimal timing and dosing in the critically ill pop’n
    B – evidence that arginine and n-3 supplementation is always beneficial
    C – evidence that immune enhancing formulas should never be used in that pop’n
    D – no clear consensus or recommendation for the provision of immune enhancing nutrients
    D – no clear consensus or recommendation for the provision of immune enhancing nutrients
    (this multiple choice question has been scrambled)

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