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?

Obtain a random blood glucose daily.

Change the PN infusion bag every 48 hr.

Prepare the client for a central venous line.

Administer the PN and fat emulsion separately.

Answer and Explanation

The Correct Answer is C

A.   Obtaining a random blood glucose daily is important for monitoring glucose levels but might not be specifically related to the introduction of PN in this context.
B.   Changing the PN infusion bag every 48 hours might not be universally applicable; the frequency of changing PN bags depends on institutional policies and the stability of the solution being administered.
C.   PN with high concentrations of dextrose and fat emulsions typically requires a central venous line for administration to prevent peripheral vein irritation or damage.
D.   Administering PN and fat emulsion separately might not be practical as PN usually includes all necessary components in a single infusion.

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Correct Answer is C

Explanation

A. Dismissing concerns by suggesting that they won't need to worry with physical therapy is not therapeutic. It invalidates the client's feelings.
B. Discouraging the client from worrying may seem dismissive of their emotions and concerns.
C. Acknowledging and reflecting the client's concern about the future demonstrates empathy and encourages further discussion.
D. Asking why the client is concerned might make them feel defensive and does not validate their emotions.

A. Side-lying with the right side of the chest elevated B. Right lateral in Trendelenburg position C. Prone with pillows under the lower extremities D. Supine in low-Fowler's position

Correct Answer is B

Explanation

Rationale for A: Side-lying with the right side of the chest elevated does not provide the necessary gravitational effect to drain the left lower lobe. The Trendelenburg position is more effective for lower lobe drainage.

Rationale for B: Right lateral in Trendelenburg position is the appropriate position for postural drainage of the left lower lobe. The combination of gravity and positioning helps drain secretions from the lower lobe effectively.

Rationale for C: Prone with pillows under the lower extremities does not facilitate proper drainage of the left lower lobe. This position might be more useful for posterior lobe drainage, not the lower lobes.

Rationale for D: Supine in low-Fowler's position is not ideal for draining secretions from the lower lobes of the lungs. Postural drainage requires specific positions that use gravity to promote secretion clearance from the affected lobe.

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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?

Nursing Test Bank

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