Nokea
A nurse is aware of the high incidence of catheter-related bloodstream infections in patients receiving parenteral nutrition. What nursing action has the greatest potential to reduce catheter-related bloodstream infections?
- A. Use clean technique and wear a mask during dressing changes.
- B. Change the dressing no more than weekly.
- C. Apply antibiotic ointment around the site with each dressing change.
- D. Irrigate the insertion site with sterile water during each dressing change.
Correct Answer: B
Rationale: The CDC (2011) recommends changing CVAD dressings not more than every 7 days unless the dressing is damp, bloody, loose, or soiled. Sterile technique (not clean technique) is used. Irrigation and antibiotic ointments are not used.
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A nurse is preparing to administer a patients scheduled parenteral nutrition (PN). Upon inspecting the bag, the nurse notices that the presence of small amounts of white precipitate are present in the bag. What is the nurses best action?
- A. Recognize this as an expected outcome.
- B. Place the bag in a warm environment for 30 minutes.
- C. Shake the bag vigorously for 10 to 20 seconds.
- D. Contact the pharmacy to obtain a new bag of PN.
Correct Answer: D
Rationale: Before PN infusion is administered, the solution must be inspected for separation, oily appearance (also known as a cracked solution), or any precipitate (which appears as white crystals). If any of these are present, it is not safe to use. Warming or shaking the bag is inappropriate and unsafe.
A nurse is participating in a patients care conference and the team is deciding between parenteral nutrition (PN) and a total nutritional admixture (TNA). What advantages are associated with providing TNA rather than PN?
- A. TNA can be mixed by a certified registered nurse.
- B. TNA can be administered over 8 hours, while PN requires 24-hour administration.
- C. TNA is less costly than PN.
- D. TNA does not require the use of a micron filter.
Correct Answer: C
Rationale: TNA is mixed in one container and administered to the patient over a 24-hour period. A 1.5-micron filter is used with the TNA solution. Advantages of the TNA over PN include cost savings. Pharmacy staff must prepare both solutions.
A nurse is caring for a patient who has an order to discontinue the administration of parenteral nutrition. What should the nurse do to prevent the occurrence of rebound hypoglycemia in the patient?
- A. Administer an isotonic dextrose solution for 1 to 2 hours after discontinuing the PN.
- B. Administer a hypertonic dextrose solution for 1 to 2 hours after discontinuing the PN.
- C. Administer 3 ampules of dextrose 50% immediately prior to discontinuing the PN.
- D. Administer 3 ampules of dextrose 50% 1 hour after discontinuing the PN.
Correct Answer: A
Rationale: After administration of the PN solution is gradually discontinued, an isotonic dextrose solution is administered for 1 to 2 hours to protect against rebound hypoglycemia. The other listed actions would likely cause hyperglycemia.
A nursing educator is reviewing the care of patients with feeding tubes and endotracheal tubes (ET). The educator has emphasized the need to check for tube placement in the stomach as well as residual volume. What is the main purpose of this nursing action?
- A. Prevent gastric ulcers
- B. Prevent aspiration
- C. Prevent abdominal distention
- D. Prevent diarrhea
Correct Answer: B
Rationale: Protecting the client from aspirating is essential because aspiration can cause pneumonia, a potentially life-threatening disorder. Gastric ulcers are not a common complication of tube feeding in clients with ET tubes. Abdominal distention and diarrhea can both be associated with tube feeding, but prevention of these problems is not the primary rationale for confirming placement.
Prior to a patients scheduled jejunostomy, the nurse is performing the preoperative assessment. What goal should the nurse prioritize during the preoperative assessment?
- A. Determining the patients nutritional needs
- B. Determining that the patient fully understands the postoperative care required
- C. Determining the patients ability to understand and cooperate with the procedure
- D. Determining the patients ability to cope with an altered body image
Correct Answer: C
Rationale: The major focus of the preoperative assessment is to determine the patients ability both to understand and cooperate with the procedure. Body image, nutritional needs, and postoperative care are all important variables, but they are not the main focuses of assessment during the immediate preoperative period.