Parenteral Nutrition

89) A client with parenteral nutrition (PN) infusing has disconnected the tubing from the central line catheter. The nurse assesses 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 than 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) On the left side with the head lower than the feet - Air embolism occurs when air enters the catheter system such as when the system is opened for IV tubing changes. This position is used to minimize the effect of air traveling as a bolus to the lungs by trapping it in the right side of the heart.

96) The nurse, caring for a group of adult clients on an acute care medical surgical nursing unit determines that which clients would be the most likely candidates for parenteral nutrition PN? Select all that apply 1) A client with extensive burns 2) A client with cancer who is septic 3) A client who has had an open cholecystectomy 4) A client with severe exacerbation of crohns disease 5) A client with persistent nausea and vomiting.

1,2,4,5

98) The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (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 in water 2. 10% dextrose in water 3. 5% dextrose in Ringer's lactate 4. 5% dextrose in 0.9% sodium chloride

2) 10% dextrose in water - The client is at risk for hypoglycemia therefore the solution with the highest amount of glucose should be hung until the new PN becomes availible

97) The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line 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. Noninvasive blood pressure monitor

3) Electronic infusion pump - Because of the high glucose content use of an infusion pump is necessary to ensure that the solution does not infuse to rapidly.

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

3) Secure all connections in the PN system - This helps to prevent the restless client from pulling the connections apart accidentally

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

4) Take a deep breath, hold it and bear down - The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tubing changes.

94) A client receiving parenteral nutrition (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. Save them for return to the manufacturer 4. Send them to the laboratory for culture

4) send them to the lab for cultures - When the client who is receiving PN develops a fever a catheter related infection should be suspected. The solution and tubing should be changed and the DC'd materials should be cultured for infectious organisms.

91) The nurse monitors the client recieving PN for complications of the therapy and should assess the client for which manifestation of hyperglycemia? 1) Fever, weak pulse, and thirst 2) nausea, vommiting, and oliguria 3) sweating, chills, and abdominal pain 4) weakness, thirst, and increased urine output

4) weakness, thirst, and increased urine output - The high glucose concentrations in PN places the client at risk for hyperglycemia.

92) The nurse is changing the central line dressing of a client receiving parenteral nutrition (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 connection

1) Clients temperature - Redness at the catheter insertion site is a possible indication of infection. The nurse should assess for other signs of infection.

99) The nurse is monitoring the status of a client's fat emulsion (lipid) 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 in infusion rate to catch up over the next 2 hours 3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate 4. Adjust the infusion rate to run wide open until the solution is back on time

3) Ensure that the fat emulsion infusion rate is infusing at the prescribed rate - The nurse should not increase the rate of a fat emulsion to make up the difference

102) A client receiving parenteral nutrition (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 - Occurs from excess fluid administration or administration of fluids to rapidly

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

4) Crackles on auscultation of the lungs - optimal wt gain when the client is recieving PN is 1-2 lbs a week. This client shows signs of fluid retention

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

2) Decrease PN rate to 50 ml/hr - When a client begins eating a regular diet after a period of receiving PN the PN is decreased gradually. PN that is DC'd abruptly can cause hypoglycemia.

90) Which nursing action is essential prior to initiating a new prescription for 500 mL of fat emulsion (lipids) to infuse at 50 mL/hr? 1. Ensure that the client does not have diabetes 2. Determine whether the client has an allergy to eggs 3. Add regular insulin to the fat emulsion, using aseptic technique 4. Contact the HCP to have a central line inserted for fat emulsion infusion

2) Determine whether the client has an allergy to eggs - The client beginning infusions of fat emulsions must be first assessed for known allergies to eggs to prevent prophylaxis. egg yolk is a component to the solution and provides emulsification.

93) The nurse is preparing to hang fat emuslion (lipids) and notes that 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 warm water

2) Obtains a different bottle of solution - Fat emulsions (lipids ) is a white opaque solution administered IV during PN therapy to prevent fatty acid deficiency.

95) A client has been discharged to home on parenteral nutrition (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) Temp and weight - The client receiving PN at home should have her temp monitored as a means of detecting infection, The clients wt is monitored as a measure of the effectiveness of this nutritional therapy and to detect hypervolemia.