Nokea
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.
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A patients health decline necessitates the use of total parenteral nutrition. The patient has questioned the need for insertion of a central venous catheter, expressing a preference for a normal IV. The nurse should know that peripheral administration of high-concentration PN formulas is contraindicated because of the risk for what complication?
- A. Chemical phlebitis
- B. Hyperglycemia
- C. Dumping syndrome
- D. Line sepsis
Correct Answer: A
Rationale: Formulations with dextrose concentrations of more than 10% should not be administered through peripheral veins because they irritate the intima (innermost walls) of small veins, causing chemical phlebitis. Hyperglycemia and line sepsis are risks with both peripheral and central administration of PN. PN is not associated with dumping syndrome.
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 administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. Which of the nurses assessments most directly addresses a major complication of TPN?
- A. Checking the patients capillary blood glucose levels regularly
- B. Having the patient frequently rate his or her hunger on a 10-point scale
- C. Measuring the patients heart rhythm at least every 6 hours
- D. Monitoring the patients level of consciousness each shift
Correct Answer: A
Rationale: The solution, used as a base for most TPN, consists of a high dextrose concentration and may raise blood glucose levels significantly, resulting in hyperglycemia. This is a more salient threat than hunger, though this should be addressed. Dysrhythmias and decreased LOC are not among the most common complications.
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.
A nurse is initiating parenteral nutrition (PN) to a postoperative patient who has developed complications. The nurse should initiate therapy by performing which of the following actions?
- A. Starting with a rapid infusion rate to meet the patients nutritional needs as quickly as possible
- B. Initiating the infusion slowly and monitoring the patients fluid and glucose tolerance
- C. Changing the rate of administration every 2 hours based on serum electrolyte values
- D. Increasing the rate of infusion at mealtimes to mimic the circadian rhythm of the body
Correct Answer: B
Rationale: PN solutions are initiated slowly and advanced gradually each day to the desired rate as the patients fluid and glucose tolerance permits. The formulation of the PN solutions is calculated carefully each day to meet the complete nutritional needs of the individual patient based on clinical findings and laboratory data. It is not infused more quickly at mealtimes.