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 B

Explanation

Choice A: Sensitivity to cold. This is incorrect because sensitivity to cold is a manifestation of hypothyroidism, not hyperthyroidism. Clients with hyperthyroidism have increased metabolism and heat production, which makes them more sensitive to heat.

Choice B: Frequent mood changes. This is correct because frequent mood changes are a manifestation of hyperthyroidism. Clients with hyperthyroidism have increased levels of thyroid hormones, which can aﬀect their nervous system and cause irritability, anxiety, nervousness, or emotional instability.

Choice C: Weight gain. This is incorrect because weight gain is a manifestation of hypothyroidism, not hyperthyroidism. Clients with hyperthyroidism have increased metabolism and appetite, which makes them lose weight or have difficulty gaining weight.

Choice D: Constipation. This is incorrect because constipation is a manifestation of hypothyroidism, not hyperthyroidism. Clients with hyperthyroidism have increased bowel motility and peristalsis, which makes them more prone to diarrhea or frequent stools.

A. Thyroxine (T4) level B. Triiodothyronine (T3) level C. Thyroid stimulating hormone (TSH) level D. Glucose level

Correct Answer is C

Explanation

Choice A: Thyroxine (T4) level. This is incorrect because T4 is one of the thyroid hormones that is increased in hyperthyroidism. T4 is produced by the thyroid gland and converted to T3 in the tissues. A high level of T4 indicates overactivity of the thyroid gland.1

Choice B: Triiodothyronine (T3) level. This is incorrect because T3 is another thyroid hormone that is increased in hyperthyroidism. T3 is the more active form of thyroid hormone and regulates the metabolism of cells. A high level of T3 indicates overactivity of the thyroid gland.1

Choice C: Thyroid stimulating hormone (TSH) level. This is correct because TSH is a hormone that stimulates the thyroid gland to produce T4 and T3. TSH is produced by the pituitary gland and regulated by a feedback mechanism. When the levels of T4 and T3 are high, the pituitary gland reduces the secretion of TSH to inhibit further production of thyroid hormones. Therefore, a low level of TSH indicates hyperthyroidism.1

Choice D: Glucose level. This is incorrect because glucose level is not directly related to thyroid function. However, hyperthyroidism can aﬀect glucose metabolism and cause increased blood sugar levels due to increased breakdown of glycogen and glucose uptake by cells. Therefore, glucose level may be elevated in some cases of hyperthyroidism, but it is not a specific indicator.

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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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