Nokea
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.
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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 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 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.
A nurse is participating in a patients care conference and the team is deciding between parenteral nutrition (PN) and a total nutritional admixture (TNA). What advantages are associated with providing TNA rather than PN?
- A. TNA can be mixed by a certified registered nurse.
- B. TNA can be administered over 8 hours, while PN requires 24-hour administration.
- C. TNA is less costly than PN.
- D. TNA does not require the use of a micron filter.
Correct Answer: C
Rationale: TNA is mixed in one container and administered to the patient over a 24-hour period. A 1.5-micron filter is used with the TNA solution. Advantages of the TNA over PN include cost savings. Pharmacy staff must prepare both solutions.
A patient is postoperative day I following gastrostomy. The nurse is planning interventions to address the nursing diagnosis of Risk for Infection Related to Presence of Wound and Tube. What intervention is most appropriate?
- A. Administer antibiotics via the tube as ordered.
- B. Wash the area around the tube with soap and water daily.
- C. Cleanse the skin within 2 cm of the insertion site with hydrogen peroxide once per shift.
- D. Irrigate the skin surrounding the insertion site with normal saline before each use.
Correct Answer: B
Rationale: Infection can be prevented by keeping the skin near the insertion site clean using soap and water. Hydrogen peroxide is not used, due to associated skin irritation. The skin around the site is not irrigated with normal saline and antibiotics are not administered to prevent site infection.