A nurse is caring for a client who has been receiving long-term total parenteral nutrition (TPN). Which of the following actions should the nurse take first to taper the client from the TPN?

Encourage the client to take sips of diluted fruit juice.

Give the client a pureed diet.

Check the client's swallowing reflex.

Provide the client with a full liquid diet.

Answer and Explanation

The Correct Answer is C

A. Encourage the client to take sips of diluted fruit juice: Offering small amounts of juice may help introduce oral intake gradually, but it is not the first step. Ensuring the client can safely swallow is essential before providing any oral fluids to prevent aspiration and other complications.

B. Give the client a pureed diet: Transitioning to a pureed diet is part of advancing nutrition after confirming that the client can swallow safely. Starting this too early without assessing swallowing ability can increase the risk of choking or aspiration.

C. Check the client's swallowing reflex: Assessing the swallowing reflex is the priority when tapering a client from TPN. Safe oral intake depends on intact swallowing function, and identifying any deficits early prevents aspiration, aspiration pneumonia, or other serious complications during the transition to oral nutrition.

D. Provide the client with a full liquid diet: A full liquid diet is a step in progressing from TPN to oral intake, but it should only be introduced after confirming the client can swallow safely. Skipping the assessment of the swallowing reflex could place the client at risk for airway compromise.

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Correct Answer is B

Explanation

A. Morphine 2 mg IV bolus every 4 hr PRN pain: The prescription clearly indicates the dose, route, frequency, and PRN instructions, making it complete and appropriate for administration.

B. Acetaminophen 1,000 PO three times daily: The prescription is missing the unit of measure (mg, g, etc.), which is essential to ensure safe dosing. Without the unit, there is a risk of overdose or underdose, so the nurse must verify this prescription with the provider before administration.

C. Ibuprofen 800 mg PO every 8 hr: This prescription includes the dose, route, and frequency, making it complete. While monitoring for side effects is important, there is no issue requiring verification.

D. Ceftriaxone 250 mg IM x1 dose now: The prescription specifies the dose, route, and single administration, making it clear and safe to administer without additional verification.

A. Remove the skin markings following radiation. B. Apply lotions liberally to the skin. C. Wear protective clothing when outside. D. Cleanse skin with an antibacterial cleanser.

Correct Answer is C

Explanation

A. Remove the skin markings following radiation: Skin markings should not be removed during radiation therapy, as they are necessary for accurate targeting of radiation. Removing them can interfere with treatment accuracy and is not recommended.

B. Apply lotions liberally to the skin: While moisturizing can help with dryness, during radiation therapy, the nurse should recommend only mild, non-irritating, fragrance-free lotions approved by the radiation team. Applying products liberally or unapproved lotions can interfere with radiation dosing.

C. Wear protective clothing when outside: Radiation can make the skin more sensitive to sunlight. Wearing protective clothing and using sun protection helps prevent additional irritation, burns, or damage to already vulnerable skin. This is an appropriate measure to manage skin integrity.

D. Cleanse skin with an antibacterial cleanser: Antibacterial or harsh cleansers can irritate the sensitive skin of a child undergoing radiation therapy. Gentle, mild, fragrance-free soap and lukewarm water are preferred to maintain skin integrity without causing further damage.

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A nurse is caring for a client who has been receiving long-term total parenteral nutrition (TPN). Which of the following actions should the nurse take first to taper the client from the TPN?

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