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CNSC Exam > Nutrition Assessment Overview > Flashcards

Nutrition Assessment Overview Flashcards

1
Q

What compromises the reliability of urinary urea nitrogen to calculate nitrogen balance

A

creatinine clearance <50mL/min

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2
Q

What micronutrient has been shown to decrease plasma homocysteine concentrations

A

folic acid

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3
Q

hyperhomocysteinemia concentrations has been associated with an increased risk of

A

atherosclerosis

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4
Q

which three micronutrients can be supplemented to decrease homocysteine levels in plasma to decrease the risk of atherosclerosis

A

folic acid, vitamin B12 and vitamin B6

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5
Q

what is the most appropriate fluid requirement for a healthy 78 year old adults

A

25mL/kg/day

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6
Q

what is the recommended fluid requirement for healthy adults between the ages of 18-55

A

35mL/kg/day

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7
Q

what is the recommended fluid requirement for adults between the ages of 55 and 75 years old

A

30mL/kg/day

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8
Q

what is the recommended fluid requirement for adults with fluid restriction such as CHF

A

25mL/kg/day

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9
Q

What enzyme initiates the digestive process of carbohydrates in the mouth

A

salivary amylase

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10
Q

Lipase is an enzyme released by the pancreas that helps the digestion of

A

fat

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11
Q

Lactase and Maltase are enzymes located in the ______ of the small intestine to aid in intraluminal carbohydrate digestion

A

brush border

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12
Q

Iron is primarily absorbed in the __________ and ________ in the _______ state. Gastric ____ is very important in maintaining dietary iron in the _____ state

A

duodenum and jejunum
ferrous
acid
ferrous

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13
Q

What amino acid is most crucial in small intestine structure and function

A

glutamine

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14
Q

In persons with phenylketonuria (PKU), tyrosine becomes an essential amino acid due to a deficiency of

A

the phenylalanine hydroxylase enzyme

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15
Q

Phenylalanine Hydroxylase catalyzes the hydroxylation of phenylalanine to _______, so phenylalanine levels become _____ and _____ levels are decreased

A

tyrosine
elevated
tyrosine

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16
Q

Conditionally essential amino acids are synthesized from other amino acids under normal conditions but require increased needs from dietary sources during ________. For example, arginine becomes conditionally essential for _______ and _____ during trauma

A

stress
wound healing
glutamine

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17
Q

glutamine becomes conditionally essential during

A

trauma

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18
Q

arginine becomes conditionally essential during

A

wound healing

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19
Q

What are the conditionally essential amino acids

A

arginine, cysteine, glutamine, glycerin, proline, tyrosine

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20
Q

An NPO post operative patient has been on 2 in 1 PN for 3 weeks. He develops hair loss, diffuse scaly dermatitis, anemia and thrombocytopenia. What is the probable cause

A

he has not been getting ILE for 3 weeks

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21
Q

Provision of fat free PN for ____ weeks has resulted in essential fatty acid deficiency

A

3 weeks

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22
Q

Essential Fatty Acid deficiency usually results after ___ weeks of fat free PN, although signs and symptoms of deficiency can be as early as ___ to ____ days

A

10-20 days

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23
Q

what are the signs and symptoms of EFAD

A

alopecia, scaly dermatitis, impaired wound healing, anemia, thrombocytopenia

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24
Q

Provide __ to ___% total calories from ____ or ____ ILE to prevent EFAD

A

4-10% total calories

soy of safflower oil ILE

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25
Q

Which IV fluid most closely resembles jejunal and ileal electrolyte content

A

lactated ringers

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26
Q

Fluids and electrolytes of the jejunum contains ____ mEq of sodium, ___ mEq of potassium, ___ mEq of chloride and ____ mEq of bicarb

A

95-120 mEq of sodium
5-15 mEq of potassium
80-130 mEq of chloride
10-20 mEq of bicarb

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27
Q

Fluids and electrolytes of the ileum contains ____ mEq of sodium, ___mEq of potassium, ___ mEq of chloride and ___ mEq of bicarb

A

110-130 mEq of sodium
10-20 mEq of potassium
90-110 mEq of chloride
20-30 mEq of bicarb

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28
Q

Lactated Ringers IV solution contains ___ mEq/L of sodium, ___ mEq/L of potassium ____ mEq/L of chloride, ____ mEq/L of lactate and ___ mEq/L of calcium

A 
130 mEq/L of sodium
4 mEq/L of potassium
109 mEq of chloride
28 mEq/L of lactate
2.7 mEq/L of calcium
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29
Q

Normal saline contains ___ mEq/L of sodium, ____mEq/L of chloride

A

154 mEq/L sodium

154 mEq/L chloride

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30
Q

Half Normal saline contains ___ mEq/L of sodium and ____ mEq/L of chloride

A

77 mEq/L sodium

77 mEq/L chloride

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31
Q

Dextrose and half normal saline contains ____ g/L of glucose, ___ mEq/L of sodium and ____ mEq/L of chloride

A

50 g/L dextrose
77 mEq/L sodium
77 mEq/L chloride

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32
Q

What are the clinical symptoms of inappropriate diuretic hormone (SIADH)

A

increased urinary sodium
hyponatremia
increased urinary osmolality

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33
Q

a disorder of sodium and water balance caused by inappropriate release of anti-diuretic hormone which causes increased total body water which causes dilution hyponatremia

A

SIADH

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34
Q

In SIADH, increased sodium and osmolality of the urine is due to

A

excessive water retention/re-absorption

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35
Q

In SIADH to compensate for the expansion of the extracellular fluid, aldosterone secretion is inhibited to maintain

A

euvolemia

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36
Q

A 45 year old patient with chronic corticosteroid use has suspected vitamin A deficiency. Supplementation of vitamin A (3,000 to 5,000 IU) should be given at a max of ____ days

A

7 days

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37
Q

what are the main functions of vitamin A

A

wound healing, cell differentiation, and collagen synthesis

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38
Q

what is the typical dose for vitamin A supplementation

A

3,000 to 5,000 IU for 7 days

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39
Q

when should vitamin A be supplemented

A

to enhance wound healing with corticoid steroid therapy

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40
Q

Corticosteroid therapy has been shown to decrease vitamin ______

A

vitamin A

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41
Q

A patient with alcoholism is admitted with a small bowel obstruction and is started on PN. The PN provides 400 grams of dextrose, If after 3 days, the patient develops mental status changes, it is most likely due to a deficiency of

A

thiamine

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42
Q

alcohol related thiamine deficiency presents as

A

Wernicke’s Encephalopathy

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43
Q

Symptoms of Wernicke’s Encephalopathy are

A

mental status changes, confusion, nystagmus, gait ataxia

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44
Q

The glucose load in PN is associated with PN increases metabolic demand for ____ which is essential for glucose metabolism

A

thiamine

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45
Q

Lactic acidosis can be a result of which vitamin deficiency

A

thiamine

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46
Q

Thiamine is required for ____ metabolism. When Pyruvate is converted to acetyl CoA. If thiamine is not present, pyruvate will convert to production of _____ fermentation

A

glucose

lactic acid fermentation

47
Q

In addition to aggressive refeeding, what else places patients at high risk for hypophosphatemia

A

DKA

48
Q

Which patients are at the highest risk for hypophosphatemia

A

malnourished, DKA, chronic alcoholism, respiratory and metabolic acidosis, critical illness

49
Q

Insulin is an anabolic hormone that drives potassium and phosphorous into the cells causing serum _____ of these electrolytes

A

depletion

50
Q

in DKA, large amounts of ____ is lost in urine from the osmotic diuresis resulted from hyperglycemia

A

phosphorous

51
Q

The risk of metastatic calcification in soft tissues begins to increase when the product of serum calcium and phosphorous exceeds

A

55 mEq

52
Q

Hyperphoshpatemia can cause which issues

A

soft tissue and vascular calcification
hyperparathyroidism
renal osteodystorphy

53
Q

Zinc deficiency is most commonly associated with

A

diarrhea

54
Q

what are the functions of zinc

A

catalytic reactions
structural function
regulatory functions

55
Q

When is additional zinc provision recommended

A

thermal injury (burns)
excessive GI loss from diarrhea
decubitus ulcers
high output fistulas

56
Q

Copper toxicity is associated with ___ disease

A

liver

57
Q

what are the signs of copper toxicity

A

severe nausea, diarrhea

58
Q

Copper toxicity can cause

A 
Wilson's disease
Coma 
Hepatic Necrosis
Liver Failure
Renal Failure
Death
59
Q

80% of copper is excreted via

A

bile

60
Q

a patient with liver disease should be monitored and supplemented or be

A

decreased or eliminated

61
Q

Hemolysis increases copper

A

loss

62
Q

Enteral zinc supplementation can compete with ____ for absorption

A

copper

63
Q

Hepatic encephalopathy is most likely to be improved by which trace element

A

zinc

64
Q

Liver disease can cause altered ____ metabolism leading to decreased serum ____ levels. ____ supplementation has been shown to help in hepatic encephalopathy

A

zinc
zinc
zinc

65
Q

In hepatic encephalopathy zinc should be supplemented in doses of ____ mg/day for 3 months

A

150 mg per day

66
Q

What is the function of aluminum in PN solutions

A

Aluminum has NO KNOWN BIOLOGICAL function

67
Q

Aluminum is only present in PN as

A

a contaminant

68
Q

What can result in an invalid indirect calorimetry measurement

A 
air leak
chest tube leak
extracorperoal membrane oxygenation
hemodialysis
FiO2 >60% in mechanically ventilated patients/spontaneously breathing patients
reliance on supplementation oxygen
unable to cooperate
claustrophobia
anxiety
69
Q

How should a critically ill patient’s energy delivery be modified in response to resting energy expenditure measured by indirect calorimetry

A

use the caloric target WITHOUT adding a stress or activity factor

70
Q

in calculating energy delivery, should a stress or activity factor be added

A

no, it can result in overfeeding

71
Q

A respiratory quotient of 0.87 most likely suggests

A

mixed substrate utilization

72
Q

RQ measures CO2 _____ divided by O2 _____

A

CO2 produced

O2 consumed

73
Q

An RQ 0.7 or less likely indicates and >1 likely indicates

A

hyperventilation , hypoventilation

74
Q

An RQ of 0.71 indicates primarily ____ oxidation

A

fat

75
Q

An RQ of 0.82 indicates primarily ____ oxidation

A

protein

76
Q

An RQ of 0.85 indicates _____ oxidation

A

mixed substrate

77
Q

An RQ of 1.0 indicates primarily ____ oxidation

A

carbohydrate

78
Q

which predictive equation has demonstrated the greatest accuracy in estimating actual resting metabolic rate in healthy obese and non-obese adults

A

Mifflin St. Jeor

79
Q

Cheilosis is a physical symptom associated with a deficiency of _____, which can include hyperemia, edema of the oral mucosa, angular stomatitis, or glossitis

A

riboflavin

80
Q

Malnutrition is most common in which form of IBD due to its involvement in the small intestine where micronutrients are absorbed

A

Chron’s Disease

81
Q

A patient with end stage liver disease with refractory ascites awaiting liver transplantation is on PN due to intolerance to tube feeding. Sodium is 123 mEq/L. In addition to fluid restriction, what changes to his PN prescription is most appropriate?

A

restrict sodium

give 1.5 g/kg/day of protein

82
Q

What is the dietary recommendations for patients on ascites

A

fluid and sodium restriction 1-1.5 g/kg/day of protein with cirrhosis

83
Q

_______ nutrition formula should be used with patients who have ascites from ESLF to avoid further sodium and fluid overload

A

concentrated

84
Q

Arginine supplementation should be used most cautiously in patients with

A

septic shock

85
Q

arginine increases the production of ______ which causes vasodilation. Providing arginine during septic shock would further exacerbate ______

A

nitrous oxide

hemodynamic instability

86
Q

the normal length of the small intestine in adults is about

A

300-600 cm long

87
Q

when the small bowel is less than _____ cm, to an end jejunostomy/ileostomy, PN and hydration will likely be needed

A

120 cm

88
Q

The presence of an ileocecal valve and colon significantly improves _____ , ______ and _____ absorption. If the ileocecal valve is left intact, a patient may NOT need PN with as little as 60 cm left of the small bowel

A

fluid, electrolytes, and short chain fatty acids

89
Q

What is the primary fuel of colonocytes

A

short chain fatty acids

90
Q

the three primary short chain fatty acids are

A

butyrate, acetate and propionate

91
Q

short chain fatty acids can provide up to ______ kcals in short bowel syndrome

A

1,000 kcals

92
Q

Dietary fat is predominantly absorbed in what part of the GI tract

A

duodenum and proximal jejunum

93
Q

Gastrectomy patients are at risk for a deficiency of which vitamin

A

B12

94
Q

___ is the total or partial removal of the stomach

A

gastrectomy

95
Q

the _____ cells of the stomach produce intrinsic factor

A

parietal cells

96
Q

Intrinsic factor aids in the absorption of ___ in the small bowel

A

vitamin B12

97
Q

When the stomach is resected, there is no longer adequate intrinsic factor to bind is B12 and may result in

A

deficiency

98
Q

what areas of the GI tract has the the LEAST impact on nutrient absorption and intestinal adaptation following significant intestinal resection?

A

jejunum

99
Q

resecting the proximal bowel (duodenum & upper jejunum) is usually _____ tolerated than ilelal resection

A

BETTER tolerated because the ileum is good at adaptation of absorption of nutrients

100
Q

the jejunum _____ adapt well when the ileum is resected

A

doesn’t

101
Q

preservation of the ____ is important as it slows intestinal transit allowing for better absorption of nutrients

A

ileocecal valve

102
Q

The colon is critical for ___ and ____ absorption. patients without a colon are at increased risk for _____ but can salvage calories through _____________

A

water & nutrient absorption
dehydration
anaerobic bacterial fermentation of undigested carbohydrates into short chain fatty acids

103
Q

During fasting, fuel oxidation shifts from carbs to mainly ____ oxidation

A

lipid

104
Q

During fasting lipolysis will _____, glycogenesis will ____, gluconeogenesis and glucose oxidation will ______

A

Increase
decrease
decrease. The body increases lipid oxidation to provide the body with fatty acids for energy

105
Q

how much fluid per day is required to maintain fluid balance in an average healthy adult

A

25-35mL/kg/day

106
Q

Valproic acid has been shown to induce a deficiency of ______

A

carnitine

107
Q

Valproic acid is a ____ drug and can cause a deficiency in carnitine

A

anti epileptic drug

108
Q

Carnitine plays a role in fatty acid metabolism and is an essential cofactor in the elimination of ___ and ___ from the body

A

valproic acid and ammonia

109
Q

carnitine supplementation should be considered for patients

A

in a coma, with elevated ammonia, have liver disease or with valproic acid medications >450mg/day

110
Q

methotrexate acts by interfering with the normal intracellular metabolism of which of the following nutrients

A

folate

111
Q

Methotrexate is a ____ drug and ______ analogue, so that it’s binding sites are commentative

A

chemotherapeutic drug

folate

112
Q

Methotrexate competes with folate for absorption to catalyze the function of the enzyme dihydrofolate reductase, which converts dihydrofolate to tetrahydrofolate, a cofactor for the production of purine synthesis making up ______

A

DNA

113
Q

what vitamin absorption is most likely to be impaired with chronic use of proton pump inhibitors

A

B12

CNSC Exam (32 decks)

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