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: Cheddar cheese is not a good food choice for maintaining water intake, as it contains only about 37% water¹. Cheese and other dairy products are also high in sodium, which can increase the water loss through urine.
Choice B reason: Broccoli is a good food choice for maintaining water intake, as it contains about 89% water². Broccoli and other vegetables are also rich in vitamins, minerals, and antioxidants, which can benefit the child's health and hydration.
Choice C reason: Whole-wheat bread is not a good food choice for maintaining water intake, as it contains only about 35% water³. Bread and other grains are also high in carbohydrates, which can increase the water retention in the body.
Choice D reason: Almonds are not a good food choice for maintaining water intake, as they contain only about 4% water⁴. Almonds and other nuts are also high in fat and calories, which can contribute to weight gain and inflammation.
Correct Answer is C
Explanation
Choice C reason: This statement shows that the client has understood the importance of vitamin D and calcium for bone health. Fortified milk, fatty fish, and cheese are good sources of both nutrients, which help to maintain bone density and prevent osteoporosis.
Choice A reason: This statement is incorrect, as vitamin A supplementation can have adverse effects on bone health. Excessive intake of vitamin A can increase the risk of fractures and reduce bone mineral density.
Choice B reason: This statement is partially correct, as calcium supplementation can help to meet the daily requirement of calcium for bone health. However, calcium alone is not enough, as vitamin D is also needed to facilitate the absorption of calcium and prevent its loss from the bones.
Choice D reason: This statement is irrelevant, as none of the foods mentioned are particularly beneficial for bone health. Orange juice, lean meats, and egg whites are good sources of vitamin C, protein, and biotin, respectively, but they do not provide significant amounts of vitamin D or calcium.
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