A nurse on a medical surgical unit is caring for a client who has a small bowel obstruction and is receiving parenteral nutrition through a central venous catheter. Which of the following actions should the nurse plan to take? (Select all that apply)
Observe for dyspnea.
Infuse parenteral nutrition by gravity.
Administer parenteral nutrition solution within 30 min after removing from the refrigerator.
Change parenteral nutrition bag and infusion tubing every 72 hr.
Begin infusion of parenteral nutrition once central venous catheter position is confirmed by radiology.
Correct Answer : A,C,E
Choice A reason: Dyspnea is a sign of pulmonary edema, which can occur as a complication of parenteral nutrition due to fluid overload or allergic reaction¹². The nurse should monitor the client's respiratory status and oxygen saturation and report any signs of respiratory distress.
Choice B reason: Parenteral nutrition should not be infused by gravity, as this can cause fluctuations in the infusion rate and lead to hyperglycemia or hypoglycemia¹³. The nurse should use an infusion pump to deliver parenteral nutrition at a constant and controlled rate.
Choice C reason: Parenteral nutrition solution should be administered within 30 min after removing from the refrigerator, as prolonged exposure to room temperature can increase the risk of bacterial contamination and infection¹⁴. The nurse should check the expiration date and inspect the solution for any discoloration, cloudiness, or particulate matter before administration.
Choice D reason: Parenteral nutrition bag and infusion tubing should be changed every 24 hr, not every 72 hr, to prevent the growth of microorganisms and reduce the risk of infection¹⁵. The nurse should use aseptic technique when changing the bag and tubing and follow the facility's protocol for dressing changes and catheter care.
Choice E reason: Parenteral nutrition should be started only after the central venous catheter position is confirmed by radiology, as incorrect placement can cause serious complications such as pneumothorax, hemothorax, or cardiac tamponade¹⁶. The nurse should obtain a chest x-ray and wait for the provider's confirmation before initiating parenteral nutrition.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Increased glucose levels are not a positive outcome of the client's interventions, but rather a sign of impaired glucose metabolism and insulin resistance, which can increase the risk of cardiovascular disease. The Mediterranean diet can help lower glucose levels by providing complex carbohydrates, fiber, and healthy fats, which can improve insulin sensitivity and blood sugar control.
Choice B reason: Increased HDL levels are a positive outcome of the client's interventions, as HDL stands for high-density lipoprotein, which is the "good" cholesterol that helps remove excess cholesterol from the arteries and protect against atherosclerosis and cardiovascular disease. The Mediterranean diet can help increase HDL levels by providing monounsaturated and polyunsaturated fats, such as olive oil, nuts, seeds, and fish, which can boost HDL production and function.
Choice C reason: Increased LDL levels are not a positive outcome of the client's interventions, but rather a sign of increased cholesterol deposition and inflammation in the arteries, which can lead to plaque formation and cardiovascular disease. LDL stands for low-density lipoprotein, which is the "bad" cholesterol that carries cholesterol from the liver to the cells. The Mediterranean diet can help lower LDL levels by providing antioxidants, fiber, and plant sterols, which can reduce LDL synthesis and oxidation.
Choice D reason: Increased triglyceride levels are not a positive outcome of the client's interventions, but rather a sign of increased fat storage and metabolic syndrome, which can increase the risk of cardiovascular disease. Triglycerides are a type of fat that circulates in the blood and provides energy to the cells. The Mediterranean diet can help lower triglyceride levels by providing omega-3 fatty acids, which can modulate triglyceride synthesis and breakdown.
Correct Answer is A
Explanation
Choice A reason: TPN is a form of nutrition that is delivered directly into the bloodstream through a central venous catheter. It is used for clients who have impaired or nonfunctional gastrointestinal tracts, such as those with acute kidney injury, bowel obstruction, or short bowel syndrome.
Choice B reason: The TPN does not necessarily have higher levels of vitamins than the recommended daily intake. The TPN is individually tailored to meet the client's nutritional needs, which may vary depending on their condition, weight, and laboratory values.
Choice C reason: The TPN does not ensure that the client's glucose level stays within the expected range. In fact, TPN can cause hyperglycemia due to the high concentration of dextrose in the solution. The client's blood glucose level should be monitored frequently and insulin should be administered as prescribed to prevent complications.
Choice D reason: The TPN is not higher in fats and protein, but lower in carbohydrates. The TPN contains a balanced mixture of macronutrients, including carbohydrates, proteins, and lipids, as well as micronutrients, such as electrolytes, vitamins, and minerals. The ratio of these components may vary depending on the client's nutritional needs and goals.
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