Chapter 13: NCLEX book questions

The nurse is caring for a group of adult clients on an acute care medical-surgical nursing unit. The nurse understand that which client would be the least likely candidate for PN? 1. A 66 year old client with extensive burns 2. A 42 year old client who has had an open cholecystectomy 3. A 27 year old client with severe exacerabatin of Chron's disease 4. A 35 year old client with persistent nausea and vomitting from chemotherapy

2. The client with the open cholecystectomy is not a candidate because this client would resume a regular diet within a few days following surgery.

The nurse is preparing to hang fat emulsions and notes that the fat globules are visible at the top of the solution. The nurse should take which action? 1. Rolls the bottle of solution gently 2. Obtains a different bottle of solution 3. Shakes the bottle of solution vigorously 4. Runs the bottle of solution under arm water

2. The nurse should not hang a fat emulsion if the bottle has a seperation of emulsion into layers of fat globules or for the accumulation of froth. The solution should be returned to the pharmacy

A client is being weaned from parenteral nutrition and is expected to begin taking solid food today. The ongoing solution rate has been 100mL/hour. The nurse anticipates that which prescription regarding the PN solution will accompany the diet prescription? 1. Discontinue the PN 2. Decrease the PN rate to 50mL/hour 3. Start 0.9% normal saline at 25mL/hour 4. Continue current infusion rate prescription for PN

2. When a client begins eating a regular diet after a period of receiving PN, the PN is decreased gradually, PN that is discontinued abruptly can cause hypoglycemia

The nurse is making initial rounds at the beginning of a shift and notes the PN bag of an assigned client is empty. Which solution readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit? 1. 5% dextrose water 2. 10% dextrose water 3. 5% dextrose in ringers lactate 4. 5% dextrose in 0.9% sodium chloride

2. The client is at risk for hypoglycemia; therefore, the solution containing the highest amount of glucose should be hung until the new PN solution becomes available.

The nurse is preparing to change the parenteral nutrition solution bag and tubing. The client's central venous line is locatedin the right subclavian vein. The nurse asks the client to take which essential action during the tubing change? 1. Breathe normally 2. Turn head slightly to the right 3. Exhale slowly and evenly 4. Take a deep breath, hold it and bear down

4. The client should be asked to perform the Valsalva maneuver during tubing changes. This helps to avoid air embolism.

A client is receiving parenteral nutrition. The nurse monitors the client for complications of the therapy and should assess the client for which manifestations of hyperglycemia? 1. Fever, weak pulse and thirst 2. Nausea, vomiting, and oliguria 3. Sweating, chills, and abdominal pain 4. Weakness, thirst and increased UO

4. Signs of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness, Kussmauls respirations, diuresis, and coma when hyperglycemia is severe.

A client has been discharged to home on PN. With each visit, the home care nurse should assess which parameter most closely in monitoring this therapy? 1. Pulse and weight 2. Temperature and weight 3. Pulse and blood pressure 4. Temperature and blood pressure

2. Temperature to monitor infection and weight to monitor hypervolemia

A client receiving PN in the home setting has a weight gain of 5lbs in one week. The nurse should next assess the client for the presence of which condition? 1. Thirst 2. Polyuria 3. Decreased BP 4. Crackles on auscultation on lungs

4. Optimal weight gain is 1 to 2lbs per week. This client is likely to have fluid retention which can result in hypervolemia.

Which nursing action is essential prior to initiating new prescription for 500mL of fat emulsions to infuse at 50mL/hour? 1. Ensure that the client does not have diabetes 2. Determine if the client has an allergy to eggs 3. Add regular insulin to the fat emulsion, using aseptic technique 4. Contact health care provider to have a CL inserted for fat emulsion infusion

2. Egg yolk is a component of the solution and provides emulsification.

The nurse is changing the CL dressing of a client receiving PN and notes that the catheter insertion site appears reddened. The nurse should next assess which item? 1. Client's temperature 2. Expiration date on the bag 3. Time of last dressing change 4. Tightness of tubing connections

1. Redness at the catheter insertion site is a possible indication of infection. The nurse would next assess for other signs of infection.

A client with PN infusing has disconnected the tubing from the CL catheter. The nurse assess the client and suspects an air embolism. The nurse should immediately place the client in which position? 1. On the left side, with the head lower the the feet 2. On the left side, with the head higher than the feet 3. On the right side with the head lower than the feet 4. On the right side with the head higher than the feet.

1. This is a critical situation. If suspected the client should be placed in a left side-lying position. The head should be lower than the feet. This is to minimize the effect of the air traveling as a bolus to the lungs by trapping it in the right side of the heart.

A client receiving PN suddenly develops a fever. The nurse notifies the HCP, and the HCP initially prescribes that the solution and tubing be changed. What should the nurse do with the discontinued materials? 1. Discard them in the unit trash 2. Return them to the hospital pharmacy 3. Send them to the laboratory for culture 4. Save them for return to the manufacturer

3. An infection should be suspected and the discontinued materials should be cultured for infectious organisms.

The nurse is preparing to hang the first bag of PN solution via the CL of an assigned client. The nurse should obtain which most essential piece of equipment before hanging the solution? 1.Urine test strips 2. Blood glucose meter 3. Electronic infusion pump 4. Non-invasive BP monitor

3. Because of the high glucose content, use of an infusion pump is necessary to enusre that the solution does not infuse too rapidly or fall behind.

A client receiving PN complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally. The nurse determines that the client is experiencing which complication of PN therapy? 1. Sepsis 2. Air embolism 3. Hypervolemia 4. Hyperglycemia

3. Hypervolemia

The nurse is monitoring the status of a client's fat emulsion infusion and notes that the infusion is 1 hour behind. Which action should the nurse take? 1. Adjust the infusion rate to catch up over the next hour 2. Increase the infusion rate to catch up over the next 2 hours 3. Ensure that the fat emulsion rate is infusing at the prescribed rate 4. Adjust the infusion rate to run wide open until the solution is back on time

3. The nurse should not increase the rate of infusion to make up the difference if the timing falls behind. Doing so could place the client at risk for fat overload or fluid overload.

The nurse is caring for a restless client who is beginning nutritional therapy with PN. The nurse should plan to ensure that which action is taken to prevent the client from sustaining injury? 1. Calculate daily intake and output 2. Monitor the temp once daily 3. Secure all connections in the PN system 4. Monitor blood glucose levels every 12 hours.

3. The nurse should plan to secure all connections in the tubing. This helps prevent the restless client from pulling the connections apart accidentally.