A student asks the nurse why a peripherally inserted central catheter is needed for a patient receiving Total Parenteral Nutrition (TPN) with 25% dextrose. Which response by the nurse is accurate?
The required blood glucose monitoring is based on samples obtained from a central line.
There is a decreased risk for infection when 25% dextrose is infused through a central line.
The hypertonic solution will be more rapidly diluted when given through a central line.
The prescribed infusion can be given more rapidly when the patient has a central line.
The Correct Answer is C
Choice A reason: While blood glucose monitoring is essential for patients receiving TPN, it is not specifically necessary to obtain samples from a central line. Blood glucose levels can be monitored through peripheral blood samples.
Choice B reason: There is actually an increased risk of infection with central lines compared to peripheral lines due to the invasive nature of central line placement and its location. Proper aseptic technique is critical to minimize this risk.
Choice C reason: The hypertonic solution will be more rapidly diluted when given through a central line. This is a critical point because the central veins have a higher blood flow and larger volume, which helps to quickly dilute the hypertonic TPN solution. This reduces the risk of phlebitis and damage to the smaller peripheral veins, making central lines more suitable for infusing highly concentrated solutions like 25% dextrose.
Choice D reason: While a central line can allow for the rapid administration of infusions, this is not the primary reason for its use with TPN. The key factor is the dilution of the hypertonic solution, as central lines handle high osmolarity solutions better than peripheral veins.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Administering Furosemide (Lasix) 40 mg IV is important for reducing fluid overload, but the immediate priority is to address the patient's low oxygen saturation levels.
Choice B reason: Assessing lung sounds and peripheral edema is important for ongoing monitoring, but the immediate action should focus on stabilizing the patient's oxygen levels.
Choice C reason: Placing the patient on oxygen to titrate to oxygen saturations 94% or greater is the most immediate and critical intervention. The patient's oxygen saturation is significantly low at 86%, and addressing this ensures adequate oxygenation and reduces the risk of hypoxia.
Choice D reason: Educating the patient on lifestyle modifications is important for long-term management but is not the immediate priority in an acute situation.
Correct Answer is D
Explanation
Choice A reason: A hemoglobin level of 12.0 g/dL is slightly below the normal range for men but is not the most critical concern preoperatively. It indicates mild anemia, which should be monitored but does not present an immediate high risk.
Choice B reason: A serum creatinine level of 1.3 mg/dL is slightly elevated and indicates mild renal impairment. While this should be considered, it is not as immediately concerning as a significantly abnormal coagulation value.
Choice C reason: A Blood Urea Nitrogen (BUN) level of 24 mg/dL is slightly above normal, indicating some renal function impairment or dehydration. However, it does not pose the most significant immediate risk compared to a high INR value.
Choice D reason: An INR of 3.5 is significantly elevated and indicates a high risk of bleeding. For a surgical patient, this is the most concerning pre-op lab value because it suggests that the patient's blood is not clotting properly. This increases the risk of excessive bleeding during and after surgery, making it a priority to address before proceeding with the operation.
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