A nurse is planning care for a client who is to start receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?

Change the TPN tubing every 48 hr

Allow 18 hr for the lipids to infuse when not mixed with the TPN solution.

Use a 1.2 micron filter when infusing TPN with fat emulsions added.

Change the TPN solution after 36 hr.

Answer and Explanation

The Correct Answer is C

Rationale:

A. The tubing for TPN must be changed every 24 hr (not 48 hr) to reduce the risk of central line–associated bloodstream infection (CLABSI).

B. Lipid emulsions should not hang for more than 12 hr to prevent bacterial growth and infection.

C. A 1.2-micron filter is required for TPN that contains lipids to remove particulate matter, bacteria, and fungi, since lipid solutions cannot pass through smaller filters.

D. TPN solutions should be changed every 24 hr (not 36 hr) to reduce infection risk.

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Correct Answer is A

Explanation

Rationale:
A. Petechiae are small, red or purple spots caused by capillary bleeding and are common in advanced cirrhosis due to thrombocytopenia and coagulation defects.
B. Peripheral ulcers are not typically associated with cirrhosis.
C. Osteoarthritis is a degenerative joint condition unrelated to liver disease.
D. Hypertension is not a hallmark of advanced cirrhosis; portal hypertension may occur, but systemic hypertension is not expected.

A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis

Correct Answer is B

Explanation

Rationale:

A. This occurs when there is hypoventilation, leading to elevated PaCO2 and decreased pH. In this case, the PaCO2 is low (32 mm Hg) and the pH is high (7.48), so this is not consistent with respiratory acidosis.

B. The high pH (7.48) indicates alkalosis, and the low PaCO2 (32 mm Hg) shows that the alkalosis is caused by excessive exhalation of CO2, characteristic of respiratory alkalosis. The HCO3 is normal, indicating the kidneys have not yet compensated.

C. Metabolic acidosis is characterized by a low pH and low HCO3. Here, the pH is elevated and HCO3 is normal, so this is not consistent with metabolic acidosis.

D. Metabolic alkalosis would present with high pH and elevated HCO3, often due to vomiting or diuretic use. In this scenario, HCO3 is normal, indicating the alkalosis is not metabolic in origin.

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A nurse is planning care for a client who is to start receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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