A nurse is planning care for a client who has a new prescription for parenteral nutrition (PN) in 20% dextrose and fat emulsions. Which of the following is an appropriate action to include in the plan of care?

Administer the PN and fat emulsion separately.

Change the PN infusion bag every 48 hr.

Obtain a random blood glucose daily.

Prepare the client for a central venous line

Answer and Explanation

The Correct Answer is D

. PN with 20% dextrose requires a central venous line for administration. Peripheral veins cannot handle the high osmolarity of such solutions, which can cause phlebitis and vein damage. A central venous line is necessary to deliver the solution safely into a larger vein with a higher blood flow.
A. Fat emulsions (lipids) are often administered separately from the PN solution, but they can also be infused concurrently through a Y-connector to minimize the risk of contamination. However, it is crucial to follow the specific guidelines of the healthcare facility and the manufacturer’s recommendations. The decision to administer separately or concurrently depends on the prescribed protocol.
B. PN solutions are typically changed every 24 hours to reduce the risk of infection. The high glucose content in PN solutions provides a rich medium for bacterial growth, making it essential to adhere to strict aseptic techniques and timely changes of the infusion bag.
C. Blood glucose monitoring is crucial for clients receiving PN due to the high dextrose content, which can significantly impact blood glucose levels. However, more frequent monitoring, such as every 4-6 hours initially, is often required rather than just a random daily check. This helps in promptly identifying and managing hyperglycemia or hypoglycemia.

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Correct Answer is D

Explanation

D. Auscultating bowel sounds is a non-invasive assessment that can provide important information about the functioning of the gastrointestinal system. It is typically done before palpation because palpation can alter bowel sounds and affect the accuracy of the assessment.
A. While pain relief is important, administering pain medication before a thorough assessment can mask symptoms and make diagnosis more difficult. Pain medication should be provided after an initial assessment and once a clearer understanding of the underlying issue is obtained.
B. Palpating the abdomen is a crucial part of the physical examination, especially when assessing abdominal pain. However, it should not be the first step. Before palpation, the nurse needs to gather more information through less invasive assessments to avoid causing additional discomfort or complications.
C. Administering an antiemetic can help alleviate nausea and vomiting, but similar to pain medication, it should not be done before a thorough assessment. The underlying cause of the symptoms needs to be identified first to ensure that the treatment provided is appropriate and does not obscure important diagnostic signs.

A. "I will move your joints quickly." B. These movements will be performed once per day." C. "I will move your joints to the point of mild pain. D. "I will repeat these movements 3 to 5 times."

Correct Answer is D

Explanation

D. Passive range-of-motion (ROM) exercises involve moving the client's joints through their full range of motion without the client's assistance. This helps prevent contractures, maintain joint mobility, and improve circulation. Repeating the movements 3 to 5 times is a standard practice for passive ROM exercises. This repetition helps promote joint flexibility and prevents stiffness. However, the exact number of repetitions may vary depending on the client's individual needs and tolerance.

A.Moving the joints quickly is not recommended for passive ROM exercises, as it can cause discomfort or injury to the client. These exercises should be performed slowly and gently to prevent strain or damage to the joints or surrounding tissues.
B. Performing passive ROM exercises once per day may not be sufficient for maintaining joint mobility, especially for clients with decreased mobility. These exercises are often performed multiple times throughout the day to maximize their benefits and prevent joint contractures.
C. Moving the joints to the point of mild pain is also not recommended for passive ROM exercises. The movements should be performed within the client's pain tolerance and should not cause discomfort or exacerbate pain. Pushing the joints beyond the point of mild pain can lead to injury or discomfort for the client.

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A nurse is planning care for a client who has a new prescription for parenteral nutrition (PN) in 20% dextrose and fat emulsions. Which of the following is an appropriate action to include in the plan of care?

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