Nokea
The peripheral parenteral nutrition bag that has been infusing into the patient is empty, and the nurse realizes that the next bag is not ready. The nurse should immediately hang which of these intravenous solutions until the new bag arrives?
- A. 10% dextrose in water
- B. 20% dextrose in water
- C. 0.9% sodium chloride
- D. Lactated Ringer's solution
Correct Answer: A
Rationale: If intravenous parenteral nutrition is discontinued abruptly, rebound hypoglycemia may occur. This can be prevented with infusion of 5% to 10% glucose until the parenteral nutrition infusion is ready. For peripheral infusions, the dextrose must not be more than 10%.
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During the night shift, a patient's total parenteral nutrition (TPN) infusion ran out, and the nurse discovered that there was no TPN solution on hand to continue the infusion. The pharmacy is closed and will not reopen for 5 hours. The nurse will have to implement measures to prevent which consequence of abruptly discontinuing TPN infusions?
- A. Dehydration
- B. Hyperglycemia
- C. Dumping syndrome
- D. Rebound hypoglycemia
Correct Answer: D
Rationale: Rebound hypoglycemia may occur if TPN is discontinued abruptly. It may be prevented by infusion of 5% to 10% glucose in situations in which TPN must be stopped abruptly. The other options are incorrect.
A patient has been receiving total parenteral nutrition. Upon assessment, the nurse notes these assessment findings: blood pressure 160/98 mm Hg (elevated from previous readings); pulse rate 110 beats/min and weak; pitting edema on both ankles; and new-onset confusion. The nurse suspects that the patient is experiencing which condition?
- A. Infection
- B. Hypoglycemia
- C. Hyperglycemia
- D. Fluid overload
Correct Answer: D
Rationale: Fluid overload may occur with parenteral nutrition. It is manifested by weak pulse, hypertension, tachycardia, confusion, decreased urine output, and pitting edema.
A patient with type 2 diabetes will be receiving a nasogastric tube feeding for a few days. The nurse expects which type of formula to be used?
- A. Jevity
- B. Ensure Plus
- C. Glucerna
- D. Polycose
Correct Answer: C
Rationale: Glucerna is a formulation designed for use in patients with impaired glucose tolerance (e.g., diabetic patients). The other options are not designed for patients with diabetes.
An older adult patient needs to receive an enteral supplement to improve her overall nutritional status. When considering enteral supplements, the nurse notes that which formulation provides complex nutrients?
- A. Ensure Plus
- B. Moducal
- C. ProMod
- D. Microlipid
Correct Answer: A
Rationale: Ensure Plus is a polymeric formulation that contains complex nutrients, including proteins, carbohydrates, and fats. Moducal provides carbohydrates only; ProMod is a protein formulation, and Microlipid supplies only fats.
The nurse is preparing to administer medications to a patient who is receiving a feeding via a gastric tube. When reviewing the patient's medication list, the nurse notes a potential concern about a food-drug interaction if which medication is listed?
- A. Multivitamin solution
- B. Phenytoin (Dilantin)
- C. Metoclopramide (Reglan)
- D. Warfarin (Coumadin)
Correct Answer: B
Rationale: Tube feedings can reduce the absorption of phenytoin, which may result in seizures. It is recommended that tube feedings be held for at least 2 hours before and after the administration of phenytoin.