Chapter 16: Nutrition in Metabolic Stress: Burns, Trauma and Surgery

Chapter 16: Nutrition in Metabolic Stress: Burns, Trauma and Surgery

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. If a 75-year-old woman needs hip replacement surgery but reports that she has lost 15 lb since her husband died 3 months ago because she has had very little appetite, the best approach would be to

a.	provide enteral feedings immediately after surgery.
b.	delay surgery until the patient returns to usual body weight.
c.	recommend using a multivitamin or multimineral supplement.
d.	ensure at least 2 weeks of good nutritional intake before surgery.

 

 

ANS:  D

Loss of 15 lb in 3 months is probably associated with significant nutritional risk; at least 2 weeks of good nutritional intake should be encouraged before surgery to minimize risk of complications and improve healing. The patient is able to eat, and so enteral feedings are not needed, and it would be better to improve nutritional status before surgery rather than afterwards. Supplements may be helpful, but it is always better to obtain nutrients from food rather than supplements. Delaying surgery until the patient returns to usual body weight is not necessary so long as nutrient stores are replenished.

 

DIF:    Cognitive Level: Applying               REF:   Page 350 | Page 353

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological integrity

 

2. If a patient is healing more slowly than expected after surgery, he or she may benefit from

a.	enteral feedings.
b.	supplemental zinc and vitamins A and C.
c.	supplemental iron and vitamins B12 and D.
d.	additional branched-chain amino acids.

 

 

ANS:  B

Vitamins A and C and zinc play an important role in wound healing. Iron and vitamin B₁₂ are important for maintaining optimal immune status, and vitamin D is important for healing broken bones. Branched-chain amino acids do not play a specific role in healing. Enteral feedings are not needed unless the patient is unable to maintain adequate oral intake.

 

DIF:    Cognitive Level: Analyzing             REF:   Pages 348-349 | Pages 351-353

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological integrity

 

3. Of the following, the most stressful physical traumas would be

a.	a single bone fracture.
b.	a low-grade fever
c.	minor surgery.
d.	a large third-degree burn.

 

 

ANS:  D

Serious burns result in significant increases in metabolic rate. Fractures, low-grade fevers, and minor surgery also increase metabolic rate, but to a lesser degree than do burns.

 

DIF:    Cognitive Level: Analyzing             REF:   Page 350 | Pages 353-354 | Pages 356-358

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological integrity

 

4. If someone has been fasting for 36 hours, his or her body is meeting its glucose needs by breaking down

a.	glycogen.
b.	keto acids.
c.	amino acids.
d.	fatty acids.

 

 

ANS:  C

Glycogen stores are depleted after 24 hours of starvation, so after 36 hours, the body would have to deaminate amino acids and produce glucose by gluconeogenesis. The body cannot make glucose from fatty acids. Keto acids are byproducts of incomplete fatty acid metabolism and also cannot be converted to glucose.

 

DIF:    Cognitive Level: Applying               REF:   Pages 349-350

TOP:   Nursing Process: Assessment           MSC:  Client Needs: Physiological integrity

 

5. If a malnourished patient has a poor appetite, the nurse’s first priority should be to recommend

a.	enteral feedings.
b.	increasing intake of fruits and vegetables.
c.	several small meals and snacks each day.
d.	limiting between-meal snacks to promote hunger.

 

 

ANS:  C

The nurse should encourage malnourished patients to eat several small meals and snacks each day to promote adequate intake without fatigue. Enteral feedings may be necessary if the patient cannot achieve adequate intake, but it would not be the first strategy used. Increasing intake of fruits and vegetables would increase the volume of food eaten, which may cause satiety before the patient has ingested sufficient energy and protein. Limiting between-meal snacks is likely to decrease overall food intake.

 

DIF:    Cognitive Level: Applying               REF:   Pages 353-354

TOP:    Nursing Process: Assessment    MSC:   Client Needs: Physiological integrity