Page 1 of 37
NTR 604 final Exam 2026-2027 COMPLETE 200
QUESTIONS AND VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR
NTR 604 final
What pulmonary condition may be a severe complication of critical illness
Acute respiratory distress syndrome (ARDS)
Rationale: ARDS is a severe, life-threatening form of type I respiratory failure that develops
during critical illness due to sepsis, trauma, or pancreatitis.
Which of the following in excess contributes the most to carbon dioxide retention?
Calories
Rationale: Total calorie excess (overfeeding) increases CO₂ production more than any single
macronutrient composition, as shown in the Talpers 1992 study.
Several factors can modulate REE. Place the right factors/conditions in the right category.
Increase REE: stress, burns, inflammation, severe obesity | Decrease REE: coma, paralysis,
underfeeding, hypoventilation
Rationale: Stress, burns, and inflammation elevate metabolism, while coma, paralysis, and
underfeeding reduce metabolic rate.
,Page 2 of 37
Patients with the following symptoms should be evaluated for potential overfeeding and
their energy provision reduced
Fluid overload, Liver dysfunction, Azotemia
Rationale: Overfeeding causes hyperglycemia, lipogenesis, liver dysfunction, azotemia, and
fluid overload. These signs indicate the need to reduce caloric provision.
Which of the following is an ASPEN guideline for Nutrition Support in patients with
pulmonary failure?
Consider hypocaloric PN dosing with adequate protein.
Rationale: ASPEN recommends hypocaloric PN (≤20 kcal/kg/day or ≤80% of needs) with
adequate protein (≥1.2 g/kg/day) to prevent overfeeding and preserve lean mass.
For patients in the prone position, the head of bed can be elevated using the Trendelenburg
strategy at 10-20 degrees.
True
Rationale: In ARDS, the Trendelenburg 10-20° strategy allows head elevation during prone
positioning to reduce aspiration risk while maintaining enteral feeding.
Indirect calorimetry can be used to measure REE in both mechanically ventilated and
spontaneous breathing patients
True
Rationale: Indirect calorimetry can measure REE in ventilated patients via the ventilator
circuit and in spontaneous patients using a canopy or handheld device.
,Page 3 of 37
Malnutrition can adversely impact lung function by which of the following mechanisms?
Respiratory muscles are catabolized for energy
Rationale: Malnutrition leads to catabolism of respiratory muscles for energy, causing
reduced diaphragmatic strength and contractility, impaired ventilation, and respiratory failure
risk.
What is the effect of chronic obstructive pulmonary disease on a patient's energy
requirements?
Increased need for energy due to increased work of breathing and ventilatory muscle
inefficiency
Rationale: COPD increases resting energy expenditure due to the higher work of breathing
and inefficient ventilatory muscles. ASPEN recommends 25-30 kcal/kg/day or 125-150% of BEE
if IC unavailable.
Chronic lung disease can impact Nutritional status by which of the following?
Bloating, Early satiety, and Hypoxemia
Rationale: Chronic lung disease causes diaphragm flattening and gastric compression,
leading to bloating and early satiety; hypoxemia makes swallowing difficult, reducing intake
The physiological range of RQ is ____ to ____
0.67 to 1.3
Rationale: The physiological range of respiratory quotient (RQ) is 0.67-1.3, reflecting the
balance of substrate oxidation (fat → 0.7, CHO → 1.0)
, Page 4 of 37
Which of the following is NOT a contraindication for Indirect Calorimetry?
Fluid overload
Rationale: Fluid overload affects body weight estimates but does not interfere with IC
measurement; ECMO, HD, and poor cooperation are true contraindications.
You have performed an indirect calorimetry study in a patient admitted to the ICU 3 days ago.
The test was valid and shows a measured REE of 2300 kcal. What is the patient's energy
requirement?
2300 kcal
Rationale: ASPEN recommends feeding to 100% of the measured REE from IC without adding
stress/activity factors; this best reflects true energy needs.
Which of the following are common factors contributing to malnutrition in cancer patients?
Inflammation and Depression, Rationale: Inflammation increases metabolic rate and protein
breakdown, while depression reduces appetite and oral intake. Both are common contributors
to cancer-related malnutrition.
Which of the following are common metabolic changes seen in cancer?
Increased protein catabolism, Increased lipolysis and hypertriglyceridemia, Insulin resistance,
Rationale: Cancer promotes protein and fat breakdown while increasing glucose production and
insulin resistance, leading to a catabolic and hypermetabolic state.
Cancer cachexia is characterized by which of the following?
NTR 604 final Exam 2026-2027 COMPLETE 200
QUESTIONS AND VERIFIED SOLUTIONS LATEST
UPDATE THIS YEAR
NTR 604 final
What pulmonary condition may be a severe complication of critical illness
Acute respiratory distress syndrome (ARDS)
Rationale: ARDS is a severe, life-threatening form of type I respiratory failure that develops
during critical illness due to sepsis, trauma, or pancreatitis.
Which of the following in excess contributes the most to carbon dioxide retention?
Calories
Rationale: Total calorie excess (overfeeding) increases CO₂ production more than any single
macronutrient composition, as shown in the Talpers 1992 study.
Several factors can modulate REE. Place the right factors/conditions in the right category.
Increase REE: stress, burns, inflammation, severe obesity | Decrease REE: coma, paralysis,
underfeeding, hypoventilation
Rationale: Stress, burns, and inflammation elevate metabolism, while coma, paralysis, and
underfeeding reduce metabolic rate.
,Page 2 of 37
Patients with the following symptoms should be evaluated for potential overfeeding and
their energy provision reduced
Fluid overload, Liver dysfunction, Azotemia
Rationale: Overfeeding causes hyperglycemia, lipogenesis, liver dysfunction, azotemia, and
fluid overload. These signs indicate the need to reduce caloric provision.
Which of the following is an ASPEN guideline for Nutrition Support in patients with
pulmonary failure?
Consider hypocaloric PN dosing with adequate protein.
Rationale: ASPEN recommends hypocaloric PN (≤20 kcal/kg/day or ≤80% of needs) with
adequate protein (≥1.2 g/kg/day) to prevent overfeeding and preserve lean mass.
For patients in the prone position, the head of bed can be elevated using the Trendelenburg
strategy at 10-20 degrees.
True
Rationale: In ARDS, the Trendelenburg 10-20° strategy allows head elevation during prone
positioning to reduce aspiration risk while maintaining enteral feeding.
Indirect calorimetry can be used to measure REE in both mechanically ventilated and
spontaneous breathing patients
True
Rationale: Indirect calorimetry can measure REE in ventilated patients via the ventilator
circuit and in spontaneous patients using a canopy or handheld device.
,Page 3 of 37
Malnutrition can adversely impact lung function by which of the following mechanisms?
Respiratory muscles are catabolized for energy
Rationale: Malnutrition leads to catabolism of respiratory muscles for energy, causing
reduced diaphragmatic strength and contractility, impaired ventilation, and respiratory failure
risk.
What is the effect of chronic obstructive pulmonary disease on a patient's energy
requirements?
Increased need for energy due to increased work of breathing and ventilatory muscle
inefficiency
Rationale: COPD increases resting energy expenditure due to the higher work of breathing
and inefficient ventilatory muscles. ASPEN recommends 25-30 kcal/kg/day or 125-150% of BEE
if IC unavailable.
Chronic lung disease can impact Nutritional status by which of the following?
Bloating, Early satiety, and Hypoxemia
Rationale: Chronic lung disease causes diaphragm flattening and gastric compression,
leading to bloating and early satiety; hypoxemia makes swallowing difficult, reducing intake
The physiological range of RQ is ____ to ____
0.67 to 1.3
Rationale: The physiological range of respiratory quotient (RQ) is 0.67-1.3, reflecting the
balance of substrate oxidation (fat → 0.7, CHO → 1.0)
, Page 4 of 37
Which of the following is NOT a contraindication for Indirect Calorimetry?
Fluid overload
Rationale: Fluid overload affects body weight estimates but does not interfere with IC
measurement; ECMO, HD, and poor cooperation are true contraindications.
You have performed an indirect calorimetry study in a patient admitted to the ICU 3 days ago.
The test was valid and shows a measured REE of 2300 kcal. What is the patient's energy
requirement?
2300 kcal
Rationale: ASPEN recommends feeding to 100% of the measured REE from IC without adding
stress/activity factors; this best reflects true energy needs.
Which of the following are common factors contributing to malnutrition in cancer patients?
Inflammation and Depression, Rationale: Inflammation increases metabolic rate and protein
breakdown, while depression reduces appetite and oral intake. Both are common contributors
to cancer-related malnutrition.
Which of the following are common metabolic changes seen in cancer?
Increased protein catabolism, Increased lipolysis and hypertriglyceridemia, Insulin resistance,
Rationale: Cancer promotes protein and fat breakdown while increasing glucose production and
insulin resistance, leading to a catabolic and hypermetabolic state.
Cancer cachexia is characterized by which of the following?
