Lewis Med-Surg, Chapter 44|Advanced Clinical Nutrition and Metabolic Assessment: Protein-Calorie Malnutrition, Macronutrient Requirements, Micronutrient Deficiencies, Enteral and Parenteral Nutrition, Refeeding Syndrome, Electrolyte Imbalances, Glycogen a

Lewis Med-Surg, Chapter 44|Advanced Clinical Nutrition and Metabolic Assessment: Protein-Calorie Malnutrition, Macronutrient Requirements, Micronutrient Deficiencies, Enteral and Parenteral Nutrition, Refeeding Syndrome, Electrolyte Imbalances, Glycogen and Fat Metabolism, Vitamins and Minerals, Nutritional Screening, Anthropometric Measurements, Gastrointestinal Surgery, Feeding Tube Placement, Aspiration Risk, Hyperglycemia, Hypophosphatemia, Fluid-Electrolyte Balance, Malabsorption, High-Protein Diets, High-Calorie Diets, Dietary Guidelines, Vegetarian and Vegan Nutrition, Protein Supplementation, Wound Healing, Anemia, Edema, Insulin Management, IV Therapy, Nutritional Monitoring, Laboratory Indicators, Nutrition-Related Complications, Critical Nursing Decisions Exam Questions Verified and Provided with Complete A+ Graded Rationales Latest Updated 2026 The percentage of daily calories for a healthy individual consists of a. 50% carbohydrates, 25% protein, 25% fat, and 10% of fat from saturated fatty acids. b. 65% carbohydrates, 25% protein, 25% fat, and 10% of fat from saturated fatty acids. c. 50% carbohydrates, 40% protein, 10% fat, and 10% of fat from saturated fatty acids. d. 40% carbohydrates, 30% protein, 30% fat, and 10% of fat from saturated fatty acids. Correct answer: a Rationale: The 2005 Dietary Guidelines for Americans recommend that 45% to 65% of total calories should come from carbohydrates. Ideally, 10% to 35% of daily caloric needs should come from protein. Individuals should limit their fat intake to 20% to 35% of total calories. Additional recommendations focus on the type of fat consumed because diets high in excess calories, usually in the form of fats, contribute to the development of obesity. Individuals should consume less than 10% of calories from saturated fatty acids, limit intake of fat and oils high in trans fatty acids, and should limit intake of dietary cholesterol to 300 mg/day. During starvation, the order in which the body obtains substrate for energy is a. visceral protein, skeletal protein, fat, glycogen b. glycogen, skeletal protein, fat stores, visceral protein c. visceral protein, fat stores, glycogen, skeletal protein d. fat stores, skeletal protein, visceral protein, glycogen Correct answer: b Rationale: Initially, the body selectively uses carbohydrates (e.g., glycogen) rather than fat and protein to meet metabolic needs. These carbohydrate stores, found in the liver and muscles, are minimal and may be totally depleted within 18 hours. After carbohydrate stores are depleted, skeletal protein begins to be converted to glucose for energy. Within 5 to 9 days, body fat is fully mobilized to supply much of the needed energy. In prolonged starvation, up to 97% of calories are provided by fat, and protein is conserved. Depletion of fat stores depends on the amount available, but fat stores typically are used up in 4 to 6 weeks. After fat stores are used, body or visceral proteins, including those in internal organs and plasma, can no longer be spared and rapidly decrease because they are the only remaining body source of energy available. A complete nutritional assessment including anthropometric measurements is important for the patient who a. has a BMI of 25.5 kg/m2. b. complains of frequent nocturia. c. reports a 5-year history of constipation. d. reports an unintentional weight loss of 10 lb in 2 months. Correct answer: d Rationale: A loss of more than 5% of usual body weight over 6 months, whether intentional or unintentional, is a critical indicator for further assessment. The nurse confirms initial placement of a blindly inserted small-bore NG feeding tube by a. x-ray. b. air insufflation. c. observing patient for coughing. d. pH measurement of gastric aspirate. Correct answer: a Rationale: The nurse should obtain x-ray confirmation to determine whether a blindly placed nasogastric or orogastric tube (small bore or large bore) is properly positioned in the gastrointestinal tract before administering feedings or medications. A patient is receiving peripheral parenteral nutrition. The parenteral nutrition solution is completed before the new solution arrives on the unit. The nurse administers a. 20% intralipids. b. 5% dextrose solution. c. 0.45% normal saline solution. d. 5% lactated Ringer's solution Correct answer: b Rationale: If a peripheral parenteral nutrition (PPN) formula bag empties before the next solution is available, a 5% dextrose solution (based on the amount of dextrose in the peripheral PN solution) may be administered to prevent hypoglycemia. Which statement accurately describes vitamin deficiencies? a. The two nutrients most often lacking in the diet of a vegan are vitamin B6 and folic acid. b. Vitamin imbalances occur frequently in the United States because of excessive fat intake. c. Surgery on the GI tract may contribute to vitamin deficiencies because of impaired absorption. d. Vitamin deficiencies in adults most commonly are clinically manifested by disorders of the skin. Correct answer: c Rationale: Patients who have surgery on the GI tract may be at risk for vitamin deficiencies because of inability to absorb or metabolize them. The strict vegan diet most often lacks cobalamin (vitamin B12)