Nokea
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.
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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 nurse is caring for a patient who is receiving parenteral nutrition. When writing this patients plan of care, which of the following nursing diagnoses should be included?
- A. Risk for Peripheral Neurovascular Dysfunction Related to Catheter Placement
- B. Ineffective Role Performance Related to Parenteral Nutrition
- C. Bowel Incontinence Related to Parenteral Nutrition
- D. Chronic Pain Related to Catheter Placement
Correct Answer: B
Rationale: The limitations associated with PN can make it difficult for patients to maintain their usual roles. PN does not normally cause bowel incontinence and catheters are not associated with chronic pain or neurovascular dysfunction.
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.
A nurse is admitting a patient to the postsurgical unit following a gastrostomy. When planning assessments, the nurse should be aware of what potential postoperative complication of a gastrostomy?
- A. Premature removal of the G tube
- B. Bowel perforation
- C. Constipation
- D. Development of peptic ulcer disease (PUD)
Correct Answer: A
Rationale: A significant postoperative complication of a gastrostomy is premature removal of the G tube. Constipation is a less immediate threat and bowel perforation and PUD are not noted to be likely complications.
A patients enteral feedings have been determined to be too concentrated based on the patients development of dumping syndrome. What physiologic phenomenon caused this patients complication of enteral feeding?
- A. Increased gastric secretion of HCl and gastrin because of high osmolality of feeds
- B. Entry of large amounts of water into the small intestine because of osmotic pressure
- C. Mucosal irritation of the stomach and small intestine by the high concentration of the feed
- D. Acid-base imbalance resulting from the high volume of solutes in the feed
Correct Answer: B
Rationale: When a concentrated solution of high osmolality entering the intestines is taken in quickly or in large amounts, water moves rapidly into the intestinal lumen from fluid surrounding the organs and the vascular compartment. This results in dumping syndrome. Dumping syndrome is not the result of changes in HCl or gastrin levels. It is not caused by an acid-base imbalance or direct irritation of the GI mucosa.