Nutrition And Diet Therapy 8th Edition By Linda Kelly DeBruyne -Test Bank





Nutrition And Diet Therapy 8th Edition By Linda Kelly DeBruyne -Test Bank

Chapter 2 – Carbohydrates


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




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.





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




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 12 – Nutrition Through the Life Span:
Infancy, Childhood, and Adolescence


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




T     K     318                 1.     Breast milk or infant formula normally provides enough water to replace fluid losses in healthy infants.


T     K     320                 2.     There are factors in breast milk that protect the infant against infection.


T     K     326                 3.     A child’s appetite begins to diminish around the first birthday.


F      K     331                 4.     A child’s brain is not affected by iron deficiency until a blood deficit of this mineral develops.


T     K     330                 5.     Children who eat nutritious breakfasts function better in school than their peers who do not.


F      K     333                 6.     Allergic reactions to multiple foods are common, while reactions to single foods are the exception.


T     K     334                 7.     Children’s food aversions may be the result of nature’s efforts to protect them from allergic or other adverse reactions.


T     K     336                 8.     Children who spend more than one to two hours daily watching television or other media can become obese even while consuming fewer kcalories than more active children.


T     K     339                 9.     Children forced to try new foods are less likely to try those foods again than are children who are left to decide for themselves.


F      K     339                 10.  The more often a food is presented to a young child, the less likely the child will like that food.


T     K     342                 11.  The problem of obesity is most evident in African American females and in Hispanic children.


T     K     342                 12.  Teenage boys experience a more intense growth spurt and develop more lean body mass than girls do.


Nutrition in Practice – Childhood Obesity and the Early Development of Chronic Diseases


T     K     351                 13.  Restricting dietary sodium causes an immediate drop in most children’s and adolescents’ blood pressure.


T     K     352                 14.  Recommendations limiting fat and cholesterol are not intended for infants or children under two years of age.


T     K     353                 15.  Adult heart disease is a major pediatric problem.


Multiple Choice


b      K     317                 1.     An infant weighing 7 pounds at birth would normally weigh about _____ pounds at five months of age.

  1. 8
  2. 14
  3. 21
  4. 28


a      K     317                 2.     During what period are kcalorie needs per unit of body weight the highest?

  1. infancy
  2. toddler years
  3. childhood
  4. adolescence


b      A     317                 3.     An infant who weighs 8 pounds will require about _____ kcalories per day.

  1. 290
  2. 360
  3. 420
  4. 800


a      K     319                 4.     Most standard infant formulas are fortified with:

  1. DHA and arachidonic acid.
  2. DHA and linoleic acid.
  3. linolenic and linoleic acid.
  4. DHA and EPA.


b      K     319                 5.     With the possible exception of _____, the vitamin content of the breast milk of a well-nourished mother is ample.

  1. vitamin C
  2. vitamin D
  3. thiamin
  4. zinc


d      K     320                 6.     The American Academy of Pediatrics recommends a supplement of _____ for all infants who are exclusively breastfed in the first six months of life.

  1. iron
  2. vitamin C
  3. folic acid
  4. vitamin D


b      K     319-320         7.     Characteristics of breast milk include all of the following except:

  1. ample vitamin content.
  2. high in sodium.
  3. adequate in zinc.
  4. iron which is highly absorbable.


d      K     320                 8.     Infants are given a single dose of vitamin _____ at birth.

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


d      K     320-321         9.     Advantages to breastfeeding include all of the following except:

  1. it provides protection against the development of allergies.
  2. it provides possible protection against excessive weight gain later in life.
  3. it protects against intestinal infections.
  4. it is the only way to develop a true loving relationship with the baby.


c      K     321                 10.  The only acceptable alternative to breast milk is:

  1. goat’s milk.
  2. cow’s milk.
  3. iron-fortified infant formula.
  4. low-iron infant formula.


d      K     321                 11.  Which of the following should be used to feed an infant under one year of age who is being weaned from breast milk?

  1. whole milk
  2. low-iron infant formula
  3. evaporated milk
  4. iron-fortified infant formula


b      K     322                 12.  Which of the following is considered a risk of formula feeding an infant?

  1. The infant may not receive all of the nutrients he/she needs.
  2. Formula may be incorrectly prepared and cause malnutrition and growth failure.
  3. Parents may not be aware that some formulas do not meet FDA requirements.
  4. Many infants are allergic to formula.


d      K     322                 13.  Children one to two years of age should drink _____ milk.

  1. reduced-fat
  2. low-fat
  3. fat-free
  4. whole


c      K     323                 14.  A good age to introduce solid foods to infants is:

  1. one to two weeks.
  2. two to three months.
  3. four to six months.
  4. one year.
  5. two years.


d      K     323                 15.  All of the following are considerations in deciding when to add solid foods to the diet of an infant except:

  1. the infant’s nutrient needs.
  2. the infant’s physical readiness to handle different forms of food.
  3. the need to detect and control allergic reactions.
  4. the type of milk the infant is consuming.


b      K     323                 16.  The two nutrients needed early by infants and provided by the introduction of solid foods are:

  1. protein and calcium.
  2. iron and vitamin C.
  3. sodium and fat.
  4. vitamin D and fluoride.


d      K     324                 17.  Excessive consumption of fruit juice in infants and young children can lead to all of the following except:

  1. diarrhea.
  2. excessive kcal intake.
  3. poor intake of food.
  4. toxicity of the water-soluble vitamins.


d      K     324                 18.  Which of the following cereals causes allergy least often?

  1. wheat
  2. barley
  3. oats
  4. rice


b      K     324-325         19.  All of the following foods should be omitted from a baby’s diet except:

  1. canned vegetables.
  2. canned fruits.
  3. honey.
  4. corn syrup.


b      K     325                 20.  _____ develops when excessive milk intake displaces iron-rich foods in the diet of a young child.

  1. Scurvy
  2. Milk anemia
  3. Growth failure
  4. Weight loss


a      A     325                 21.  An important aspect of infant feeding is the prevention of future health problems. An appropriate measure is:

  1. encouragement of eating habits that will support normal weight.
  2. encouraging the infant to eat only those foods she likes.
  3. introduction of solid foods as early as possible.
  4. forcing the infant to finish her bottle.


c      A     326                 22.  Nancy consumes fewer kcalories at 14 months than she did at 11 months. This change in appetite probably indicates that she is:

  1. ill and needs medical attention.
  2. not as physically active now as when she was 11 months old.
  3. in a less rapid stage of growth now.
  4. becoming malnourished.


c      K     327                 23.  Research studies conducted on preschool children’s food intakes have shown that:

  1. food energy intake varied very little from meal to meal.
  2. the total daily energy intake was highly inconsistent.
  3. if they ate more at one meal, they ate less at the next.
  4. energy intake decreases as children get older.


a      K     327                 24.  Which of the following statements accurately describes the energy needs of a child?

  1. Total energy needs increase with age, but energy needs per kilogram of weight decline with age.
  2. Energy needs fluctuate as children get older.
  3. Total energy needs decrease with age, but energy needs per kilogram of weight increase with age.
  4. Energy needs remain the same until puberty.


c      K     327                 25.  Vegan diets must be planned carefully for children, because otherwise they may not provide enough:

  1. protein.
  2. fiber.
  3. kcalories.
  4. sodium.


a      K     327                 26.  A one-year-old child needs about _____ kcalories a day.

  1. 800
  2. 1000
  3. 1200
  4. 1400


a      A     325, 328        27.  A child who drinks a lot of milk and won’t consume much else is likely to show signs of:

  1. anemia.
  2. ariboflavinosis.
  3. hypercalcemia.
  4. rickets.


c      K     328                 28.  To prevent iron deficiency, a child needs _____ mg of iron per day.

  1. 2–3
  2. 3-5
  3. 7-10
  4. 9-12


d      A     328                 29.  Among the following, the foods that help most to meet children’s iron requirements are:

  1. milk, cheese, or yogurt.
  2. dark green, deep orange, or yellow vegetables.
  3. prunes , grapes, or raisins.
  4. whole-wheat, enriched, or fortified breads.


c      A     328                 30.  Which of the following foods would provide a child with a rich source of iron?

  1. ice cream
  2. applesauce
  3. bean dip
  4. cheese


b      K     328, 329        31.  According to MyPyramid for Preschoolers and Kids, how many cups of milk or milk products are needed daily for a 2-5 year old child?

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


a      K     330                 32.  Which of the following is likely to occur if candy, cola, and other concentrated sweets are permitted in large quantities during the growing years?

  1. obesity
  2. hypertension
  3. nutrient toxicities
  4. developmental delays


c      K     330                 33.  Which of the following statements is not true?

  1. Normal-weight children naturally regulate their energy intake.
  2. The preference for sweet tastes is innate.
  3. Children can be trusted to naturally choose healthful foods.
  4. Underweight children can be allowed to eat higher-kcal but nutritious snacks.

c      A     330, 339        34.  The easiest and most practical way to control the amount of candy and carbonated drinks a child consumes is to:

  1. prevent the child from knowing of their existence.
  2. never let the child visit his grandparents.
  3. limit the availability of these items.
  4. teach the child that such foods are highly noxious.


a      K     330                 35.  How many ounces from the meat and beans group are needed daily to meet nutrient needs for a child who needs 1000 kcal/day?

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


d      K     330                 36.  One of the most significant effects of long-term hunger on children is:

  1. behavioral problems.
  2. poor performance in school.
  3. apathetic attitude.
  4. impaired growth.


b      K     331                 37.  Nutrient deficiencies during childhood:

  1. have no effect on future health.
  2. can affect a child’s mood and behavior.
  3. are directly associated with dysfunctional families.
  4. are rare.


d      K     330-331         38.  Children who skip breakfast exhibit all of the following characteristics except:

  1. lower energy intakes.
  2. poor concentration.
  3. lower test scores.
  4. higher energy intakes.


c      K     331                 39.  The best known and most widespread effects of iron-deficiency anemia are its impacts on:

  1. memory and sleep patterns.
  2. growth and athletic performance.
  3. behavior and intellectual performance.
  4. the immune system and reading level.


d      K     331                 40.  A child with any of several nutrient deficiencies may be described in all of these ways except:

  1. depressed.
  2. unlikable.
  3. hyperactive.
  4. unclean.


b      A     332                 41.  To prevent a child’s exposure to lead, you would do all of the following except:

  1. prevent the child from putting old painted objects in the mouth.
  2. allow the child to play with crayons made in other countries.
  3. make sure the child consumes nutritious meals consistently.
  4. make infant formula with lead-free water.


a      K     332                 42.  When a food protein enters the body and causes an immunologic response, this causes:

  1. a food allergy.
  2. an food intolerance.
  3. hyperactivity.
  4. anemia.


a      K     333                 43.  Which of the following foods is most likely to cause anaphylactic shock?

  1. peanuts
  2. rice
  3. oatmeal
  4. bananas


b      K     333                 44.  All of these foods are likely to cause allergic reactions except:

  1. milk.
  2. coconut.
  3. soybeans.
  4. wheat.


d      K     334                 45.  Which of the following statements is true regarding hyperactivity?

  1. It can be cured with dietary changes.
  2. It is caused by consuming sugary foods.
  3. It can be cured by eliminating all food additives.
  4. It is not caused by poor nutrition.


b      K     335                 46.  Based on data from the BMI-for-age growth charts, children and adolescents are categorized as overweight when their weight is above the _____ percentile.

  1. 75th
  2. 85th
  3. 95th
  4. 99th


d      A     335                 47.  Logan is 14 years old and has a BMI in the 85th percentile. His mother’s BMI is 23 and his father’s BMI is 32. Logan’s chance of becoming an obese adult is:

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


b      K     335                 48.  Which of the following statements regarding children’s food intake and health status is true?

  1. Children are lighter today than they were 20 years ago.
  2. The prevalence of overweight in children 6 to 11 years of age and adolescents has tripled over the last three decades.
  3. Changes in children’s weight status can be largely explained by genetics.
  4. The increase in children’s weight status can be blamed entirely on poor parenting skills.


c      K     336                 49.  As a strategy to help prevent childhood obesity, the American Academy of Pediatrics recommends that children be limited to _____ of television and video time per day.

  1. 30 minutes
  2. 1 hour
  3. 2 hours
  4. 3 hours


d      K     336                 50.  Which of the following statements about children and television viewing is not true?

  1. Children who have a TV in their room are more likely to be overweight.
  2. Children who watch excessive amounts of TV are least likely to eat fruits and vegetables.
  3. Children who watch excessive amounts of TV often snack on high-fat foods.
  4. Children who watch excessive amounts of TV are more likely to eat fruits and vegetables.


b      K     336                 51.  A leading cause of pediatric hypertension is:

  1. a low intake of whole-grain foods.
  2. obesity.
  3. excessive sodium intake from soft drink consumption.
  4. type 1 diabetes.


b      K     337                 52.  The Expert Committee of the American Medical Association recommends healthy habits for children and adolescents to prevent obesity. Which of the following is not one of those recommendations?

  1. Eat together as a family as often as possible.
  2. Engage in at least 20 minutes of moderate to vigorous physical activity every day.
  3. Learn to eat age-appropriate portions of foods.
  4. Limit the frequency of restaurant meals.


d      K     336-337         53.  Which of the following is not a recommended approach for the treatment of childhood obesity?

  1. psychological support
  2. behavior modification
  3. family involvement
  4. diet restriction


a      K     338                 54.  Which obese teenager would be considered a candidate for bariatric surgery?

  1. Preston, who has a BMI of 52 and has an average IQ
  2. Jacob, who has a BMI of 38 and has reached physical maturity
  3. Darla, who has type 2 diabetes and hasn’t yet begun to menstruate
  4. Cynthia, who has just enrolled in a weight-loss program for the first time due to her BMI of 50


c      K     339                 55.  Children are more likely to eat vegetables when they are:

  1. not seasoned.
  2. cut in small pieces.
  3. raw or slightly undercooked.
  4. overcooked and very soft.


a      K     339                 56.  Power struggles over food arise when:

  1. parents try to control every aspect of a child’s eating.
  2. children are allowed to regulate their own food intake.
  3. parents don’t demonstrate healthy eating habits.
  4. children are presented with too many food choices.


b      A     338                 57.  Because the interactions between parents and children can set the stage for lifelong attitudes and habits, wise parents:

  1. do not attempt change.
  2. treat their child’s food preferences with respect.
  3. exert continuous pressure to initiate good food habits.
  4. impose their own eating habits on their children.
  5. wait until their children start school to initiate changes.


a      A     339                 58.  Positive eating habits for a young child can be promoted by:

  1. presenting a new food at the beginning of the meal.
  2. allowing him to stand and play at the table.
  3. making sure he eats all the food he is given at each meal.
  4. rewarding him with dessert when he has cleaned his plate.
  5. offering him a choice of two new foods at a time.


a      K     339                 59.  Children should not be allowed to eat while running because:

  1. this increases the child’s risk of choking.
  2. they should not be allowed to play until after meals.
  3. physical activity in children should be discouraged.
  4. this increases the child’s risk of food allergies.


c      K     340                 60.  The majority of children who eat school breakfast are:

  1. boys.
  2. girls.
  3. from low-income families.
  4. from high-income families.


b      K     341                 61.  All of the following factors undermine the efforts of the National School Lunch Program to serve nutritious foods at school except:

  1. short lunch periods and long lines.
  2. the availability of salad bars.
  3. access to vending machines.
  4. the presence of fast-food restaurants.


a      A     342                 62.  The adolescent growth spurt:

  1. begins earlier in girls than in boys.
  2. affects every organ except the brain.
  3. decreases total nutrient needs.
  4. causes a greater weight gain in girls.


a      A     342-343         63.  Nutrients often found lacking in teenage groups include:

  1. iron, calcium, and vitamin D.
  2. vitamin C, sodium, and protein.
  3. fat, iron, and fiber.
  4. calcium, zinc, and vitamin B12.


a      K     343                 64.  Iron intake often does not meet the iron needs of adolescent females because they tend to:

  1. eat less iron-rich foods and fewer kcalories.
  2. consume more foods that interfere with iron absorption.
  3. have a longer growth spurt.
  4. develop greater lean body mass.


c      K     343                 65.  Adolescents who eat at home with family members:

  1. tend to gain more weight.
  2. are less influenced by their peers.
  3. consume a more nutritious diet.
  4. watch more television.


a      K     343                 66.  A good way for an adolescent to build and protect her bones is to:

  1. snack on dairy products.
  2. eat tuna fish sandwiches for lunch.
  3. consume more fiber.
  4. choose low-fat snacks.


c      K     344                 67.  Which of the following statements is not true regarding teenagers and beverages?

  1. Juice is usually only consumed at breakfast.
  2. Soft drinks may affect bone density because they displace milk from the diet.
  3. Girls are more likely to drink enough milk to meet their calcium needs.
  4. Regular soft drink consumption can contribute to weight gain.


b      K     344                 68.  Snacks provide about _____ of the average teenager’s total daily food energy intake.

  1. 1/3
  2. ¼
  3. 2/3
  4. ¾


b      A     343-344         69.  At home, where teenagers are frequently snacking, the best strategy for parents is to stock the pantry with:

  1. plenty of diet drinks and low-fat snacks.
  2. easy-to-grab foods that are nutritious.
  3. enough food for only one snack a day.
  4. 100-kcalorie snack packs.


b      K     344                 70.  Adolescents eat about _____ of their meals away from home, which can enhance or hinder their nutritional well being.

  1. ¼
  2. 1/3
  3. ½
  4. 2/3


d      K     341                 71.  Schools that participate in the USDA’s National School Lunch Program must develop and implement a wellness policy. By law, wellness policies must accomplish all of the following except:

  1. set goals for nutrition education and physical activity.
  2. establish nutrition guidelines for all foods available on school campuses.
  3. develop a plan to measure implementation of the policy.
  4. ensure that all curricula include nutrition education.


Nutrition in Practice – Childhood Obesity and the Early Development of Chronic Diseases


b      K     350                 72.  Which of the following statements is true regarding the role of genetics in obesity?

  1. One is destined at birth to become obese.
  2. One inherits the potential to become obese.
  3. Obesity genes come from the mother’s side of the family.
  4. Obesity genes come from the father’s side of the family.


c      K     350-351         73.  The most important risk factor for type 2 diabetes in children is:

  1. food intolerances.
  2. high cholesterol.
  3. obesity.
  4. food allergies.


a      K     351                 74.  Fatty streaks can appear in the arteries as early as:

  1. childhood.
  2. adolescence.
  3. the thirties.
  4. the fifties.


a      K     351                 75.  An acceptable cholesterol level for a child or adolescent is:

  1. < 170 mg/dL.
  2. 170-199 mg/dL.
  3. 200-239 mg/dL.
  4. > 240 mg/dL.


b      K     352-353         76.  Persistent high blood cholesterol levels may need to be treated with drugs in children once they are _____ years old.

  1. 6
  2. 8
  3. 10
  4. 16




a 319 1.     alpha-lactalbumin a.     the chief protein in human breast milk.

b.     a milklike secretion from the breasts that is rich in protective factors.

c.     a protein in breast milk that binds iron and keeps it from supporting the growth of the infant’s intestinal bacteria.

d.     factors in colostrum and breast milk that favor the growth of the “friendly” bacterium Lactobacillus bifidus in the infant’s intestinal tract.

e.     a protein in breast milk that attacks diarrhea-causing viruses.

f.     to gradually replace breast milk with infant formulas or other foods appropriate to an infant’s diet.

g.     extensive tooth decay due to prolonged tooth contact with a carbohydrate-rich liquid offered to an infant in a bottle.

d 320 2.     bifidus factors
b 320 3.     colostrum
e 321 4.     lactadherin
c 321 5.     lactoferrin
g 323 6.     nursing bottle tooth decay
f 321 7.     wean



f 341 1.     adolescence a.     an adverse reaction to food that involves an immune response.

b.     an adverse response to a food or food additive that does not involve the immune system.

c.     a life-threatening whole-body allergic reaction to an offending substance.

d.     one of the stress hormones secreted whenever emergency action is needed; prescribed therapeutically to relax the bronchioles during allergy or asthma attacks.

e.     inattentive and impulsive behavior that is more frequent and severe than is typical of others of a similar age.

f.     the period of growth from the beginning of puberty until full maturity.

g.     the period in life in which a person becomes physically capable of reproduction.

h.     with respect to nutrition, a key person who controls other people’s access to foods and thereby exerts a profound impact on their nutrition.

i.      the maximum amount of residue permitted in a food when a pesticide is used according to the label directions.

c 333 2.     anaphylactic shock
d 333 3.     epinephrine
a 333 4.     food allergy
b 333 5.     food intolerance
h 343 6.     gatekeeper
e 335 7.     hyperactivity
g 343 8.     puberty
i 333 9.     tolerance level




319-321         1.     Describe the nutrient attributes of breast milk and how it is tailor-made to meet the nutrient needs of the human infant.


330-331         2.     Describe the relationship between hunger and school performance.


336                 3.     Identify ways in which watching television adversely affects children’s nutritional health.


336-338         4.     Describe an ideal treatment program for childhood obesity.


338-339         5.     Describe characteristics of vegetables preferred by children.


340-341         6.     Discuss the problems associated with providing nutritious lunches to students at school.


342-343         7.     Identify the nutrients most often found lacking in the diets of teenagers.


343-344         8.     What is the role of the “gatekeeper” as applied to nutrition?




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


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




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.




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?



  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.




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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