NSG 2400 Inflammation/TPN

A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse should assess for which complications? Select all that apply. 1 Infection 2 Hyperglycemia 3 ABO incompatibility 4 Electrolyte imbalance 5 Cardiac dysrhythmias

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A client arrives at the clinic with swollen, tender breasts and flulike symptoms. A diagnosis of mastitis is made. What does the nurse plan to do? 1 Help her wean the infant gradually. 2 Teach her to empty her breasts frequently. 3 Review breastfeeding techniques with her. 4 Send a sample of her milk to the laboratory for testing.

2 Emptying the breasts limits engorgement because engorgement causes pressure and tenderness in an already tender area. Breastfeeding should be continued; it is not only unnecessary but also unwise to remove the infant from breastfeeding. Suckling keeps the breasts empty, limits engorgement, and reduces pain. Learning is difficult when the client is in pain; reviewing breastfeeding techniques may be done eventually, after the client has some relief from pain. The milk culture may be negative because the infection may be limited to the connective tissue of the breast.

The nurse is obtaining a health history from a client with endometriosis. What consequences can occur as a result of this disorder? Select all that apply. 1 Menopause 2 Metrorrhagia 3 Impaired fertility 4 Bowel strictures 5 Voiding difficulties

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A nurse is administering total parenteral nutrition (TPN) to a client who asks why the solution is yellow. What is the nurse's best response? 1 "Vitamin B complex makes it yellow." 2 "Preservatives in the solution change its color." 3 "I will have the pharmacist come to speak with you." 4 "There is no reason to be concerned because all TPN is yellow."

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A primary health care provider prescribes 1000 mL total parenteral nutrition (TPN) to be infused over 12 hours via a central venous access device. What is most important for the nurse to obtain when preparing the equipment? 1 An infusion pump 2 A steady intravenous (IV) pole 3 An infusion set delivering 60 gtts/mL 4 A set of hemostats to be taped at the bedside

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While awaiting surgery, a client with a long history of Crohn disease is receiving total parenteral nutrition (TPN) on an outpatient basis. The nurse teaches the client that TPN helps to prepare for surgery by which process? 1 Decreasing fecal bulk 2 Preventing bowel infection 3 Providing stimulation of secretions 4 Maintaining negative nitrogen balance

1 By decreasing fecal bulk and bowel stimulation, TPN provides rest for the bowel while the client awaits surgery. TPN does not prevent a bowel infection. TPN does not stimulate gastrointestinal secretions. TPN promotes positive nitrogen balance.

A client with a history of liver disease is found to have endometriosis. Which drug is contraindicated in this client? 1 Danazol 2 Celecoxib 3 Leuprolide 4 Ketoconazole

1 Danazol is a synthetic androgenic steroid that acts by suppressing secretion of follicle-stimulating hormone and luteinizing hormone. This results in decreased secretion of estrogen and progesterone and regression of endometrial tissue. It may result in decreased lipoprotein levels and an increase in low-density lipoprotein. It is contraindicated in clients with liver disease. Celecoxib, a nonsteroidal antiinflammatory drug, should be used with caution in liver disease. Leuprolide is a gonadotropin-releasing hormone (GnRH) agonist; it may be safe for use in clients with liver disease. Ketoconazole is a nonsteroidal antiinflammatory drug and should be used with caution in clients with liver disease.

A client with malabsorption syndrome is admitted to the hospital for medical intervention. A subclavian catheter is inserted, and the client is started on total parenteral nutrition (TPN). What should the nurse teach the client in order to prevent the most common complication of TPN? 1 Avoid disturbing the dressing or getting it wet. 2 Keep the head as still as possible whenever moving. 3 Regulate the flow rate on the infusion pump as necessary. 4 Monitor daily weights at the same time while wearing the same clothing.

1 Disturbing the dressing may expose the area to pathogens. Infection is the most common complication; sterile technique at the catheter insertion site must be maintained. Keeping the head still is not necessary; the catheter is sutured in place, and reasonable movement is permitted. The client should be taught to leave the infusion pump set at the rate prescribed by the healthcare provider and to call the nurse if the alarm rings. Excessive weight gain or loss is not a complication of total parenteral nutrition.

A client with a history of endometriosis has abdominal surgery to remove abdominal adhesions. What should this client's postoperative plan of care include? 1 Encouraging the client to ambulate in the hallway 2 Elevating the client's legs by gatching the bed 3 Helping the client dangle her legs over the side of the bed 4 Maintaining the client on bed rest until the dressings have been removed

1 Muscle contraction during ambulation improves venous return, which prevents venous stasis and thrombus formation. Gatching the bed and dangling the legs each place pressure on the popliteal spaces, limiting venous return and increasing the risk of thrombus formation. Bed rest is associated with venous stasis, which increases the risk of thrombus formation.

A 15-year-old adolescent is diagnosed with endometriosis. The client has severe, acute, and incapacitating symptoms. What would be the anticipated line of treatment? 1 Surgical intervention 2 NSAIDs during menstruation 3 OCP with low estrogen-to-progestin ratio 4 Continuous combined hormone therapy and NSAIDs

1 Surgical intervention is needed in adolescents with severe, acute, and incapacitating symptoms. NSAIDs can be used for symptomatic pain relief. Women having mild symptoms and desire for future pregnancy are treated with limited use of NSAIDs during menstruation. Women having mild symptoms and who can postpone pregnancy are treated with oral contraceptive pills that have low estrogen-to-progestin levels. In adolescents less than 16 years of age diagnosed with endometriosis, continuous combined hormone therapy and NSAIDs is the treatment option.

A pregnant woman who was admitted to the high-risk maternity unit for severe hyperemesis gravidarum is receiving total parenteral nutrition (TPN). Intralipids are not being administered. Which potential complication should the nurse monitor this client for? 1 Dehydration 2 Hypoglycemia 3 Allergic reaction 4 Diabetes insipidus

1 TPN is a hypertonic solution that pulls fluid from the interstitial compartment into the intravascular compartment, resulting in diuresis and dehydration. Because of its high glucose content, TPN may cause hyperglycemia, not hypoglycemia. Allergic reaction is unlikely; the administration of lipids is associated more commonly with allergic reactions. TPN may precipitate hyperglycemia (pseudo diabetes mellitus), not diabetes insipidus.

A client with endometriosis asks the nurse what side effects to expect from leuprolide. What should the nurse include in the response? 1 Weight gain 2 Increased libido 3 Frequent urination 4 Heavy menstrual bleeding

1 The nurse should teach the client that the side effects of leuprolide include edema, which causes an increase in weight. Leuprolide decreases libido. Frequent urination is not a side effect of leuprolide. Clients who take leuprolide do not experience menstrual periods because follicle-stimulating hormone and luteinizing hormone are suppressed.

A 37-year-old client with endometriosis visits the women's health clinic because she has dysmenorrhea and dyspareunia. Which statement is the most accurate description of dysmenorrhea? 1 Pain with menses 2 Endometrial hyperplasia 3 Bleeding between menses 4 Heavy bleeding with menses

1 dyspareunia is pain with sex

A client is receiving total parenteral nutrition (TPN) through a central venous access device. The nurse discovers that the TPN bag is empty and the next bag has not been received yet from the pharmacy. What is the most appropriate action for the nurse to take? 1 Perform a finger stick glucose test and call the primary healthcare provider with the results. 2 Hang a bag of 10% dextrose at the ordered TPN rate and place an urgent request for the next TPN bag. 3 Discontinue the infusion and flush the IV line with saline solution until the next TPN bag is ready. 4 Hang a bag of 5% dextrose at a keep-open rate and notify the nurse manager of the occurrence.

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A client who has a diagnosis of endometriosis is concerned about the side effect of hot flashes from her prescribed medications. Which medication should the nurse explain causes this side effect? 1 Estrogen 2 Leuprolide 3 Diclofenac 4 Ergonovine

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To begin the administration of total parenteral nutrition (TPN), a client has a right subclavian central venous access device inserted. Immediately after insertion of the catheter, what is the priority nursing action? 1 Obtain a chest x-ray to determine placement. 2 Auscultate the lungs to evaluate breath sounds. 3 Draw a blood sample to assess blood glucose level. 4 Assess the right upper extremity for neurologic deficits.

2 The most significant and life-threatening complication of insertion of a subclavian catheter is a pneumothorax because of the proximity of the subclavian vein and the apex of the upper lobe of the lung; a client's respiratory status always is the priority. Although a chest x-ray may be done before TPN is begun, it is not the priority immediately after insertion of the catheter. A baseline blood glucose level should be obtained before insertion of the catheter. After TPN is started, routine monitoring of blood glucose levels is important. Although assessing for a neurologic deficit should be done eventually, it is not the priority at this time.

A client with a history of malabsorption syndrome is admitted to the hospital for medical management. Total parenteral nutrition (TPN) has been prescribed. What action will the nurse take to prevent a major reaction to the TPN infusion? 1 Record the intake and output. 2 Administer the infusion slowly. 3 Change the site every 24 hours. 4 Check the vital signs every 4 hours.

2 Total parenteral nutrition should be infused at a slow, constant rate; this will prevent both hyperglycemia and cellular dehydration from too rapid infusion of a hypertonic solution. Recording intake and output is essential because of the danger of fluid overload; however, monitoring will not prevent the complication. Generally a major vein is selected for administration of total parenteral nutrition; the site is not changed every 24 hours. Monitoring vital signs may identify a complication such as infection; monitoring will not prevent a complication from occurring.

The primary healthcare provider has prescribed 500 mg of cephalexin by mouth every 6 hours for 10 days for a client with mastitis. The primary healthcare provider has given the client 24 sample tablets of 250 mg apiece. How many days should this supply last? Record your answer using a whole number of days

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Which microorganism causes maternal mastitis? 1 Escherichia coli 2 Group B streptococcus 3 Staphylococcus aureus 4 Chlamydia trachomatis

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During the administration of total parenteral nutrition (TPN), an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? 1 Restart the client's infusion at another site. 2 Slow the rate of the client's infusion of the TPN. 3 Interrupt the client's infusion and notify the healthcare provider. 4 Obtain the vital signs and continue monitoring the client's status.

3 The client is experiencing pulmonary edema because of a fluid volume excess. The high concentration of TPN precipitates a fluid shift from the interstitial compartment into the intravascular compartment. Fluid will continue to be infused, which will continue to increase the intravascular volume.

A client at the women's health clinic tells the nurse that she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply. 1 Insomnia 2 Ecchymosis 3 Rectal pressure 4 Abdominal pain 5 Skipped periods 6 Pelvic infections

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Which gonadotropin-releasing hormone agonists are used to treat endometriosis? Select all that apply. 1 Trazodone 2 Diclofenac 3 Leuprolide 4 Isotretinoin 5 Nafarelin acetate

3 5 Leuprolide and nafarelin acetate are gonadotropin-releasing hormone (GnRH) agonists used to treat endometriosis. Trazodone is used in cases of erectile dysfunction. Diclofenac is a nonsteroidal antiinflammatory drug used to relieve pain in endometriosis. Isotretinoin is an oral agent that is effective against severe cystic acne.

A client is admitted to the hospital with a diagnosis of acute pancreatitis. The health care provider's prescriptions include nothing by mouth and total parenteral nutrition (TPN). The nurse explains that the TPN therapy provides what benefit? 1 Is the easiest method for administering needed nutrition 2 Is the safest method for meeting the client's nutritional requirements 3 Will satisfy the client's hunger without the discomfort associated with eating 4 Will meet the client's nutritional needs without causing the discomfort precipitated by eating

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A client with a history of endometriosis gives birth to a healthy infant. She expresses concern that the problems associated with endometriosis will return now that her pregnancy is over. What is the best response by the nurse? 1 "Pregnancy usually cures the problem." 2 "Endometriosis usually causes early menopause." 3 "You may need a hysterectomy if the problems recur." 4 "Breast-feeding will delay the return of the endometriosis."

4 Lactation delays ovarian function during the postpartum period; therefore lactation will delay the return of endometriosis. Pregnancy temporarily suppresses ovarian function; the aberrant endometrial tissue is still present. Endometriosis may lead to sterility; it does not cause menopause. Conservative medical therapy will be used first; hysterectomy is a last resort.

What should the nurse include in the discharge instructions for a client who will be receiving total parenteral nutrition (TPN) at home? 1 Changing the TPN access device daily 2 Contacting and scheduling professionals to administer the TPN 3 Listing the schedule of the days the client is to receive the TPN 4 Administering the TPN while working around the client's normal activities

4 The less disruptive the procedure, the greater the acceptance by the client. Most often, total parenteral nutrition is set up to run daily during sleeping hours. Depending on the type of circulatory access used, it may not need to be changed for weeks. The client or a significant other can be taught the principles of administration.