Critical Care - Parenteral Nutrition

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Author:
nursedaisy98
ID:
256710
Filename:
Critical Care - Parenteral Nutrition
Updated:
2014-04-20 10:31:06
Tags:
NCLEXRN
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Critical Care
Description:
Parenteral Nutrition
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  1. Which nursing action is essential prior to initiating a new prescription for 500 mL of fat emulsion (lipids) to infuse at 50 mL/hour?
    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 health care provider (HCP) to have a central line inserted for fat emulsion infusion.
    2. Determine whether the client has an allergy to eggs.
  2. A client is receiving parenteral nutrition (PN). 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 urine output
    4. Weakness, thirst, and increased urine output
  3. 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. Temperature and weight
  4. The nurse is caring for a group of adult clients on an acute care medical-surgical nursing unit. The nurse understands that which client would be the least likely candidate for parenteral nutrition (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 exacerbation of Crohn's disease
    4. A 35-year-old client with persistent nausea and vomiting from chemotherapy
    2. A 42-year-old client who has had an open cholecystectomy
  5. 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
  6. 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
  7. 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 the 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.
  8. A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb 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
  9. 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
  10. The nurse is performing an assessment on a client who has been receiving parenteral nutrition at 125 mL/hour. On assessment, the nurse notes the presence of bilateral crackles in the lungs and 2+ pedal edema. The nurse also notes that the client has gained 3 pounds in 5 days. Which nursing action would be most appropriate for this client?
    1. Slow the infusion rate to 100 mL/hour.
    2. Encourage the client to cough and deep breathe.
    3. Notify the health care provider (HCP) of the assessment findings.
    4. Administer the prescribed daily diuretic and reassess the client in 2 hours.
    3. Notify the health care provider (HCP) of the assessment findings.
  11. The nurse is caring for a client who is receiving total parenteral nutrition (TPN) via a central line. Which nursing intervention would specifically provide assessment data related to the most common complication associated with TPN?
    1. Weighing the client daily
    2. Monitoring the temperature
    3. Monitoring intake and output (I&O)
    4. Monitoring the blood urea nitrogen (BUN) level
    2. Monitoring the temperature
  12. The nurse is developing a plan of care for a client who is receiving total parenteral nutrition (TPN). The nurse identifies assessments to be made to help identify complications related to the infusion of the TPN solution. The care plan should include monitoring of which assessment item(s)?
    1. Apical rate
    2. Pulse oximetry
    3. Blood glucose levels
    4. Hemoglobin and hematocrit
    3. Blood glucose levels
  13. Fat emulsion is prescribed for the client receiving parenteral nutrition. The nurse is preparing to administer the fat emulsion and notes the presence of fat globules in the solution. What should the nurse do?
    1. Call the health care provider (HCP).
    2. Return the solution to the pharmacy.
    3. Shake the solution to dissolve the globules.
    4. Place the solution in a bath of warm water until the globules dissolve.
    2. Return the solution to the pharmacy.
  14. A client receiving total parenteral nutrition experiences sudden development of chest pain, dyspnea, tachycardia, cyanosis, and a decreased level of consciousness. What should the nurse suspect as a complication of the total parenteral nutrition?
    1. Air embolism
    2. Hyperglycemia
    3. Catheter-related sepsis
    4. Allergic reaction to the catheter
    1. Air embolism
  15. A client receiving parenteral nutrition through a central intravenous (IV) line is scheduled to receive an antibiotic by the IV route. Which action by the nurse is appropriate before hanging the antibiotic solution?
    1. Ensure a separate IV access for the antibiotic.
    2. Turn off the solution for 30 minutes before administering the antibiotic.
    3. Flush the central IV line with 60 mL of normal saline before giving the antibiotic.
    4. Check with the pharmacy to be sure the antibiotic can be given through the parenteral nutrition solution line.
    1. Ensure a separate IV access for the antibiotic.
  16. The nurse notes that a client's parenteral nutrition solution is 4 hours behind. Which action should the nurse take?
    1. Assess the infusion pump to be sure it is functioning properly and is set at the correct rate.
    2. Increase the infusion rate to a rate that allows the infusion volume to correct itself within a 2-hour period.
    3. Replace the parenteral nutrition solution with 10% dextrose, and restart the solution the following day.
    4. Administer the parenteral nutrition solution using gravity flow because the infusion pump is malfunctioning.
    1. Assess the infusion pump to be sure it is functioning properly and is set at the correct rate.
  17. A client receiving total parenteral nutrition (TPN) is demonstrating signs and symptoms of an air embolism. What is the first action by the nurse?
    1. Stop the PN solution.
    2. Notify the health care provider (HCP).
    3. Place the client in high Fowler's position.
    4. Place the client on the left side in Trendelenburg's position.
    4. Place the client on the left side in Trendelenburg's position.
  18. A nurse is preparing to administer lipid emulsion to a client who has just been started on parenteral nutrition. Before administering the lipid emulsion, the nurse asks the client about allergies. The nurse should withhold the lipid emulsion and contact the health care provider if the client identifies an allergy to which food item?
    1. Milk
    2. White bread
    3. Soybean oil
    4. Strawberries
    3. Soybean oil
  19. The nurse notes redness, warmth, and a yellowish drainage at the insertion site of a central venous catheter in a client receiving parenteral nutrition. The nurse notifies the health care provider of these findings because they can be indicative of which problem?
    1. The client is allergic to the dressing material covering the site.
    2. Infections of a central venous catheter site can lead to septicemia.
    3. The parenteral nutrition solution has infiltrated and must be stopped.
    4. The client is experiencing an allergy to the parenteral nutrition solution.
    2. Infections of a central venous catheter site can lead to septicemia.
  20. A client with cancer is placed on permanent parenteral nutrition. The nurse considers psychosocial support when planning care for this client because of which piece of information?
    1. Death is imminent for this client.
    2. Parenteral nutrition requires disfiguring surgery for permanent port implantation.
    3. The client will need to adjust to the idea of living without eating by the usual route.
    4. Nausea and vomiting occur regularly with this type of treatment and will prevent the client from social activity.
    3. The client will need to adjust to the idea of living without eating by the usual route.
  21. The nurse is assigned to a client receiving total parenteral nutrition (TPN) who had a blood glucose measurement done at 06:00. The nurse documents on the client's clinical worksheet for the day that the blood glucose level should be checked next at which time?
    1. 08:00
    2. 12:00
    3. 16:00
    4. 18:00
    2. 12:00
  22. The home care nurse is monitoring a client's response to total parenteral nutrition (TPN). The client's weight 1 week earlier was 114 lb. The nurse determines that the client is gaining weight as expected if which morning weight is noted?
    1. 116 lb
    2. 119 lb
    3. 120 lb
    4. 122 lb
    1. 116 lb
  23. A nurse discovers that an infusion of peripheral parenteral nutrition (PPN) is empty, and a replacement bag is not yet ready. What should the nurse do next while waiting for the PPN bag?
    1. Hang an intravenous infusion of normal saline.
    2. Convert the intravenous infusion to a saline lock.
    3. Hang an intravenous infusion of 10% dextrose in water.
    4. Hang an intravenous infusion of 20% dextrose in water.
    3. Hang an intravenous infusion of 10% dextrose in water.
  24. A client who has been receiving total parenteral nutrition (TPN) by way of a central venous access device complains of chest pain and dyspnea. The nurse quickly assesses the client's vital signs and notes that the pulse rate has increased and the blood pressure has dropped. The nurse determines that the client is most likely experiencing which problem?
    1. Sepsis
    2. Air embolism
    3. Fluid overload
    4. Fluid imbalance
    2. Air embolism
  25. A client with pancreatitis is being weaned from total parenteral nutrition (TPN). The client asks the nurse why the TPN cannot just be stopped. The nurse formulates a response knowing that which complication could occur with sudden termination of TPN formula?
    1. Dehydration
    2. Hypokalemia
    3. Hypernatremia
    4. Rebound hypoglycemia
    4. Rebound hypoglycemia
  26. A nurse hears in intershift report that a client receiving total parenteral nutrition (TPN) at 100 mL/hr has bilateral crackles and 1+ pedal edema. When the nurse obtains a daily weight, the nurse notes that the client has gained 4 lb in 2 days. Which action should the nurse take first?
    1. Administer the prescribed daily diuretic.
    2. Encourage the client to cough and deep-breathe.
    3. Compare the intake and output records of the last 2 days.
    4. Slow the TPN infusion rate to 50 mL/hr per infusion pump.
    3. Compare the intake and output records of the last 2 days.
  27. The nurse is caring for a client receiving total parenteral nutrition (TPN) via a central line. What should the nurse monitor to detect the most common complication of TPN?
    1. Temperature
    2. Daily weight
    3. Intake and output
    4. Serum creatinine level
    1. Temperature

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