Nutrition/malnutrition/obesity Flashcards by V costa

Which diagnostic test is considered the gold standard for assessing energy expenditure in malnourished patients?
A) Calorimetry
B) BMI measurement
C) Serum albumin levels
D) Bioelectrical impedance analysis

Answer: A) Calorimetry

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Which type of malnutrition is characterized by chronic starvation without inflammation?
A) Starvation-related malnutrition
B) Chronic disease-related malnutrition
C) Acute disease or injury-related malnutrition
D) Protein-energy malnutrition

Answer: A) Starvation-related malnutrition

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What is the target blood glucose range in ICU patients receiving nutritional support?
A) 100-140
B) 120-160
C) 140-180
D) 160-200

Answer: C) 140-180

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Enteral nutrition is preferred over parenteral nutrition for critically ill patients because:
A) It is easier to administer.
B) It reduces the risk of infections.
C) It provides higher caloric intake.
D) It requires fewer nursing interventions.

Answer: B) It reduces the risk of infections

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Which nutritional management strategy is recommended for a patient with a BMI >30 and polytrauma?
A) Reduce caloric intake to 15 kcal/kg/day
B) Use high-protein, calorie-restricted enteral nutrition
C) Initiate parenteral nutrition immediately upon admission
D) Avoid nutritional support for the first 48 hours

Answer: B) Use high-protein, calorie-restricted enteral nutrition

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The clinical presentation of obesity includes all of the following EXCEPT:
A) Regional fat distribution
B) Increased susceptibility to infection
C) Elevated BMI
D) Dyslipidemia

Answer: B) Increased susceptibility to infection

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Which diagnostic test is recommended to evaluate metabolic complications in obesity?
A) MRI of adipose tissue
B) Thyroid function test
C) Pulmonary function test
D) Bone density scan

Answer: B) Thyroid function test

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Which of the following is the most effective first step in managing obesity?
A) Surgical intervention
B) Nutrition consultation
C) Pharmacological therapy
D) High-protein diet

Answer: B) Nutrition consultation

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Which of the following nutritional markers may be unreliable in critically ill patients?
A) Albumin
B) C-reactive protein
C) Hemoglobin
D) Calcium

Answer: A) Albumin

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For a critically ill patient, when should enteral nutrition ideally be initiated?
A) Within 12 hours of admission
B) Within 24-48 hours of admission
C) After 7 days of fasting
D) Only if parenteral nutrition is not feasible

Answer: B) Within 24-48 hours of admission

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Which of the following is an appropriate protein requirement for a critically ill burn patient?
A) 0.8 g/kg/day
B) 1.0 g/kg/day
C) 1.2–2.0 g/kg/day
D) 2.5 g/kg/day

Answer: C) 1.2–2.0 g/kg/day

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Which type of malnutrition is characterized by inflammation that is acute and severe?
A) Starvation-related malnutrition
B) Chronic disease-related malnutrition
C) Acute disease or injury-related malnutrition
D) Protein-energy malnutrition

Answer: C) Acute disease or injury-related malnutrition

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A 58-year-old female with a history of gastric bypass surgery is admitted for evaluation of fatigue and dizziness. Labs reveal anemia and low albumin levels. What is the most appropriate initial intervention?
A) Begin enteral nutrition
B) Administer parenteral nutrition immediately
C) Obtain a detailed dietary history and order nutritional supplementation
D) Refer for a bone density scan

Answer: C) Obtain a detailed dietary history and order nutritional supplementation

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A critically ill 75-year-old male in the ICU requires nutritional support. He has hemodynamic instability and cannot tolerate enteral nutrition. What is the best course of action?
A) Start parenteral nutrition immediately
B) Wait 7 days before initiating parenteral nutrition
C) Start total parenteral nutrition within 24 hours
D) Begin enteral nutrition through a nasogastric tube

Answer: B) Wait 7 days before initiating parenteral nutrition

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A 40-year-old male with a BMI of 40 is admitted with cellulitis and poorly controlled Type 2 diabetes. Which intervention is most appropriate to address his obesity in the inpatient setting?
A) Start a very low-calorie diet
B) Encourage weight loss of 5-10% and schedule a nutrition consult
C) Initiate bariatric surgery referral immediately
D) Provide only clear liquids until cellulitis resolves

Answer: B) Encourage weight loss of 5-10% and schedule a nutrition consult

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Which lab test is the most sensitive marker for acute malnutrition?
A) Albumin
B) Prealbumin
C) C-reactive protein
D) Hemoglobin

Answer: B) Prealbumin

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What is the primary complication of parenteral nutrition?
A) Gut atrophy
B) Hypernatremia
C) Hypoglycemia
D) Fluid retention

Answer: A) Gut atrophy

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Intentional permissive underfeeding is commonly recommended for which population?
A) Patients with renal failure
B) Obese critically ill patients
C) Malnourished elderly patients
D) Pediatric patients

Answer: B) Obese critically ill patients

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Which type of feeding is preferred for a patient with a functioning gastrointestinal tract?
A) Enteral nutrition
B) Parenteral nutrition
C) Intravenous dextrose
D) Total parenteral nutrition

Answer: A) Enteral nutrition

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Which nutritional intervention can prevent refeeding syndrome?
A) Rapid reintroduction of carbohydrates
B) Gradual increase in calorie intake
C) High-dose thiamine supplementation
D) Restricting protein intake

Answer: B) Gradual increase in calorie intake

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A patient with a BMI of 40 requires nutritional support. Which is the most appropriate initial strategy?
A) Enteral feeding within 48 hours
B) Total parenteral nutrition
C) Restriction of protein intake
D) Early initiation of low-calorie parenteral nutrition

Answer: A) Enteral feeding within 48 hours

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Which type of malnutrition is associated with chronic inflammation?
A) Starvation-related malnutrition
B) Acute disease-related malnutrition
C) Chronic disease-related malnutrition
D) Injury-induced malnutrition

Answer: C) Chronic disease-related malnutrition

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What is a key complication of refeeding syndrome?
A) Hypernatremia
B) Hypophosphatemia
C) Hypercalcemia
D) Hyponatremia

Answer: B) Hypophosphatemia

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Which patient population is most at risk for malnutrition during hospitalization?
A) Patients with obesity
B) Patients with burns and sepsis
C) Patients undergoing elective surgery
D) Patients on oral diets

Answer: B) Patients with burns and sepsis

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11. Enteral nutrition is preferred over parenteral nutrition because it: A) Reduces aspiration risk B) Provides higher calorie content C) Preserves gut integrity and reduces infections D) Eliminates the need for electrolyte monitoring

Answer: C) Preserves gut integrity and reduces infections

13. What percentage of total energy expenditure is resting energy expenditure? A) 50% B) 60% C) 75% D) 90%

Answer: C) 75%

14. A patient with chronic disease-related malnutrition typically experiences: A) No inflammation B) Mild to moderate chronic inflammation C) Acute, severe inflammation D) Overhydration

Answer: B) Mild to moderate chronic inflammation

15. Which screening tool is mandated within 24 hours of acute admission? A) BMI measurement B) Nutrition Screening and Assessment Tool C) Subjective Global Assessment D) Calorimetry

Answer: B) Nutrition Screening and Assessment Tool

16. Refeeding syndrome results in: A) Hypercalcemia B) Hypophosphatemia C) Hyperkalemia D) Hypermagnesemia

Answer: B) Hypophosphatemia

2. Which factor increases resting energy expenditure in hospitalized patients? A) Chronic illnesses B) Acute illness or stress C) Overnutrition D) Sleep deprivation

Answer: B) Acute illness or stress

3. What are the primary macronutrients required for energy and tissue repair? A) Protein, carbohydrates, and vitamins B) Protein, amino acids, and fatty acids C) Carbohydrates, fats, and proteins D) Vitamins, minerals, and proteins

Answer: C) Carbohydrates, fats, and proteins

4. What does the term "total energy expenditure" refer to? A) The amount of dietary energy required during rest B) The amount of energy consumed in maintaining fat stores C) The total dietary energy required for basal metabolic rate, physical activity, and thermogenesis D) The energy needed solely for metabolism

Answer: C) The total dietary energy required for basal metabolic rate, physical activity, and thermogenesis

5. What is a hallmark sign of starvation-related malnutrition? A) Acute systemic inflammation B) Skin thinning and muscle atrophy C) Hyperlipidemia D) Hypoglycemia

Answer: B) Skin thinning and muscle atrophy

6. Which type of malnutrition is associated with systemic inflammatory response syndrome (SIRS)? A) Starvation-related malnutrition B) Chronic disease-related malnutrition C) Acute disease-related malnutrition D) Subclinical malnutrition

Answer: C) Acute disease-related malnutrition

7. Which population is most likely to develop malnutrition due to food insecurity? A) Patients with liver failure B) Patients in food deserts C) Patients with advanced dementia D) Patients with polytrauma

Answer: B) Patients in food deserts

8. What is the main risk of untreated acute malnutrition in critically ill patients? A) Decreased length of hospital stay B) Improved gut integrity C) Increased risk of infection due to gut bacteria translocation D) Reduced inflammatory response

Answer: C) Increased risk of infection due to gut bacteria translocation

9. What is the primary purpose of nutrition screening? A) To provide definitive diagnosis of malnutrition B) To identify individuals at risk for malnutrition C) To calculate caloric requirements D) To initiate parenteral nutrition immediately

Answer: B) To identify individuals at risk for malnutrition

10. Which laboratory test is least reliable during acute illness for assessing nutrition? A) Albumin B) Prealbumin C) Retinol-binding protein D) Electrolytes

Answer: A) Albumin

11. Which nutrition screening tool is commonly used for hospitalized patients? A) Braden Scale B) Subjective Global Assessment Tool C) Geriatric Depression Scale D) CAM-ICU

Answer: B) Subjective Global Assessment Tool

12. What Joint Commission mandate applies to nutrition screening? A) Conduct a detailed nutrition assessment within 48 hours B) Ensure all hospitalized patients are screened within 24 hours of admission C) Limit calorie intake for obese patients D) Use parenteral nutrition for critically ill patients

Answer: B) Ensure all hospitalized patients are screened within 24 hours of admission

13. Which is the preferred method of nutritional support for hospitalized patients? A) Parenteral nutrition B) Enteral nutrition C) Total parenteral nutrition (TPN) D) Continuous glucose infusion

Answer: B) Enteral nutrition

14. What is the recommended protein requirement for critically ill patients with burns or polytrauma? A) 0.8–1.0 g/kg/day B) 1.0–1.5 g/kg/day C) 1.2–2.0 g/kg/day D) 2.5–3.0 g/kg/day

Answer: C) 1.2–2.0 g/kg/day

15. What is a common adverse effect of parenteral nutrition? A) Gastrointestinal bleeding B) Central line-associated bloodstream infection (CLABSI) C) Hypercalcemia D) Hyperalbuminemia

Answer: B) Central line-associated bloodstream infection (CLABSI)

16. Why is enteral nutrition preferred over parenteral nutrition? A) It is less expensive B) It maintains gut integrity and reduces infection risk C) It avoids the need for protein supplementation D) It prevents electrolyte imbalances

Answer: B) It maintains gut integrity and reduces infection risk

18. Which intervention is recommended for managing diarrhea in patients receiving enteral nutrition? A) Switching to parenteral nutrition B) Administering fiber-enriched formulas C) Increasing bolus feeding frequency D) Adding prophylactic antidiarrheals

Answer: B) Administering fiber-enriched formulas

19. What is the glucose target range for patients receiving nutritional support in the ICU? A) 80–100 mg/dL B) 100–140 mg/dL C) 140–180 mg/dL D) 180–220 mg/dL

Answer: C) 140–180 mg/dL

. What is the threshold gastric residual volume (GRV) to hold enteral tube feeding, according to updated guidelines? A) 250 mL B) 300 mL C) 400 mL D) 500 mL

Answer: D) 500 mL

21. What type of nutrient is essential for the repair of lean body mass in critically ill patients? A) Fats B) Proteins C) Vitamins D) Carbohydrates

Answer: B) Proteins

22. Which of the following is considered a micronutrient? A) Glucose B) Fatty acids C) Vitamins D) Proteins

Answer: C) Vitamins

23. What is the primary purpose of micronutrients in the body? A) Provide energy B) Maintain cellular functions and metabolism C) Increase resting energy expenditure D) Build muscle mass

Answer: B) Maintain cellular functions and metabolism

24. Which is a common clinical sign of chronic disease-related malnutrition? A) Starvation edema B) Muscle atrophy with mild inflammation C) Severe tissue injury D) Hyperglycemia

Answer: B) Muscle atrophy with mild inflammation

25. Which lab value is most reflective of acute malnutrition in the absence of systemic inflammation? A) Albumin B) Prealbumin C) Retinol-binding protein D) Transferrin

Answer: B) Prealbumin

26. What does a positive nutrition screening indicate? A) Immediate need for parenteral nutrition B) The presence of malnutrition C) The need for further nutritional assessment D) Adequate nutritional status

Answer: C) The need for further nutritional assessment

27. What is a relative contraindication for starting enteral nutrition? A) Coagulopathy B) Stable hemodynamic status C) Functional GI tract D) Normal phosphorus levels

Answer: A) Coagulopathy

28. What is the primary goal of enteral nutrition in critically ill patients? A) Prevent hyperglycemia B) Restore gut integrity and immune function C) Eliminate the need for physical activity D) Replace protein catabolism

Answer: B) Restore gut integrity and immune function

29. Which of the following is an advantage of continuous enteral feeding compared to bolus feeding? A) Reduced aspiration risk B) Increased protein absorption C) Improved patient satisfaction D) Higher calorie delivery

Answer: A) Reduced aspiration risk

30. What is the preferred time frame to start enteral nutrition in critically ill patients? A) Within the first 2–3 hours B) Within the first 12 hours C) Within the first 24–48 hours D) Within the first week

Answer: C) Within the first 24–48 hours

31. Which electrolyte imbalance is commonly observed in refeeding syndrome? A) Hypernatremia B) Hypercalcemia C) Hypokalemia D) Hypoglycemia

Answer: C) Hypokalemia

32. What is the most important intervention when managing refeeding syndrome? A) Provide high-calorie feeding immediately B) Correct electrolyte imbalances before and during feeding C) Switch to parenteral nutrition D) Increase fluid intake

Answer: B) Correct electrolyte imbalances before and during feeding

33. What is the primary risk of abruptly stopping parenteral nutrition? A) Hypoglycemia B) Hypernatremia C) Protein deficiency D) Diarrhea

Answer: A) Hypoglycemia

35. Which patient population is at higher risk for developing malnutrition despite appearing well-nourished? A) Patients with advanced dementia B) Patients with liver failure C) Obese patients D) Patients with polytrauma

Answer: C) Obese patients

36. What is the preferred intervention for patients with advanced dementia who cannot safely eat? A) Start total parenteral nutrition immediately B) Optimize voluntary nutrition and assess goals of care C) Use high-calorie enteral formulas D) Administer appetite stimulants

Answer: B) Optimize voluntary nutrition and assess goals of care

37. Which guideline is followed for managing glycemic control in ICU patients receiving nutrition support? A) Maintain blood glucose between 100–140 mg/dL B) Target blood glucose of 140–180 mg/dL C) Aim for blood glucose below 80 mg/dL D) Avoid glucose monitoring to prevent interruptions

Answer: B) Target blood glucose of 140–180 mg/dL

38. Why is frequent phosphorus monitoring critical in patients receiving nutritional support? A) Prevents hyperglycemia B) Avoids hypophosphatemia-related respiratory failure C) Ensures gut integrity D) Reduces infection risk

Answer: B) Avoids hypophosphatemia-related respiratory failure

39. When should caloric requirements for patients on nutritional support be re-evaluated? A) Daily B) Every 48 hours C) Weekly D) Monthly

Answer: C) Weekly

40. What is a key measure to prevent complications in patients on enteral nutrition? A) Use prophylactic antidiarrheals B) Monitor tolerance through residual volumes every 2 hours C) Use postpyloric feeding for high aspiration risk D) Avoid bolus feeding for all patients

Answer: C) Use postpyloric feeding for high aspiration risk

24. What is a complication of untreated refeeding syndrome? A) Hyperkalemia B) Heart failure C) Bradycardia D) Hypoglycemia

Answer: B) Heart failure

A 55-year-old male with a BMI of 15 is admitted after prolonged fasting. After receiving 24 hours of enteral nutrition, he develops weakness, tachycardia, and hypophosphatemia. 1. What is the key pathophysiological change in refeeding syndrome? A) Hyperglycemia due to insulin resistance B) Cellular uptake of electrolytes due to insulin surge C) Dehydration due to osmotic diuresis D) Increased gluconeogenesis leading to hypoglycemia

Answer: B) Cellular uptake of electrolytes due to insulin surge