Nokea
A patients physician has determined that for the next 3 to 4 weeks the patient will require parenteral nutrition (PN). The nurse should anticipate the placement of what type of venous access device?
- A. Peripheral catheter
- B. Nontunneled central catheter
- C. Implantable port
- D. Tunneled central catheter
Correct Answer: B
Rationale: Nontunneled central catheters are used for short-term (less than 6 weeks) IV therapy. A peripheral catheter can be used for the administration of peripheral parenteral nutrition for 5 to 7 days. Implantable ports and tunneled central catheters are for long-term use and may remain in place for many years. Peripherally inserted central catheters (PICCs) are another potential option.
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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.
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.
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.
You are caring for a patient who was admitted to have a low-profile gastrostomy device (LPGD) placed. How soon after the original gastrostomy tube placement can an LPGD be placed?
- A. 2 weeks
- B. 4 to 6 weeks
- C. 2 to 3 months
- D. 4 to 6 months
Correct Answer: C
Rationale: An alternative to the PEG device is a low-profile gastrostomy device (LPGD). LPGDs may be inserted 2 to 3 months after initial gastrostomy tube 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.