A nurse is assisting with teaching a newly licensed nurse about parenteral nutrition (PN). Which of the following information should the nurse include in the teaching?

Weigh the client weekly.

Reduce the rate of the solution gradually to discontinue.

Remove solution from refrigerator 2 hr before infusion.

Shake the solution before hanging if there is a layer of fat present on the top.

Answer and Explanation

The Correct Answer is B

Choice A: Weigh the client weekly. This is incorrect because the client receiving PN should be weighed daily, not weekly, to monitor ﬂuid balance and nutritional status. The nurse should also measure the client’s intake and output, blood glucose, electrolytes, and other laboratory values daily.

Choice B: Reduce the rate of the solution gradually to discontinue. This is correct because the nurse should taper oﬀ the PN solution slowly to prevent rebound hypoglycemia, which can occur when the high concentration of glucose in the PN solution is abruptly stopped. The nurse should follow the provider’s orders or the facility’s protocol for reducing and discontinuing PN.

Choice C: Remove solution from refrigerator 2 hr before infusion. This is incorrect because the nurse should remove the PN solution from the refrigerator 30 to 60 minutes before infusion, not 2 hr, to allow it to reach room temperature. Infusing a cold solution can cause discomfort, vasoconstriction, and impaired absorption of nutrients.

Choice D: Shake the solution before hanging if there is a layer of fat present on the top. This is incorrect because the nurse should not shake the PN solution at all, as this can cause fat emulsion droplets to coalesce and form large particles that can clog the filter or cause embolism. The nurse should gently invert or roll the PN solution container to mix it if there is any separation of components.

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Correct Answer is A

Explanation

Choice A: Maintain the client in Fowler’s position. This is correct because Fowler’s position, which is a semi-sitting position with the head of the bed elevated 45 to 60 degrees, can facilitate the drainage of gastric contents and reduce the risk of aspiration.

Choice B: Use sterile water to irrigate the nasogastric tube. This is incorrect because sterile water is not necessary to irrigate the nasogastric tube, unless the client is immunocompromised or has a high risk of infection. Tap water or normal saline can be used to irrigate the nasogastric tube, following the provider’s orders or the facility’s protocol.

Choice C: Moisten the client’s lips with lemon-glycerin swabs. This is incorrect because lemon-glycerin swabs can dry out and irritate the client’s lips and oral mucosa, especially if used frequently. The nurse should use water-soluble lubricant or lip balm to moisturize the client’s lips and mouth.

Choice D: Measure abdominal girth daily. This is incorrect because measuring abdominal girth daily is not enough to monitor the progression of the intestinal obstruction and the eﬀectiveness of the gastrointestinal decompression. The nurse should measure abdominal girth more frequently, such as every 4 hr or every shift, and report any changes or abnormalities.

A. Weight loss B. Diaphoresis C. Hyperpigmentation D. Hypotension

Correct Answer is C

Explanation

Choice A reason: Weight loss is not a symptom of Cushing’s syndrome. On the contrary, weight gain and obesity are common signs of this condition, especially in the trunk, face and upper back1.

Choice B reason: Diaphoresis, or excessive sweating, is not a symptom of Cushing’s syndrome. It can be caused by other conditions, such as hyperthyroidism, menopause or anxiety.

Choice C reason: Hyperpigmentation, or darkening of the skin, is a symptom of Cushing’s syndrome. It occurs due to increased production of melanin, the pigment that gives color to the skin. Hyperpigmentation can aﬀect any part of the body, but it is more noticeable in areas exposed to friction or pressure, such as the elbows, knees, knuckles and armpits.

Choice D reason: Hypotension, or low blood pressure, is not a symptom of Cushing’s syndrome. In fact, high blood pressure (hypertension) is one of the common symptoms of this condition, due to the eﬀects of cortisol on the cardiovascular system.

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A nurse is assisting with teaching a newly licensed nurse about parenteral nutrition (PN). Which of the following information should the nurse include in the teaching?

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