Nokea
A nurse is preparing to administer a patients intravenous fat emulsion simultaneously with parenteral nutrition (PN). Which of the following principles should guide the nurses action?
- A. Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered.
- B. The nurse should prepare for placement of another intravenous line, as intravenous fat emulsions may not be infused simultaneously through the line used for PN.
- C. Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site after running the emulsion through a filter.
- D. The intravenous fat emulsions can be piggy-backed into any existing IV solution that is infusing.
Correct Answer: A
Rationale: Intravenous fat emulsions may be infused simultaneously with PN through a Y-connector close to the infusion site and should not be filtered. The patient does not need another intravenous line for the fat emulsion. The IVFE cannot be piggy-backed into any existing IV solution that is infusing.
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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.
The nurse is preparing to insert a patients ordered NG tube. What factor should the nurse recognize as a risk for incorrect placement?
- A. The patient is obese and has a short neck.
- B. The patient is agitated.
- C. The patient has a history of gastroesophageal reflux disease (GERD).
- D. The patient is being treated for pneumonia.
Correct Answer: B
Rationale: Inappropriate placement may occur in patients with decreased levels of consciousness, confused mental states, poor or absent cough and gag reflexes, or agitation during insertion. A short neck, GERD, and pneumonia are not linked to incorrect placement.
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 nurse is providing care for a patient with a diagnosis of late-stage Alzheimers disease. The patient has just returned to the medical unit to begin supplemental feedings through an NG tube. Which of the nurses assessments addresses this patients most significant potential complication of feeding?
- A. Frequent assessment of the patients abdominal girth
- B. Assessment for hemorrhage from the nasal insertion site
- C. Frequent lung auscultation
- D. Vigilant monitoring of the frequency and character of bowel movements
Correct Answer: C
Rationale: Aspiration is a risk associated with tube feeding; this risk may be exacerbated by the patients cognitive deficits. Consequently, the nurse should auscultate the patients lungs and monitor oxygen saturation closely. Bowel function is important, but the risk for aspiration is a priority. Hemorrhage is highly unlikely and the patients abdominal girth is not a main focus of assessment.
A nurse is creating a care plan for a patient with a nasogastric tube. How should the nurse direct other members of the care team to check correct placement of the tube?
- A. Auscultate the patients abdomen after injecting air through the tube.
- B. Assess the color and pH of aspirate.
- C. Locate the marking made after the initial x-ray confirming placement.
- D. Use a combination of at least two accepted methods for confirming placement.
Correct Answer: D
Rationale: There are a variety of methods to check tube placement. The safest way to confirm placement is to utilize a combination of assessment methods.