Nutrition And Diet Therapy 8th Ed By Whitney – Test Bank

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Nutrition And Diet Therapy 8th Ed By Whitney – Test Bank

Chapter 2 – Carbohydrates

 

Answer, K/A, page(s)                                                                             K = knowledge question; A = application question

 

True/False

 

T     K     34                   1.     Whenever carbohydrate is available to the body, the human brain depends exclusively on it as an energy source.

 

F      K     36                   2.     Most food fiber is kcalorie-free.

 

T     A     40                   3.     A client consumes 2600 kcalories per day and 50 grams of carbohydrate from concentrated sweets. According to the USDA Food Guide recommendations, the client’s sugar intake is within the guidelines.

 

F      K     39                   4.     Experts agree that moderate amounts of sugar in the diet may pose a number of major health risks.

 

F      A     48                   5.     A client consumes 2000 kcalories per day and 200 grams of carbohydrate. This person meets the current dietary recommendations for carbohydrate intake.

 

T     A     48, 50             6.     Cindy consumed 2 servings of vegetables, 2 servings of fruit, 5 servings of whole grains, and 2 servings of legumes during the day. Cindy meets the DV recommendation for fiber for the day.

 

Multiple Choice

 

a      K     34                   1.     The main function of carbohydrates in the body is to:

  1. furnish the body with energy.
  2. provide material for synthesizing cell walls.
  3. synthesize fat.
  4. insulate the body to prevent heat loss.

 

c      K     34                   2.     Which of the following is a simple carbohydrate?

  1. starch
  2. glycogen
  3. sucrose
  4. some fibers

 

a      K     34                   3.     The _____ are the basic units of all carbohydrates.

  1. monosaccharides
  2. disaccharides
  3. polysaccharides
  4. sucrose molecules

 

e      K     34-35             4.     Three monosaccharides important in nutrition are:

  1. glucose, lactose, and fructose.
  2. fructose, glucose, and sucrose.
  3. maltose, fructose, and lactose.
  4. galactose, sucrose, and lactose.
  5. fructose, glucose, and galactose.

 

d      K     34                   5.     The primary source of energy for the brain and nervous system under normal conditions is:

  1. sucrose.
  2. amino acids.
  3. fructose.
  4. glucose.
  5. fatty acids.

 

b      K     35                   6.     The hormone that moves glucose from the blood into the cells is:

  1. glucagon.
  2. insulin.
  3. testosterone.
  4. sucrose.

 

d      K     35                   7.     Which of the following does not come exclusively from plants?

  1. glucose
  2. maltose
  3. fructose
  4. galactose

 

a      K     35                   8.     Fructose is:

  1. the sweetest of the sugars.
  2. known as milk sugar.
  3. abundant in whole grains.
  4. also known as dextrose.

 

d      K     35                   9.     Fructose occurs naturally in:

  1. bread.
  2. milk.
  3. meats.
  4. fruits.

 

d      K     35                   10.  Which monosaccharide is found most often in nature as a part of a disaccharide?

  1. glucose
  2. fructose
  3. maltase
  4. galactose

 

c      K     35                   11.  Which of the following compounds is a disaccharide?

  1. glucose
  2. fructose
  3. lactose
  4. galactose

 

b      K     35                   12.  All of the following terms are used to describe sucrose except:

  1. white sugar.
  2. milk sugar.
  3. table sugar.
  4. cane sugar.

 

b      K     35                   13.  The most familiar source of sucrose is:

  1. bread.
  2. table sugar.
  3. milk.
  4. meat.
  5. fruit.

d      A     35                   14.  The principle carbohydrate in cakes and cookies is:

  1. fructose.
  2. galactose.
  3. maltose.
  4. sucrose.

 

a      K     35                   15.  One molecule of sucrose contains _____ molecule(s) of glucose.

  1. one
  2. two
  3. three
  4. four

 

d      K     35                   16.  Which of the following is the principal carbohydrate in milk?

  1. galactose
  2. fructose
  3. sucrose
  4. lactose

 

b      K     35                   17.  Chemically, lactose is a:

  1. monosaccharide.
  2. disaccharide.
  3. dextrose.
  4. polysaccharide.

 

a      K     35                   18.  An example of a polysaccharide is:

  1. starch.
  2. meat.
  3. fruit.
  4. protein.

 

b      K     35                   19.  Which of the following carbohydrates is a polysaccharide?

  1. fructose
  2. starch
  3. maltose
  4. lactose

 

a      K     36                   20.  The stored form of glucose in the body is called:

  1. glycogen.
  2. insulin.
  3. fat.
  4. muscle.

 

d      K     34, 35             21.  Polysaccharides are composed of:

  1. one glucose unit.
  2. two glucose units.
  3. three glucose units.
  4. many glucose units.

 

b      K     36                   22.  Excess glucose in the blood is converted into glycogen and stored primarily in the:

  1. brain and liver.
  2. liver and muscles.
  3. blood cells and brain.
  4. pancreas and brain.

 

b      K     36                   23.  The richest sources of starch are:

  1. fruits.
  2. grains.
  3. vegetables.
  4. soybeans.

 

b      K     36                   24.  Whole grains, vegetables, legumes, and fruits are rich sources of:

  1. sucrose.
  2. dietary fiber.
  3. fat.
  4. glycogen.

 

c      K     36-37             25.  Cellulose, pectin, hemicellulose, and gums are:

  1. artificial sweeteners.
  2. sugar alcohols.
  3. fibers.
  4. simple carbohydrates.

 

d      K     37                   26.  _____ is a fiber found in all vegetables, fruits, and legumes.

  1. Hemicelluose
  2. Pectin
  3. Mucilage
  4. Cellulose

 

b      K     36, 37             27.  Which of the following fibers is a nonpolysaccharide?

  1. cellulose
  2. lignin
  3. pectin
  4. gum

 

c      K     37                   28.  All of the following fibers are used by the food industry as additives or stabilizers except:

  1. pectins.
  2. gums.
  3. lignins.
  4. mucilages.

 

a      K     37                   29.  _____ escape digestion and absorption in the small intestine.

  1. Resistant starches
  2. Polysaccharides
  3. Bacteria
  4. Disaccharides

 

b      K     37                   30.  Fibers are categorized by:

  1. the type of chemical bonds that hold them together.
  2. their chemical and physical properties.
  3. the number of hydrogen molecules they contain.
  4. their ability to be digested by human enzymes.

 

c      K     38                   31.  The sugars in fruits, vegetables, grains, and milk are:

  1. usually added to these foods.
  2. considered discretionary kcalories.
  3. naturally occurring.
  4. resistant to digestion.

 

b      K     38                   32.  The steady upward trend in sugar consumption among Americans can be attributed to:

  1. consumer demand.
  2. food manufacturers.
  3. better food preservation techniques.
  4. improved food safety practices.

 

c      K     38                   33.  The leading source of added sugar in the American diet is:

  1. baked goods such as cookies and cakes.
  2. fruit packed in heavy syrup.
  3. soft drinks and other sugar-sweetened beverages.
  4. chocolate bars and other candy treats.

 

b      K     39                   34.  According to the World Health Organization’s recommendations, no more than _____% of daily kcalories should come from added sugars.

  1. 5
  2. 10
  3. 15
  4. 20

 

c      K     40                   35.  Which of the following statements best describes the role of sugar in the development of obesity?

  1. Sugar consumption is a direct cause of weight gain leading to obesity.
  2. The increased use of added sugars by food manufacturers is the cause of obesity.
  3. Sugar contributes to obesity when it is part of excessive energy intakes.
  4. There is a direct correlation between the consumption of added sugars and the rise in obesity.

 

c      K     39                   36.  Which of the following statements about excessive sugar consumption is true?

  1. It causes cancer.
  2. It causes heart disease.
  3. It causes dental caries.
  4. It causes hyperactive behavior in children.

 

b      A     43                   37.  Which of the following ingredients represents a sugar alcohol?

  1. polydextrose
  2. maltitol
  3. cellulose
  4. aspartame

 

d      A     42                   38.  How many kcalories are provided by 100 grams of carbohydrate?

  1. 100
  2. 200
  3. 300
  4. 400

 

a      K     42                   39.  Sweeteners that yield energy are called:

  1. nutritive sweeteners.
  2. artificial sweeteners.
  3. resistant sweeteners.
  4. glycemic sweeteners.

 

Ice Cream

A carton of ice cream contains the following list of ingredients: milkfat and nonfat milk, sorbitol, pecans, cellulose, butter, caramel color, citric acid, aspartame, carrageenan.

 

b      A     42-44             40.  Refer to Ice Cream. How many alternative sweeteners are contained in this product?

  1. one
  2. two
  3. three
  4. four

 

a      A     44                   41.  Refer to Ice Cream. How many artificial sweeteners are contained in the product?

  1. one
  2. two
  3. three
  4. four

 

a      K     45                   42.  The artificial sweetener sucralose is made from:

  1. sucrose.
  2. an amino acid.
  3. aspartame.
  4. maltose.

 

a      K     45                   43.  The artificial sweetener that is similar in structure to fructose is:

  1. tagatose.
  2. neotame.
  3. sucralose.
  4. stevia.

 

b      A     37, 46             44.  Which of the following foods would you recommend to someone interested in lowering his or her blood cholesterol level?

  1. wheat bread
  2. oatmeal
  3. strawberries
  4. pork

 

b      K     46                   45.  Soluble fiber can help reduce blood cholesterol levels by:

  1. converting cholesterol into vitamin D.
  2. binding cholesterol and carrying it out of the body with the feces.
  3. blocking the absorption of bile.
  4. preventing the production of bile.

 

d      K     46-47             46.  Which of the following statements is not true regarding the health benefits of fiber?

  1. Fiber aids in weight management.
  2. Fiber aids in reducing the risk of type 2 of diabetes.
  3. Fiber aids in overall health of the gastrointestinal tract.
  4. Fiber aids in the prevention of osteoporosis.

 

a      K     46                   47.  The _____ describes the effect a food has on blood glucose levels.

  1. glycemic index
  2. insulin index
  3. solubility factor
  4. viscosity index

 

b      K     48                   48.  Soluble fibers are found in:

  1. celery, wheat bran, and corn.
  2. kidney beans, apples, and oatmeal.
  3. corn, apples, and sunflower seeds.
  4. celery, soybeans, and bran flakes.

 

a      K     46, 48             49.  Which of the following is the most effective at alleviating constipation?

  1. cellulose
  2. pectin
  3. gums
  4. psyllium

 

c      K     48                   50.  Carbohydrate should contribute approximately _____% of the total daily energy intake.

  1. 35-40
  2. 45-55
  3. 45-65
  4. 55-60

 

a      A     48                   51.  A 2000-kcalorie diet that provides 175 grams of carbohydrate provides:

  1. inadequate carbohydrate.
  2. excessive carbohydrate.
  3. an appropriate amount of carbohydrate.
  4. inadequate fiber.

 

c      K     48                   52.  The Dietary Reference Intake for dietary fiber is approximately _____ grams per day.

  1. 10-15
  2. 15-25
  3. 25-35
  4. 35-50

 

b      K     49-50             53.  Grains, legumes, and root vegetables contain predominantly:

  1. simple sugars and fiber.
  2. starches and fiber.
  3. fat and fiber.
  4. simple sugars and fat.

 

b      A     49-50             54.  Foods richest in carbohydrates are:

  1. eggs, cheese, and milk.
  2. rice, broccoli, and apples.
  3. milk, nuts, and oils.
  4. mayonnaise, butter, and salad dressing.

 

c      A     50-51             55.  Which of the following groups contains the least carbohydrate?

  1. grains and starchy vegetables
  2. nuts and dried fruits
  3. milk and cheese
  4. fruits and vegetables

 

a      A     49-51             56.  Jeff consumed the following foods for a meal: small baked potato, ½ cup of carrots, 1 cup skim milk, and 1 small banana. Approximately how many grams of carbohydrate did Jeff consume?

  1. 47
  2. 57
  3. 66
  4. 69

 

c      K     39-40             57.  A valid concern about excessive sugar consumption is:

  1. an increased risk for developing cancer.
  2. its contribution to behavioral problems in children.
  3. the potential for malnutrition.
  4. an increased risk for developing hypertension.

 

a      K     39-40             58.  High-fructose corn syrup is composed of:

  1. fructose and glucose.
  2. glucose and galactose.
  3. sucrose and maltitol.
  4. fructose and galactose.

 

a      K     40                   59.  Which of the following is the equivalent of 1 teaspoon of white sugar?

  1. 1 tablespoon of catsup
  2. 1 tablespoon of jelly
  3. 2 oz. of a carbonated soft drink
  4. 3 teaspoons of honey

 

c      K     44                   60.  Aspartame is made from:

  1. sucrose.
  2. fructose.
  3. two amino acids.
  4. two monosaccharides.

 

b      K     49                   61.  The World Health Organization set an upper limit for fiber intake at _____ grams per day.

  1. 30
  2. 40
  3. 50
  4. 60

 

Nutrition in Practice – The Glycemic Index in Nutrition Practice

 

a      K     55                   62.  The glycemic index ranks carbohydrate foods based on their effect on:

  1. blood glucose and insulin levels.
  2. blood pressure.
  3. weight.
  4. blood cholesterol and triglyceride levels.

 

a      K     55                   63.  The glycemic index of a food can be measured by comparing the increase in one’s blood glucose levels after consuming a carbohydrate to that caused by a reference food such as:

  1. white bread.
  2. a banana.
  3. ice cream.
  4. oatmeal.

 

d      A     56                   64.  Which of the following breakfast foods has the lowest glycemic index?

  1. cornflakes
  2. instant oatmeal
  3. white bagel
  4. cooked oatmeal

 

d      K     55-56             65.  Factors that influence the GI value of a food include all of the following except the

  1. structure of the starch.
  2. fiber content in the food.
  3. manner in which the food was processed.
  4. time of day the food is consumed.

 

c      K     55, 57             66.  People with _____ may benefit from limiting their intake of high-GI foods.

  1. heart disease
  2. arthritis
  3. diabetes
  4. migraine headaches

 

a      K     57                   67.  Which of the following statements most accurately reflects current recommendations about the glycemic index?

  1. People with type 2 diabetes may benefit from limiting high-GI foods.
  2. High-GI foods such as potatoes and bread should be avoided.
  3. There is ample evidence that low-GI diets should be recommended for the general population.
  4. All foods with a GI greater than 70 should be avoided until further research is done.

 

 

Matching

 

h 43 1.     ADI a.     a hormone secreted by the pancreas in response to high blood glucose; promotes cellular glucose uptake.

b.     a hormone that is secreted by special cells in the pancreas in response to low blood glucose concentration; elicits release of glucose from storage.

c.     a measure of the extent to which a food raises the blood glucose concentration and elicits an insulin response, as compared with pure glucose.

d.     the more common type of diabetes in which the fat cells resist insulin.

e.     indigestible food components that readily dissolve in water and often impart gummy or gel-like characteristics to foods.

f.     having a gel-like consistency.

g.     the tough, fibrous structures of fruits, vegetables, and grains; indigestible food components that do not dissolve in water.

h.     the amount of an artificial sweetener that individuals can safely consume each day over the course of a lifetime without adverse effect.

b 35 2.     glucagon
c 46, 47 3.     glycemic response
g 37 4.     insoluble fibers
a 35 5.     insulin
e 37 6.     soluble fibers
d 47 7.     type 2 diabetes
f 37 8.     viscous

 


Essay

 

34                   1.     Of all the possible alternatives, why is carbohydrate the preferred energy source?

 

40-41             2.     How would you respond to the statement that honey is more nutritious than white sugar?

 

43-45             3.     Compare and contrast the 6 FDA-approved artificial sweeteners.

 

47                   4.     Describe how fiber-rich foods help with weight control.

 

47-48             5.     Discuss the harmful effects of excessive fiber intake.

 

51                   6.     Given the nutrient information on food labels, how could you determine the number of grams of starch in a food product?

 

38                   7.     Differentiate between added sugars and naturally occurring sugars.

 

39-40             8.     Does high-fructose corn syrup contribute to obesity more than other types of sugar? Explain your answer.

Chapter 10 – Fitness and Nutrition

 

Answer, K/A, page(s)                                                                             K = knowledge question; A = application question

 

True/False

 

T     K     258-259         1.     The types and amounts of physical activity needed to promote fitness may differ from those needed to obtain health benefits.

 

T     K     263                 2.     The amount of glycogen a body stores depends partially on the amount of carbohydrate in the diet.

 

T     K     267                 3.     Areas of the body that have the most fat to spare donate the greatest amounts of fatty acids to the blood during exercise.

 

T     K     271                 4.     Sports anemia clears up without treatment.

 

F      K     273                 5.     People normally need to make special efforts to replenish electrolytes lost during exercise.

 

                                        Nutrition in Practice: Supplements and Ergogenic Aids Athletes Use

 

F      K     283                 6.     No research supports the idea that caffeine enhances endurance.

 

Multiple Choice

 

a      K     257                 1.     As many as _____ percent of adults in the U.S. are completely inactive.

  1. 20
  2. 50
  3. 60
  4. 75

 

c      A     257-258         2.     Benefits of fitness include all of the following except:

  1. it shifts body composition toward more lean tissue .
  2. it enables the body to resist colds.
  3. improved self-discipline.
  4. improved bone density.

 

d      K     258                 3.     All of the following are benefits of physical activity except:

  1. lower blood pressure.
  2. slower resting pulse.
  3. increased HDL cholesterol.
  4. increased LDL cholesterol.

 

b      K     259                 4.     The Physical Activity Guidelines for Americans specify that people need to spend at least _____ performing moderate-intensity aerobic activity on five to seven days per week.

  1. 20 minutes
  2. 30 minutes
  3. 45 minutes
  4. 60 minutes

 

a      K     258                 5.     Running at a pace of 6.5 miles/hour is an example of a(n):

  1. vigorous-intensity physical activity.
  2. moderate-intensity physical activity.
  3. muscle-strengthening physical activity.
  4. anaerobic physical activity.

 

b      K     260                 6.     The ability to bend and recover without injury is called:

  1. muscular endurance.
  2. flexibility.
  3. strength.
  4. cardiorespiratory endurance.

 

a      K     260                 7.     A fitness program should help you maintain all of the following health-related components except:

  1. speed.
  2. flexibility.
  3. muscle endurance.
  4. muscle strength.

 

a      K     260                 8.     An increase in the size and strength of muscle tissues is called:

  1. hypertrophy.
  2. overload.
  3. hyponatremia.
  4. atrophy.

 

d      K     261                 9.     Which of the following is not a benefit of weight training?

  1. improved posture
  2. enhanced psychological well-being
  3. improved muscle endurance
  4. enhanced appetite

 

a      K     262                 10.  VO2max refers to:

  1. maximal oxygen uptake.
  2. maximal pulse rate.
  3. maximal repetitions.
  4. maximal resistance.

 

b      K     262                 11.  Aerobic exercise results in all of the following except:

  1. a stronger heart muscle.
  2. an increase in blood pressure.
  3. increased stroke volume..
  4. more efficient breathing.

 

c      K     263                 12.  The average resting pulse rate for adults is around _____ beats per minute.

  1. 50
  2. 60
  3. 70
  4. 80

 

a      A     263-264         13.  Glycogen stores can be quickly depleted when an exerciser is on a diet that is:

  1. low in carbohydrates.
  2. high in protein.
  3. low in fat.
  4. high in carbohydrates.

 

b      K     263                 14.  During rest, the body derives a little more than half of its energy from:

  1. glucose.
  2. fatty acids.
  3. amino acids.
  4. glycogen.

 

b      K     264                 15.  A high-carbohydrate diet enhances an athlete’s endurance by:

  1. providing plenty of fiber.
  2. ensuring ample glycogen stores.
  3. improving oxygen uptake.
  4. ensuring ample stores of fatty acids.

 

d      K     264-266         16.  The rate at which a person uses glycogen during physical activity depends on all of the following except:

  1. duration of the activity.
  2. intensity of the activity.
  3. how well-trained the person is.
  4. body weight.

 

a      A     265                 17.  Which of the following would benefit from consuming a drink that provides glucose during exercise?

  1. someone who swims for more than an hour and a half a day
  2. someone who plays tennis three times a week for an hour
  3. someone who jogs two to three times a week for half an hour
  4. someone who rides a bike every other day for 30 minutes

 

c      K     265                 18.  Following exercise, approximately _____ grams of carbohydrate should be consumed in order to maximize an athlete’s glucose supply.

  1. 20
  2. 40
  3. 60
  4. 80

 

b      K     267                 19.  After _____ minutes of exercise, the body begins to use more fat for fuel.

  1. 10
  2. 20
  3. 30
  4. 60

 

a      K     267                 20.  Athletic performance may be inhibited by:

  1. very-low-fat diets.
  2. high-carbohydrate diets.
  3. low-protein diets.
  4. high-sodium diets.

 

a      K     268                 21.  Diets lacking in carbohydrate:

  1. necessitate the conversion of amino acids to glucose.
  2. cause amino acids to be converted to fatty acids.
  3. require more fluid intake.
  4. necessitate the conversion of glucose to amino acids.

 

c      A     269                 22.  Which of the following groups has the lowest protein needs?

  1. body builders
  2. endurance athletes
  3. sedentary people
  4. all need the same amount of protein

b      A     269                 23.  Estimate the recommended protein intake for a 150-pound male endurance athlete.

  1. 55-68 grams per day
  2. 82-95 grams per day
  3. 90-112 grams per day
  4. 109-116 grams per day

 

a      K     271                 24.  Iron-deficiency anemia hinders exercise performance by limiting the amount of _____ available to muscles.

  1. oxygen
  2. hydrogen
  3. glycogen
  4. hemoglobin

 

b      A     270                 25.  Iron deficiency is especially likely to develop in:

  1. children.
  2. physically active young women.
  3. physically active men.
  4. older active adults.

 

c      A     271                 26.  Iron supplements are needed when athletes:

  1. feel tired after exercise.
  2. have sports anemia.
  3. have iron-deficiency anemia.
  4. become dehydrated.

 

b      K     271                 27.  The most critical nutrient needed for the exerciser is:

  1. iron.
  2. water.
  3. calcium.
  4. protein.

 

c      K     272                 28.  Drinking extra fluid in the days leading up to an athletic event:

  1. increases fluid stores in the body.
  2. increases glycogen stores.
  3. ensures maximum tissue hydration to start the event.
  4. assists the body in better utilizing protein for energy.

 

b      A     273                 29.  Severe headache, vomiting, bloating, confusion, and seizure are all symptoms of:

  1. “hitting the wall.”
  2. hyponatremia.
  3. hypothermia.
  4. sports anemia.

 

b      K     272                 30.  Based on an appropriate schedule of hydration for physical activity, after exercise at least _____ cups of fluid for each pound of weight lost should be consumed.

  1. 1
  2. 2
  3. 3
  4. 4

 

c      K     273                 31.  The best fluid to support physical activity for endurance athletes is:

  1. plain, cool water.
  2. saltwater mixtures.
  3. sports drinks.
  4. lukewarm water.

 

d      K     275-276         32.  Characteristics of the best diet for fitness include all of the following except:

  1. high in carbohydrates.
  2. based on nutrient-dense foods.
  3. adequate in protein.
  4. high in fat.

 

d      K     276                 33.  The optimum diet for an athlete provides about _____ percent of kcalories from carbohydrates.

  1. 30-40
  2. 40-50
  3. 50-60
  4. 60-70

 

c      A     276                 34.  If an athlete consumes 3000 kcalories, at a minimum how many grams of carbohydrate should he consume?

  1. 200
  2. 325
  3. 450
  4. 500

 

d      K     277                 35.  Desirable characteristics of foods included in a pregame meal include:

  1. high in fat.
  2. high in fiber.
  3. low in carbohydrate.
  4. low in protein.

 

b      A     277                 36.  Which of the following foods would be the best choice for a pregame meal?

  1. black beans and rice
  2. pasta in marinara sauce
  3. peanut butter and jelly sandwich
  4. cheese and crackers

 

a      A     276-277         37.  Which of the following foods should be avoided prior to competition?

  1. ice cream
  2. grape juice
  3. banana
  4. graham crackers

 

Nutrition in Practice: Supplements and Ergogenic Aids Athletes Use

 

d      K     282                 38.  Supplements of carnitine are not necessary because it is naturally found in:

  1. fruits and vegetables.
  2. whole grains.
  3. nutrient-dense foods.
  4. milk and meat products.

 

d      K     282,284         39.  Which of the following ergogenic aids has been shown to boost performance?

  1. carnitine
  2. ribose
  3. royal jelly
  4. none of the above

 

a      A     283                 40.  If taken correctly, in which of the following sports might creatine enhance performance?

  1. weight lifting
  2. tennis
  3. swimming
  4. baseball

 

b      K     283                 41.  Adverse effects associated with steroid use include all of the following except:

  1. cancerous liver tumors.
  2. decreased blood pressure.
  3. sterility.
  4. testicular shrinkage in men.

 

a      K     284                 42.  The way to make muscle cells grow is to:

  1. make them work.
  2. take protein supplements.
  3. consume more dietary protein.
  4. a and b

 

 

Matching

 

e 262, 264 1.             aerobic a.     physically inactive (literally “sitting down a lot”).

b.     an increase in the frequency, duration, or intensity of an activity.

c.     an increase in size in response to use.

d.     a decrease in size because of disuse.

e.     requiring oxygen.

f.     the maximum rate of oxygen consumption by an individual.

g.     the volume of blood discharged by the heart each minute.

h.     the amount of oxygenated blood ejected from the heart toward body tissues at each beat.

i.      the major hormone that elicits the stress response.

j.      not requiring oxygen.

k.     a compound produced during the breakdown of glucose in anaerobic metabolism.

l.      an above-normal body temperature.

m.   an acute and life-threatening reaction to heat buildup in the body.

n.     a below-normal body temperature.

o.     a decreased concentration of sodium in the blood.

p.     compounds that supply glucose, not as single molecules, but linked in chains somewhat like starch.

q.     water that is fortified with ingredients such as vitamins, minerals, protein, oxygen, or herbs.

j 265 2.             anaerobic
d 261 3.             atrophy
g 263 4.             cardiac output
q 275 5.             enhanced water
i 263 6.             epinephrine
p 275 7.             glucose polymers
m 273 8.             heat stroke
l 273 9.             hyperthermia
c 261 10.          hypertrophy
o 273 11.          hyponatremia
n 273 12.          hypothermia
k 265 13.          lactate
b 260 14.          overload
a 257 15.          sedentary
h 263 16.          stroke volume
f 263 17.          VO2 max

 


Essay

 

262-263         1.     Describe some of the conditioning effects of cardiorespiratory training.

 

259                 2.     Explain what a person has to do in terms of type, frequency, intensity, and duration of activity to meet the ACSM’s guidelines for physical activity.

 

273                 3.     Why is plain, cool water the best fluid for noncompetitive, everyday active people?

 

275-278         4.     Describe characteristics of a diet best suited for a person who engages in physical activity.

 

276-277         5.     Describe the desirable composition of a pregame meal and explain why certain categories of foods should be avoided.

 

 

 

Chapter 18 – Fiber-Modified Diets
for Lower Gastrointestinal Tract Disorders

 

Answer, K/A, page(s)                                                                             K = knowledge question; A = application question

 

True/False

 

T     K     485                 1.     The DRI for fiber for an adult male is 38 grams per day.

 

T     K     485                 2.     Flatulence can be an unpleasant side effect of consuming a high-fiber diet.

 

F      K     486                 3.     Constipation is diagnosed when a person does not have a daily bowel movement.

 

F      K     490                 4.     Diverticulitis and ulcerative colitis are the two most prevalent inflammatory bowel diseases.

 

F      K     493                 5.     Diverticulitis is a relatively mild, non-life threatening condition.

 

T     K     486                 6.     A high-fiber diet increases stool weight and fecal water content.

 

T     A     486                 7.     Daily exercise can help treat constipation if it stimulates peristalsis.

 

T     K     487                 8.     Psyllium may be effective in the treatment of diarrhea by reducing the liquidity of the stool.

 

T     K     488                 9.     People with irritable bowel syndrome tend to have excessive colonic responses to meals, GI hormones, and stress.

 

F      K     493                 10.  The development of diverticulosis is influenced by the type of dietary protein one consumes.

 

F      K     494, 495        11.  A colostomy involves removal of the entire colon.

 

F      K     495                 12.  The patient with a colostomy or ileostomy should have a diet that is restricted in fluids.

 

Multiple Choice

 

d      K     485                 1.     All of the following are indications for modifying fiber intake except:

  1. constipation.
  2. irritable bowel syndrome.
  3. inflammatory bowel diseases.
  4. gallbladder disease.

 

d      K     486                 2.     Constipation may be caused by all of the following except:

  1. a low-fiber diet.
  2. physical inactivity.
  3. medications.
  4. a viral infection.

 

b      K     486                 3.     Dietary suggestions for treating constipation are aimed at:

  1. decreasing dietary fiber and fluids.
  2. increasing dietary fiber and fluids.
  3. increasing dietary protein.
  4. increasing carbohydrate intake.

 

d      A     485                 4.     Foods useful in increasing dietary fiber are:

  1. bran, milk, and mashed potatoes.
  2. peanut butter, oranges, and strawberry jam.
  3. saltine crackers, watermelon, and eggs.
  4. whole-wheat bread, black beans, and popcorn.

 

b      A     485                 5.     Charlie is trying to change his eating behaviors and start following a high-fiber diet. The best advice you can give Charlie is to:

  1. purchase a bulk-forming agent.
  2. gradually add high-fiber foods to his diet.
  3. avoid milk products that contain residue.
  4. limit his fluid intake.

 

b      K     487                 6.     Which of the following bulk-forming agents may cause an allergic reaction?

  1. methylcellulose
  2. psyllium
  3. polycarbophil
  4. malt soup extract

 

a      K     487                 7.     Use of stimulant laxatives can lead to:

  1. fluid and electrolyte imbalances.
  2. anemia.
  3. increased appetite.
  4. hyperglycemia.

 

a      K     485                 8.     A side effect of consuming a high-fiber diet is:

  1. flatulence.
  2. ostomy.
  3. bacterial overgrowth.
  4. diverticulosis.

 

d      A     485                 9.     Of the following beverages, which is least likely to increase intestinal gas?

  1. orange juice
  2. beer
  3. carbonated lemon-lime soda
  4. tea

 

a      A     485                 10.  Which of the following foods is most likely to increase intestinal gas?

  1. cabbage
  2. tomatoes
  3. green beans
  4. walnuts

 

d      A     485                 11.  Billy consumed the following foods at lunch: A hamburger with lettuce, tomato, and catsup on a bun; potato salad; and a diet carbonated beverage. Later that afternoon Billy began to experience gas. Which of the following foods was most likely to be responsible for production of the gas?

  1. hamburger meat
  2. tomato
  3. potato salad
  4. diet carbonated beverage

 

c      K     487                 12.  Bacterial food poisoning causes:

  1. osmotic diarrhea.
  2. steatorrhea.
  3. secretory diarrhea.
  4. chronic diarrhea.

 

a      K     487                 13.  Diarrhea is often classified according to the cause of the fluid loss. Nutrient malabsorption causes:

  1. osmotic diarrhea.
  2. secretory diarrhea.
  3. intractable diarrhea.
  4. acute diarrhea.

 

a      K     487                 14.  Secretory diarrhea  may be caused by:

  1. bacterial food poisoning.
  2. lactose intolerance.
  3. irritable bowel syndrome.
  4. swallowed air.

 

a      K     487                 15.  Which of the following would be the first step in the treatment of someone with diarrhea?

  1. correct the underlying medical condition
  2. place the patient on NPO
  3. start parenteral nutrition
  4. start an oral rehydration solution

 

d      K     488                 16.  Which of the following would not be included in a homemade oral rehydration solution?

  1. table salt
  2. sugar
  3. baking soda
  4. cornstarch

 

c      K     488                 17.  Commercial sports drinks are not recommended for the treatment of severe diarrhea because they are too:

  1. expensive.
  2. high in sodium.
  3. low in sodium.
  4. low in potassium.

 

a      K     488                 18.  Which of the following foods may help to lessen diarrhea?

  1. applesauce
  2. pear juice
  3. milk
  4. sugar-free candies

 

b      A     488                 19.  Lily is experiencing a sudden bout of diarrhea. Which of the following may worsen her symptoms?

  1. adding salt to foods
  2. whole-wheat breads and cereals
  3. noodles and couscous
  4. bananas and peeled apples

 

b      A     488                 20.  The mother of a toddler is concerned about her child’s frequent episodes of diarrhea. The dietitian suggests that the mother reduce the child’s intake of:

  1. oatmeal.
  2. fruit juice.
  3. rice.
  4. yogurt.

 

a      K     490                 21.  Inflammation that may extend deeply into intestinal tissue and be accompanied by ulcerations, fissures, and fistulas is characteristic of _____.

  1. Crohn’s disease
  2. ulcerative colitis
  3. celiac disease
  4. irritable bowel syndrome

 

a      K     490                 22.  Which form of inflammatory bowel disease is characterized by “skip” lesions?

  1. Crohn’s disease
  2. ulcerative colitis
  3. irritable bowel syndrome
  4. diverticulosis

 

b      K     490-491         23.  Mr. Taylor seeks medical treatment for frequent, urgent bowel movements streaked with mucus and blood, and tests reveal a large, continuous area of inflammation affecting the first two layers of tissue in his rectum. What is Mr. Taylor’s likely diagnosis?

  1. Crohn’s disease
  2. ulcerative colitis
  3. celiac disease
  4. irritable bowel syndrome

 

c      K     492                 24.  Anti-inflammatory drugs used to treat the symptoms of inflammatory bowel disease may contribute to:

  1. malabsorption.
  2. fluid and electrolyte imbalances.
  3. anemia.
  4. weight loss.

 

d      K     491                 25.  Aggressive dietary management of Crohn’s disease is required in children because this disorder can lead to all of the following except:

  1. growth failure.
  2. nutrient deficiencies.
  3. protein-energy malnutrition.
  4. impaired glucose tolerance.

 

b      A     491                 26.  During an  exacerbation of  inflammatory bowel disease, the patient should be placed on _____ to minimize stool output and reduce symptoms of malabsorption.

  1. a low-sodium diet
  2. a low-fat, low-fiber diet
  3. a low-protein diet
  4. parenteral nutrition

 

c      K     491-493         27.  The dietary management for ulcerative colitis includes all of the following principles except:

  1. restoration of fluid and electrolyte balance.
  2. repletion of protein stores.
  3. a high-fiber diet to manage diarrhea.
  4. a low-fiber diet to reduce irritation in the colon.

 

d      K     488                 28.  An excessive colonic response to meals, GI hormones, and stress is characteristic of:

  1. celiac disease.
  2. ulcerative colitis.
  3. Crohn’s disease.
  4. irritable bowel syndrome.

 

b      K     488-489         29.  Which of the following statements concerning irritable bowel syndrome is true?

  1. Symptoms often improve during periods of psychological stress.
  2. It is associated with alternating episodes of diarrhea and constipation.
  3. Herbal remedies are very effective at relieving the symptoms.
  4. The most common recommendation is to gradually decrease fiber intake.

 

a      K     489                 30.  The treatment for irritable bowel syndrome includes all of the following except:

  1. surgery.
  2. dietary adjustments.
  3. stress management.
  4. behavioral therapy.

 

d      K     489                 31.  The dietary adjustments frequently recommended for the person with irritable bowel syndrome include all of the following except:

  1. avoiding fried and fatty foods.
  2. avoiding alcohol.
  3. consuming small, frequent meals.
  4. consuming a high-protein diet.

 

a      A     489                 32.  Mary has been diagnosed with irritable bowel syndrome. Which of the following would the dietitian recommend?

  1. a high-fiber diet
  2. a low-fiber diet
  3. a liquid diet
  4. a low-salt diet

 

b      K     493                 33.  Diverticular disease often occurs with:

  1. a bacterial infection.
  2. aging.
  3. constipation.
  4. food intolerances.

 

c      K     493                 34.  The incidence of diverticulosis may be reduced by recommending a diet:

  1. low in dietary fiber and residue.
  2. high in dietary fiber and fat.
  3. high in dietary fiber.
  4. high in dietary protein.

 

b      K     491                 35.  Removal of a portion or all of the colon is referred to as a:

  1. colostomy.
  2. colectomy.
  3. ileostomy.
  4. gastrectomy.

 

a      K     485,493-94   36.  Low-fiber diets are used in the treatment of all of the following conditions except:

  1. diverticulosis.
  2. post-surgery.
  3. diverticulitis.
  4. inflammatory bowel diseases (active episodes).

 

c      K     495                 37.  The primary purpose of a low-fiber diet for ostomy patients is to:

  1. stimulate peristalsis.
  2. increase bulk in the colon.
  3. decrease stool output.
  4. decrease hydrochloric acid production.

 

a      A     495                 38.  All of the following foods may cause difficulty for ostomy patients except:

  1. bananas.
  2. corn.
  3. coconut.
  4. grapes.

 

a      K     495                 39.  The patient with a colostomy or ileostomy is usually concerned about foods that cause:

  1. gas and odor.
  2. weight gain.
  3. fluid retention.
  4. anemia.

 

a      K     495                 40.  To help control diarrhea, people with ostomies should consume:

  1. applesauce.
  2. caffeine.
  3. sugar-free candy.
  4. grapes.

 

Case Study Questions

 

Use the following case study to answer questions 41-46.

Noel is a 33-year-old kindergarten teacher who recently visited her doctor complaining of the sudden onset of diarrhea, abdominal pain, and bloody stools. Lab tests, imaging studies, and an endoscopy were used to diagnose Crohn’s disease. Drug therapy has helped to control the symptoms, but Noel has been told that there is no cure for the disease and she may experience exacerbations from time to time for the rest of her life.

 

b      K     490                 41.  Noel’s Crohn’s disease has most likely resulted in inflammation of her:

  1. gallbladder.
  2. ileum and/or colon.
  3. duodenum and/or jejunum.
  4. pancreas.

 

d      K     491                 42.  If Noel’s Crohn’s disease worsens, it could place her at risk for malnutrition due to all of the following reasons except:

  1. reduced food intake.
  2. surgery that shortens the small intestine.
  3. malabsorption of nutrients.
  4. ulceration in the esophagus.

 

b      K     492                 43.  Noel was prescribed a corticosteroid to help with the inflammation associated with Crohn’s disease. Which of the following side effects might she experience?

  1. diarrhea
  2. fluid retention
  3. dehydration
  4. loss of appetite

 

a      K     491                 44.  Noel requires aggressive dietary management of her disease because it can lead to:

  1. nutrient deficiencies and protein-energy malnutrition.
  2. problems with chronic constipation and laxative use.
  3. dehydration and electrolyte imbalances.
  4. a higher risk of pancreatic cancer.

 

c      A     491                 45.  During a flare-up of her disease, Noel should follow a ______ diet.

  1. high-fiber, high-fat
  2. low-sodium
  3. low-fiber, low-fat
  4. high-fat

 

b      A     492                 46.  One year after her diagnosis, Noel is hospitalized due to a severe exacerbation of her disease and requires a tube feeding. The best choice for an enteral formula is a/an:

  1. standard formula.
  2. elemental formula.
  3. disease-specific formula.
  4. modular formula.

 

Nutrition in Practice: Probiotics and Intestinal Health

 

d      K     499                 47.  Nonpathogenic bacteria in the intestinal tract perform all of the following functions except:

  1. degrade undigested or unabsorbed dietary carbohydrate.
  2. produce certain vitamins.
  3. prevent invasion of tissues by pathogenic bacteria.
  4. stimulate the production of proteins.

 

b      K     499                 48.  Nondigestible substances in foods that stimulate the growth of nonpathogenic bacteria within the large intestine are called:

  1. probiotics.
  2. prebiotics.
  3. intestinal flora.
  4. pathogenic bacteria.

 

d      K     499                 49.  To be considered “probiotic,” bacteria must meet all of the following criteria except:

  1. they must be nonpathogenic when consumed.
  2. they must be able to survive transit through the digestive tract.
  3. they must be able to alter the intestinal environment in a beneficial way.
  4. they must produce gas as a by-product of their activity.

 

b      A     499                 50.  Which of the following foods will provide sufficient probiotic bacteria to influence the bacterial population in the large intestine?

  1. two servings of margarine
  2. one serving of yogurt
  3. two servings of cottage cheese
  4. one serving of honey

 

c      K     500                 51.  Much of the research investigating probiotics and intestinal illness has focused on the prevention and treatment of:

  1. irritable bowel syndrome.
  2. diverticular disease.
  3. infectious diarrhea.
  4. Crohn’s disease.

 

d      K     500                 52.  The possible benefits of probiotics include all of the following except:

  1. altering the susceptibility to food allergies.
  2. improving the immune response.
  3. relieving the symptoms of lactose intolerance.
  4. treating AIDS.

 

Nursing Exam Review Questions

 

c      A     486                 53.  Mrs. Burgess is a 67-year-old female who was recently diagnosed with depression and prescribed a tricyclic antidepressant drug. In addition, she is on medication for high blood pressure and takes a calcium supplement. She phones her physician’s office complaining of problems with constipation. The nurse suspects that the problems may be due to:

  1. depression.
  2. age.
  3. medications.
  4. high blood pressure.

 

a      K     486                 54.  Mr. Purcell is an elderly gentleman who complains of frequent constipation. To deal with this problem, the nurse tells Mr. Purcell to:

  1. drink plenty of fluids.
  2. decrease intake of high-fiber foods.
  3. drink more apple juice.
  4. avoid fried foods.

 

d      K     488                 55.  A patient is experiencing a mild case of diarrhea and phones the health clinic to find out how she should treat it. The nurse recommends that she consume all of the following except:

  1. yogurt.
  2. broth with crackers.
  3. applesauce.
  4. a regular carbonated beverage.

 

a      A     491-492         56.  Sarah is a 21-year-old college student who has been diagnosed with Crohn’s disease. She is underweight and has a poor appetite. Realizing that Sarah is at nutritional risk, the nurse advises that Sarah:

  1. consume an enteral nutrition supplement two to three times a day.
  2. increase the fiber in her diet.
  3. increase her intake of milk to four cups a day.
  4. eat more high-fat foods.

 

a      A     488-489         57.  Mr. Simpson complains of abdominal pain, distention, and flatulence. He frequently experiences chronic diarrhea but at times he also has constipation. He states that his symptoms usually occur shortly after he eats and often stop after defecation. The nurse correctly believes that Mr. Simpson suffers from:

  1. irritable bowel syndrome.
  2. an intestinal obstruction.
  3. diverticulitis.
  4. ileus.

 

c      A     489                 58.  A patient is newly diagnosed with irritable bowel syndrome and is concerned about preventing future flare-ups. The nurse advises the patient to:

  1. follow a low-fat diet.
  2. drink plenty of water.
  3. seek support for stress management.
  4. drink a glass of wine with dinner.

 

b      A     493                 59.  A patient is newly diagnosed with diverticulosis and voices concern about future complications. What is the nurse’s most appropriate response?

  1. “Follow a low-fiber diet.”
  2. “Follow a high-fiber diet.”
  3. “Avoid nuts, popcorn, and foods with seeds.”
  4. “Drink plenty of fluids.”

 

b      A     493                 60.  The nurse is instructing a patient with diverticular disease on appropriate foods to include in his diet in order to prevent progression of the disease. She will tell him to consume all of the following except:

  1. whole-grain breads.
  2. enriched pasta.
  3. legumes.
  4. fresh vegetables.

 

c      A     495                 61.  A patient with an ileostomy complains about excessive odor. What information would the nurse suspect as revealing a cause for this?

  1. The patient eats yogurt for breakfast every morning.
  2. The patient smokes.
  3. The patient eats eggs for breakfast every morning.
  4. The patient consumes cranberry juice regularly.

 

 

Matching

 

b 491 1.     Crohn’s disease a.     the condition of having excessive intestinal gas, which causes abdominal discomfort.

b.     an inflammatory bowel disease that usually occurs in the lower portion of the small intestine and the colon. Inflammation may pervade the entire intestinal wall.

c.     an inflammatory bowel disease that involves the colon. Inflammation affects the mucosa and submucosa.

d.     an intestinal disorder of unknown cause that affects the functioning of the lower bowel. Symptoms include abdominal pain, flatulence, diarrhea, and constipation.

e.     a disorder characterized by the presence of small herniations in the intestinal wall, which often develop by middle age.

f.     an inflammation or infection that involves diverticula.

f 493 2.     diverticulitis
e 493 3.     diverticulosis
a 485 4.     flatulence
d 489 5.     irritable bowel syndrome
c 491 6.     ulcerative colitis
     
     

 

 

Essay

 

485                 1.     Briefly explain the benefits associated with a high-fiber diet. What advice would you give to a patient during the first few weeks on a high-fiber diet?

 

487-488         2.     Identify the possible causes of diarrhea and describe the appropriate treatment for both acute and chronic diarrhea.

 

493-494         3.     Differentiate between diverticulosis and diverticulitis and the appropriate dietary treatment for each.

 

495                 4.     Describe important components of nutrition management for people with ostomies.

 

Case Study Essay Questions

 

Mr. Fruge is 60 years old. After performing a routine colonoscopy, his gastroenterologist tells him everything is normal except that she noticed the presence of several diverticula in his colon. The physician suggestsed he speak with the clinic dietitian regarding dietary recommendations.

 

  1. What causes diverticula to develop?
  2. Differentiate between diverticulosis and diverticulitis.
  3. Why was Mr. Fruge unaware of his condition until now?
  4. What dietary recommendations should the dietitian discuss with Mr. Fruge?
  5. Mr. Fruge tells the dietitian that his mother had diverticulosis and he remembers that she was told to avoid nuts, seeds, and popcorn. How should the dietitian reply to this comment?
  6. Should Mr. Fruge develop diverticulitis in the future, how would the dietary recommendations change?

 

Answers:

  1. Diverticula are caused by low-fiber diets, which require more vigorous muscle contractions, increasing pressure within the segments immediately adjacent to the circular muscles. This increase in pressure may induce small areas of intestinal tissue to weaken and balloon outward over time.
  2. Diverticulosis refers to the presence of diverticula, or pebble-sized herniations or outpockets in the intestinal wall. Diverticulitis refers to inflammation or infection in the area around a diverticulum.
  3. Most people with diverticulosis have no symptoms until complications develop.
  4. The dietitian should recommend that Mr. Fruge increase his fiber intake to help prevent progression of the disease. He should emphasize insoluble fiber in his diet and increase his fiber intake gradually to ensure tolerance. Bulk-forming agents, such as psyllium, can help to increase fiber intake if he has trouble getting enough fiber from food sources.
  5. The dietitian should tell Mr. Fruge that there is no scientific evidence to justify this recommendation.
  6. A clear liquid diet is indicated initially, with progression to solid foods as tolerated. In severe cases, bowel rest may be necessary and fluids will be given intravenously. Oral intakes are gradually reintroduced as the condition improves.

 

Chapter 24 – Energy- and Protein-Modified Diets
for Metabolic and Respiratory Stress

 

Answer, K/A, page(s)                                                                             K = knowledge question; A = application question

 

True/False

 

T     K     620                 1.     Metabolic stress can result from uncontrolled infection or extensive tissue injury.

 

T     K     622                 2.     The inflammatory process can alter immune cell function in the body.

 

T     K     622                 3.     The symptoms associated with the whole-body inflammatory response to severe illness are collectively called the systemic inflammatory response syndrome.

 

T     K     621, 632        4.     An excessive response to metabolic stress can worsen illness and lead to death.

 

F      K     621, 623        5.     Recovery from an injury or illness can be hastened by hypermetabolism and positive nitrogen balance.

 

F      K     623                 6.     Overfeeding an acutely stressed patient improves nitrogen balance and decreases lean tissue losses.

 

T     K     625                 7.     The high nutrient requirements of acutely stressed patients often require a patient to be fed via the enteral or parenteral route to meet his or her nutritional needs.

 

T     K     627                 8.     Smoking is the primary risk factor in most cases of COPD.

 

F      K     630                 9.     Nutrition care for patients in acute respiratory failure is aimed at providing a low-fat, high-carbohydrate diet.

 

T     K     630                 10.  Excessive energy intake in patients with ARDS can worsen  respiratory function.

 

Multiple Choice

 

a      K     620                 1.     The increase in basal metabolic rate as a part of the stress response can be attributed to:

  1. catecholamines.
  2. cortisol.
  3. eicosanoids.
  4. cytokines.

 

a      K     621                 2.     Protein synthesis is inhibited by excess production of:

  1. cortisol.
  2. eicosanoids.
  3. mast cells.
  4. phagocytes.

 

d      K     621                 3.     The adverse effects of cortisol in prolonged stress include all of the following except:

  1. muscle wasting.
  2. bone loss.
  3. impaired wound healing.
  4. hypoglycemia.

 

b      K     622                 4.     Which of the following substances is derived from fatty acids?

  1. cortisol
  2. eicosanoids
  3. antihistamines
  4. cytokines

 

c      K     622                 5.     Which of the following compounds is produced by white blood cells and participates in the inflammatory process?

  1. glucagon
  2. catecholamines
  3. cytokines
  4. cortisol

 

c      K     622                 6.     Complications associated with SIRS or sepsis include all of the following except:

  1. tissue edema.
  2. low blood pressure.
  3. hypertriglyceridemia.
  4. impaired blood flow.

 

d      K     623                 7.     One of the initial concerns for the medical team for patients hospitalized with acute stress is to:

  1. maintain immune function.
  2. achieve positive nitrogen balance.
  3. minimize nutrient losses.
  4. restore lost fluids and electrolytes.

 

d      K     623                 8.     Clinical findings typical of patients undergoing metabolic stress include all of the following except:

  1. hyperglycemia.
  2. hypermetabolism.
  3. insulin resistance.
  4. positive nitrogen balance.

 

c      K     623-624         9.     The nutrition objectives during stress are to provide a diet that does all of the following except:

  1. maintains immune defenses.
  2. promotes healing.
  3. increases hypermetabolism.
  4. preserves muscle tissue.

 

d      K     623                 10.  The energy expenditure of acutely stressed patients may be raised due to all of the following except:

  1. fever.
  2. mechanical ventilation.
  3. presence of open wounds.
  4. inactivity.

 

a      K     623                 11.  Which of the following methods was developed for estimating energy needs in a ventilator-dependent patient with traumatic and/or burn injuries?

  1. Ireton-Jones energy equation
  2. indirect calorimetry
  3. Harris-Benedict equation
  4. 25-30 kcalories/kg body weight

 

a      A     623                 12.  Estimate the energy needs of a patient with sepsis who weighs 180 pounds.

  1. 2045-2455 kcal
  2. 2250-2700 kcal
  3. 1980-2125 kcal
  4. 2365-3050 kcal

 

d      A     624                 13.  Laura is a burn patient. She is 5’4” tall and weighs 150 pounds. What are Laura’s protein needs?

  1. 34-40 grams
  2. 54-60 grams
  3. 105-136 grams
  4. 136-204 grams

 

b      K     624                 14.  Which of the following amino acids has been shown to have beneficial effects on critically ill patients?

  1. leucine
  2. glutamine
  3. valine
  4. isoleucine

 

c      K     624                 15.  Which amino acid may have beneficial effects on the immune response of postoperative patients?

  1. glutamine
  2. tyrosine
  3. arginine
  4. phenylalanine

 

d      K     624                 16.  A parenteral feeding should supply no more than _____ milligrams of dextrose per kilogram of body weight per minute.

  1. 2
  2. 3
  3. 4
  4. 5

 

a      K     624                 17.  In critically ill patients, a high intake of _____ may suppress immune function and increase the risk of developing infections.

  1. fat
  2. dextrose
  3. protein
  4. zinc

 

d      K     625                 18.  All of the following nutrients play a critical role in immunity and wound healing except:

  1. zinc.
  2. vitamin A.
  3. vitamin C.
  4. potassium.

 

c      K     625                 19.  Increased energy metabolism in hypermetabolic patients is associated with the need for increased amounts of:

  1. vitamin C.
  2. zinc.
  3. B vitamins.
  4. vitamin E.

 

d      K     627-628         20.  Medical nutrition therapy for COPD involves all of the following except:

  1. promoting a healthy body weight.
  2. preventing muscle loss.
  3. improving food intake.
  4. relieving chronic cough.

 

c      K     628                 21.  Which of the following is not a cause of poor food intake in persons with severe COPD?

  1. medications
  2. dyspnea
  3. lower energy needs
  4. change in taste perception

 

a      A     628                 22.  A COPD patient who complains of abdominal discomfort and dyspnea may benefit from:

  1. small, frequent meals.
  2. a low-fat diet.
  3. a high-fiber diet.
  4. consuming more liquids.

 

b      K     628                 23.  Adequate fluid intake will help the person with COPD by:

  1. decreasing carbon dioxide output.
  2. preventing the secretion of overly thick mucus.
  3. aiding in weight loss.
  4. improving oxygen consumption.

 

a      K     628                 24.  Excessive kcalorie intake in COPD patients may:

  1. increase respiratory distress.
  2. alter taste perception.
  3. interfere with drug therapy.
  4. increase gas formation.

 

b      K     630                 25.  When pulmonary edema is present, a patient requires:

  1. tube feeding.
  2. a fluid restriction.
  3. increased fluids.
  4. decreased protein.

 

Case Study Questions

 

Use the following case study to answer questions 26-31.

Kati is a 19-year-old female who suffered a head injury and multiple broken bones in a motorcycle accident. She is currently in a coma, on a mechanical ventilator, and receiving enteral nutrition. Kati is 5’2” tall and weighs 115 pounds.

 

a      A     623                 26.  The most immediate nutrition concern for Kati is:

  1. restoring fluid and electrolyte balance.
  2. starting parenteral nutrition.
  3. estimating her energy needs.
  4. assessing her swallowing ability.

 

a      A     623                 27.  Estimate Kati’s energy needs using the Ireton-Jones equation:
1925 + [5 ´ wt (kg)] – [10 ´ age (yr)] + (281 ´ sex) + (292 ´ trauma) + (851 ´ burn). You must insert the appropriate numbers for gender, trauma, and burn.

  1. 2288
  2. 2569
  3. 3420
  4. 3240

 

c      A     624                 28.  Kati’s protein needs will likely be calculated using a range of:

  1. 0.6 to 0.8 g/kg.
  2. 0.8 to 1.0 g/kg.
  3. 1.2 to 2 g/kg.
  4. 2 to 3 g/kg.

 

d      K     622, 625        29.  As a result of the acute-phase response, you would expect Kati’s plasma concentrations of _____ to decrease.

  1. glucose and cholesterol
  2. sodium and potassium
  3. iron and glucose
  4. albumin and iron

 

b      A     623                 30.  To decrease the risk of infection, it will be important to keep Kati’s _____ under control while she is recovering.

  1. serum albumin
  2. blood glucose
  3. blood pressure
  4. serum prealbumin

 

a      A     623-624         31.  If Kati’s enteral feeding is not providing adequate energy and protein to meet her nutritional needs, she will experience:

  1. a loss of lean tissue.
  2. hyperglycemia.
  3. pulmonary edema.
  4. sepsis.

 

Nutrition in Practice – Multiple Organ Dysfunction Syndrome

 

c      K     634                 32.  A frequent cause of death among older intensive care patients with multiple or severe injuries is:

  1. pulmonary edema.
  2. heart attack.
  3. multiple organ dysfunction syndrome.
  4. stroke.

 

a      K     634                 33.  The first organ to fail in MODS is normally the:

  1. lungs.
  2. liver.
  3. kidneys.
  4. heart.

 

c      K     635                 34.  One of the factors that increases the risk of MODS is:

  1. age over 40 years.
  2. length of hospital stay.
  3. malnutrition.
  4. obesity.

 

a      K     635                 35.  The principal infection associated with MODS is:

  1. pneumonia.
  2. a fungal infection.
  3. herpes simplex.
  4. a viral infection.

 

d      K     635                 36.  All of the following are therapies used to manage MODS except:

  1. mechanical ventilation.
  2. fluid resuscitation.
  3. hemofiltration or dialysis.
  4. physical therapy.

 

d      K     635                 37.  Nutrition support plays a role in the therapy for MODS in all of the following ways except:

  1. providing nutrients.
  2. preventing excessive wasting.
  3. promoting recovery.
  4. maintaining blood pressure.

 

Nursing Exam Review Questions

 

a      K     621                 38.  The nurse recognizes all of the following as the classic signs of inflammation except:

  1. hyperglycemia.
  2. swelling.
  3. redness.
  4. heat.

 

b      A     622                 39.  John has been hospitalized with a severe infection in his foot. The nurse recognizes that increasing his intake of _____ may help to suppress the inflammation.

  1. protein
  2. omega-3 fatty acids
  3. carbohydrate
  4. omega 6-fatty acids

 

a      A     622                 40.  The nurse understands that the inflammatory process can cause a variety of systemic effects and monitors her patient’s:

  1. heart rate, respiratory rate, and temperature.
  2. heart rate, appetite, and blood pressure.
  3. blood pressure, temperature, and appetite.
  4. blood pressure, heart rate, and weight.

 

b      A     623                 41.  A patient is admitted to the ER with multiple gunshot wounds. The nurse understands that the initial treatment includes:

  1. beginning enteral nutrition.
  2. administering IV fluids.
  3. beginning PPN.
  4. referral to the dietitian.

 

c      A     630                 42.  A patient who is on a tube feeding gains nine pounds in three days. The nurse realizes that this may indicate:

  1. adequate nutrition.
  2. excess protein intake.
  3. fluid imbalance.
  4. nutrient imbalance.

 

a      A     623, 631        43.  Mr. Morgan is an acutely stressed patient in the ICU who is on TPN. The nurse understands that monitoring the patient’s _____ can help to determine if the patient is being overfed.

  1. glucose levels
  2. cholesterol levels
  3. iron levels
  4. albumin levels

 

b      A     623                 44.  Mrs. White is in the ICU for complications following surgery. She has been diagnosed with sepsis and is on a ventilator. In order to most accurately estimate her energy needs, the nurse recognizes that the preferred method to use is:

  1. the Harris-Benedict equation.
  2. the Ireton-Jones equation.
  3. direct calorimetry.
  4. the Mifflin-St. Jeor equation.

 

c      A     624                 45.  Mr. Jones experienced a burn and is currently in a state of stress. Mr. Jones is 5’9” tall and weighs 176 pounds. The nurse recommends that he receive a minimum of _____ grams of protein per day.

  1. 80
  2. 120
  3. 160
  4. 240

 

a      A     624                 46.  Mary is a 59-year-old patient who suffered multiple broken bones in a motor vehicle accident. She weighs 138 pounds. The nurse chooses a protein factor of 1.5 g/kg to estimate her protein needs and calculates that Mary’s protein requirements are approximately _____ grams per day.

  1. 94
  2. 103
  3. 121
  4. 207

 

a      A     625                 47.  Mark is a 23-year-old firefighter who experienced severe burns while fighting a house fire. The nurse recognizes the fact that he may benefit from supplements of minerals such as _____ to reduce the risk of infection.

  1. zinc, copper, and selenium
  2. iron, zinc, and calcium
  3. sodium, potassium, and chloride
  4. zinc, thiamin, and riboflavin

 

d      A     628                 48.  Mr. Winslett is a COPD patient who is complaining of poor appetite, abdominal discomfort, and bloating. Which of the following is the nurse’s appropriate suggestion for improving his food intake?

  1. Consume larger meals.
  2. Substitute beans for meat.
  3. Drink a supplement before eating.
  4. Eat smaller, more frequent meals.

 

a      K     630                 49.  A patient with ARDS requires mechanical ventilation. The nurse recognizes that fluid accumulation is a potential problem and understands that this may make it difficult to assess his:

  1. weight.
  2. temperature.
  3. kcalorie intake.
  4. fluid intake.

c      A     630                 50.  A critically ill patient with ARDS is on a tube feeding and requires a fluid restriction. The nurse understands that an appropriate enteral formula will be:

  1. low residue.
  2. high protein.
  3. nutrient dense.
  4. hydrolyzed.

 

Essay

 

620-621         1.     Describe the body’s hormonal responses to stress.

 

622                 2.     Describe the symptoms and complications associated with SIRS.

 

623-624         3.     Differentiate between how energy needs are estimated for a non-obese patient versus an obese patient.

 

623-624         4.     What is a “stress factor”?

 

628                 5.     Describe the diet-drug interactions that may be experienced by a patient using bronchodilators.

 

621, 628        6.     Explain the metabolic effects of corticosteroid drugs.

 

630                 7.     Why are intestinal tube feedings preferred over gastric feedings for patients with acute respiratory failure?

 

Case Study Essay Questions

 

Caroline is a 33-year-old female who was struck by a motor vehicle while she was bicycling. She suffered head and chest trauma as well as multiple broken bones. Caroline is in a medically induced coma in the ICU unit following surgery and requires mechanical ventilation due to ARDS. She is being fed enterally. Her mother reports that she is 5’7” tall and weighs approximately 140 pounds.

 

  1. a. Estimate Caroline’s energy needs using the Ireton-Jones equation:

1925 + [5 × wt (kg)] – [10 × age (yr)] + (281 × sex) + (292 × trauma) + (851 × burn).

You must insert the appropriate numbers for gender and trauma.

  1. Estimate Caroline’s protein needs based on mild to moderation lung injury.
  2. Why is Caroline likely to experience negative nitrogen balance despite being provided with adequate protein?
  3. Where is Caroline’s feeding tube likely located? Why?
  4. What type of enteral formula is best for Caroline at this time?
  5. What kind of medications might be prescribed for Caroline? Why?
  6. What are the potential diet-drug interactions Caroline might experience?

 

Answers:

  1. a. Energy needs (kcal/day) = 1925 + [5 × 64 kg] – [10 × 33] + [281 × 0] + [292 × 1] + [851 × 0] = 2207 kcal
  2. Protein needs: Protein needs are increased in patients with lung inflammation or ARDS. For mild or moderate lung injury, protein recommendations range from 1.0 to 1.5 grams of protein per kilogram body weight per day. 140/2.2 = 64 kg × 1.0-1.5 = 64 to 96 grams
  3. Even with adequate protein, negative nitrogen balance cannot be prevented during acute stress because hormonal changes encourage protein catabolism. The bed rest required during illness also contributes substantially to muscle breakdown.
  4. An intestinal feeding is likely because it reduces the risk of aspiration.
  5. Patients with acute lung injuries or ARDS may benefit from enteral formulas designed to reduce inflammation and promote healing; these formulas are typically fortified with omega-3 fatty acids and antioxidant nutrients.
  6. Diuretics may be prescribed to mobilize the fluid that has accumulated in lung tissue. Medications are given to treat infections (antibiotics), keep airways open (bronchodilators), or relieve inflammation (NSAIDS or steroidal drugs).
  7. Bronchodilators may increase gastric acid secretion and cause acid reflux. Corticosteroids may cause glucose intolerance and sodium retention, and contribute to negative nitrogen balance. Depending on the diuretic prescribed, Caroline’s potassium levels may need to be watched. Antibiotics can have varying effects depending on which one is prescribed. Diarrhea is a common side effect.

 

Matching

 

j 629 1.     ARDS a.     a disruption in the body’s chemical environment due to the effects of disease or injury.

b.     abnormal gas exchange between the air and blood, resulting in lower-than-normal oxygen levels and higher-than-normal carbon dioxide levels.

c.     a higher-than-normal metabolic rate.

d.     the breakdown of lean tissue that results from disease or malnutrition.

e.     relating to the entire body.

f.     a whole-body response to acute inflammation; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and altered body temperature.

g.     acid accumulation in the body tissues.

h.     a group of lung diseases characterized by persistent obstructed airflow through the lungs and airways; includes chronic bronchitis and emphysema.

i.      shortness of breath.

j.      respiratory failure triggered by severe lung injury; a medical emergency that causes dyspnea and pulmonary edema and usually requires mechanical ventilation.

h 627 2.     COPD
g 629 3.     acidosis
i 627 4.     dyspnea
c 620 5.     hypermetabolism
a 620 6.     metabolic stress
b 620 7.     respiratory stress
f 623 8.     SIRS
e 622 9.     systemic
d 620 10.  wasting

 

f 623 1.     abscesses a.     the chemical and physical changes that occur within the body during stress.

b.             a group of nonspecific immune responses to infection or injury.

c.     changes in body chemistry resulting from infection, inflammation, or injury; characterized by alterations in plasma proteins.

d.     a whole-body inflammatory response caused by infection; characterized by raised heart and respiratory rates, abnormal white blood cell counts, and elevated body temperature.

e.     a severe reduction in blood flow that deprives the body’s tissues of oxygen and nutrients.

f.     accumulations of pus.

g.     the surgical removal of dead, damaged, or contaminated tissue resulting from burns or wounds.

h.     signaling proteins produced by the body’s cells; those produced by white blood cells regulate various aspects of immune function

i.      20-carbon molecules derived from dietary fatty acids that help to regulate blood pressure, blood clotting, and other body functions.

j.      white blood cells that have the ability to engulf and destroy antigens.

c 622 2.     acute-phase response
h 622 3.     cytokines
g 623 4.     debridement
i 622 5.     eicosanoids
b 620 6.     inflammatory response
j 620 7.     phagocytes
d 623 8.     sepsis
e 623 9.     shock
a 620 10.  stress response

 

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