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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.
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A patient has been discharged home on parenteral nutrition (PN). Much of the nurses discharge education focused on coping. What must a patient on PN likely learn to cope with? Select all that apply.
- A. Changes in lifestyle
- B. Loss of eating as a social behavior
- C. Chronic bowel incontinence from GI changes
- D. Sleep disturbances related to frequent urination during nighttime infusions
- E. Stress of choosing the correct PN formulation
Correct Answer: A,B,D
Rationale: Patients must cope with the loss of eating as a social behavior and with changes in lifestyle brought on by sleep disturbances related to frequent urination during night time infusions. PN is not associated with bowel incontinence and the patient does not select or adjust the formulation of PN.
A critical care nurse is caring for a patient diagnosed with acute pancreatitis. The nurse knows that the indications for starting parenteral nutrition (PN) for this patient are what?
- A. 5% deficit in body weight compared to preillness weight and increased caloric need
- B. Calorie deficit and muscle wasting combined with low electrolyte levels
- C. Inability to take in adequate oral food or fluids within 7 days
- D. Significant risk of aspiration coupled with decreased level of consciousness
Correct Answer: C
Rationale: The indications for PN include an inability to ingest adequate oral food or fluids within 7 days. Weight loss, muscle wasting combined with electrolyte imbalances, and aspiration indicate a need for nutritional support, but this does not necessarily have to be parenteral.
A patient with dysphagia is scheduled for PEG tube insertion and asks the nurse how the tube will stay in place. What is the nurses best response?
- A. Adhesive holds a flange in place against the abdominal skin.
- B. A stitch holds the tube in place externally.
- C. The tube is stitched to the abdominal skin externally and the stomach wall internally.
- D. An internal retention disc secures the tube against the stomach wall.
Correct Answer: D
Rationale: A PEG tube is held in place by an internal retention disc (flange) that holds it against the stomach wall. It is not held in place by stitches or adhesives.
The management of the patients gastrostomy is an assessment priority for the home care nurse. What statement would indicate that the patient is managing the tube correctly?
- A. I clean my stoma twice a day with alcohol.
- B. The only time I flush my tube is when Im putting in medications.
- C. I flush my tube with water before and after each of my medications.
- D. I try to stay still most of the time to avoid dislodging my tube.
Correct Answer: C
Rationale: Frequent flushing is needed to prevent occlusion, and should not just be limited to times of medication administration. Alcohol will irritate skin surrounding the insertion site and activity should be maintained as much as possible.
A patient who suffered a stroke had an NG tube inserted to facilitate feeding shortly after admission. The patient has since become comatose and the patients family asks the nurse why the physician is recommending the removal of the patients NG tube and the insertion of a gastrostomy tube. What is the nurses best response?
- A. It eliminates the risk for infection.
- B. Feeds can be infused at a faster rate.
- C. Regurgitation and aspiration are less likely.
- D. It allows caregivers to provide personal hygiene more easily.
Correct Answer: C
Rationale: Gastrostomy is preferred over NG feedings in the patient who is comatose because the gastroesophageal sphincter remains intact, making regurgitation and aspiration less likely than with NG feedings. Both tubes carry a risk for infection; this change in care is not motivated by the possibility of faster infusion or easier personal care.