A nurse is providing discharge teaching to a client who will receive total parenteral nutrition (TPN) at home. Which of the following information should the nurse include?

Instruct the client that their central line dressing must be changed every 24 hr.

Instruct the client to weigh themselves daily and record their weight.

Instruct the client that one container of TPN may infuse for up to 72 hr.

Instruct the client to speed up the rate of their TPN infusion if it falls behind schedule.

Answer and Explanation

The Correct Answer is B

A) Instruct the ’lient that their central line dressing must be changed every 24 hr: While it's essential to maintain proper hygiene a’d care for a central line to prevent infection, changing the dressing every 24 hours may not be necessary. The frequency of dressing changes depends on institutional policies and the client's condition. Providing accurate informat’on about dressing changes based on specific guidelines is important for the client's safety and the prevention of central l’ne-related infections.

B) Instruct the client to weigh themselves daily and record their weight: This is the correct instruction. Monitoring daily weight allows for the assessment of fluid status and the effectiveness of TPN therapy. Weight gain or loss can indicate fluid retention or depletion, respectively, which may necessitate adjustments to the TPN prescription. Recording daily weights provides valuable data for healthcare providers to evaluate the client's response to TPN and make appropriate m’difications to the treatment plan.

C) Instruct the client that one container of TPN may infuse for up to 72 hr: The duration of TPN administration varies depending on factors such as the client's nutritional needs, medical condition, ’nd the stability of the TPN solution. While some TPN solutions may be stable for up to 24-48 hours, infusing for 72 hours could increase the risk of contamination and compromise the integrity of the solution, leading to adverse effects. Providing accurate information about the duration of TPN infusion based on the specific prescription ensures the client's safety and the efficacy of therapy.

D’ Instruct the client to speed up the rate of their TPN infusion if it falls behind schedule: Altering the rate of TPN infusion without healthcare provider guidance can lead to complications such as hyperglycemia, electrolyte imbalances, or fluid overload. TPN infusion rates are carefully prescribed based on the client's nutritional needs and metabolic status’ If the infusion falls behind schedule, it's essential for the client to contact th’ir healthcare provider for guidance on adjusting the infusion rate or managing any potential issues.

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Correct Answer is B

Explanation

B) Nalbuphine: Nalbuphine is an opioid analgesic that acts on the central nervous system to relieve pain. When administered concurrently with morphine, there is a risk of additive respiratory depression and other opioid-related side effects, such as sedation and hypotension. Therefore, the nurse should clarify the prescription for nalbuphine with the provider to ensure that the combination of opioid medications is appropriate for the client's pain management. Additionally, nalbuphine has mixed agonist-antagonist properties and can precipitate withdrawal symptoms in clients who are physically dependent on full opioid agonists like morphine. Due to these potential interactions and safety concerns, it is essential for the nurse to obtain clarification from the provider before administering nalbuphine to the client receiving morphine via a PCA pump.

A) Ondansetron: Ondansetron is an antiemetic medication commonly prescribed to manage nausea and vomiting, which can be side effects of opioid analgesics like morphine. There are no significant contraindications or interactions between ondansetron and morphine, making it a suitable choice for adjunctive therapy in clients receiving PCA morphine for cancer pain.

C) Insulin glargine: Insulin glargine is a long-acting insulin analog used to control blood glucose levels in clients with diabetes mellitus. While clients with cancer may have comorbidities such as diabetes, the prescription for insulin glargine is unlikely to require clarification in the context of concurrent morphine use. However, the nurse should verify the client's current blood glucose levels and adjust the insulin dosage as needed based on the client's glycemic control.

D) Acetaminophen: Acetaminophen is a non-opioid analgesic commonly used to manage mild to moderate pain. When used in combination with opioids like morphine, acetaminophen can provide additive pain relief and may reduce the total opioid dosage required. There are no significant contraindications or interactions between acetaminophen and morphine, making it a suitable choice for adjunctive pain management in clients receiving PCA morphine for cancer pain.

A. Stroke volume B. Cardiac output C. Urine output D. Blood pressure

Correct Answer is D

Explanation

A) Stroke volume: Stroke volume is the amount of blood ejected from the heart with each contraction, and it's an essential parameter in assessing cardiac function. However, when titrating a nitroprusside infusion, the primary goal is to manage blood pressure rather than directly targeting stroke volume. Nitroprusside is primarily used as a vasodilator to lower blood pressure in hypertensive emergencies. While changes in blood pressure may indirectly affect stroke volume, blood pressure itself is the primary parameter for titration.

B) Cardiac output: Cardiac output, which is the volume of blood pumped by the heart per minute, may be affected by nitroprusside due to its vasodilatory effects. However, like stroke volume, cardiac output is not typically the primary parameter for titrating a nitroprusside infusion. Blood pressure is a more direct indicator of the drug's effect on vascular tone and perfusion pressure.

C) Urine output: Monitoring urine output is crucial for assessing renal function and fluid status, but it is not the primary parameter used to titrate a nitroprusside infusion. While nitroprusside may affect renal blood flow and urine output indirectly, blood pressure remains the immediate indicator of the drug's hemodynamic effects.

D) Blood pressure: Nitroprusside is a potent vasodilator commonly used to lower blood pressure in hypertensive emergencies. Therefore, the primary assessment parameter for titrating a nitroprusside infusion is blood pressure. The nurse should monitor the client's blood pressure frequently and adjust the infusion rate accordingly to achieve the desired therapeutic effect while avoiding hypotension or excessive lowering of blood pressure.

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A nurse is providing discharge teaching to a client who will receive total parenteral nutrition (TPN) at home. Which of the following information should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medication administration record for a client who has cancer and is receiving morphine via a PCA pump. Which of the following prescriptions should the nurse clarify with the provider?

Correct Answer is B

Explanation

A nurse is preparing to titrate a continuous nitroprusside infusion for a client. The nurse should plan to titrate the infusion according to which of the following assessments?

Correct Answer is D

Explanation

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