Orders were written for a client to be weaned off of total parenteral nutrition (TPN) and started on a low-residue diet. The TPN solution has been infusing at a continuous rate of 90 ml/hr for three weeks. Which of the following orders should the nurse anticipate next?

Decrease the TPN rate to 60 ml/hr

Replace TPN infusion with an intravenous dextrose solution

Begin infusion of 0.9% normal saline at 30 ml/hr

Discontinue TPN infusion

Answer and Explanation

The Correct Answer is B

A. Decrease the TPN rate to 60 ml/hr: Gradually decreasing the TPN rate is a common practice, but it is typically done in conjunction with transitioning to another form of nutrition, not as a standalone order.
B. Replace TPN infusion with an intravenous dextrose solution: This is the correct choice. When weaning off TPN, it is important to prevent hypoglycemia by replacing the TPN with a dextrose solution to maintain blood glucose levels while transitioning to oral or enteral feeding.
C. Begin infusion of 0.9% normal saline at 30 ml/hr: While saline may be used for hydration, it does not address the need to manage blood glucose levels during the transition from TPN.
D. Discontinue TPN infusion: Discontinuing TPN abruptly can lead to complications such as hypoglycemia. It is important to gradually taper off TPN while replacing it with a dextrose solution.

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Correct Answer is C

Explanation

A. 10% dextrose in water: This solution is used primarily for providing calories and is not suitable for volume replacement.
B. 10% dextrose in 0.45% sodium chloride: This solution combines dextrose and a hypotonic sodium chloride solution, which is not ideal for immediate volume replacement in severe bleeding cases.
C. 0.9% sodium chloride: This is the correct choice. Normal saline (0.9% sodium chloride) is an isotonic solution used for volume replacement, especially in cases of significant blood loss.
D. 2.5% sodium chloride: This is a hypotonic solution and would not be appropriate for volume replacement in severe bleeding as it does not adequately address the need for fluid resuscitation.

A. A 47-year-old client who reports two loose stools with a serum sodium of 139 mmol/L B. A 71-year-old client with a calcium level of 8.9 mg/dL and a negative Trousseau sign C. A 52-year-old client with fluid volume excess and BUN of 18 mg/dL D. A 60-year-old client with a serum potassium of 3.2 mEq/L and heart palpitations

Correct Answer is D

Explanation

A. A 47-year-old client who reports two loose stools with a serum sodium of 139 mmol/L: Although diarrhea can lead to electrolyte imbalances, a serum sodium level of 139 mmol/L is within normal range, so this client is not the highest priority.
B. A 71-year-old client with a calcium level of 8.9 mg/dL and a negative Trousseau sign: A calcium level of 8.9 mg/dL is slightly low but not critically low, especially with a negative Trousseau sign. This client is stable compared to others.
C. A 52-year-old client with fluid volume excess and BUN of 18 mg/dL: A BUN of 18 mg/dL indicates mild elevation, and fluid volume excess can be managed with adjustments in treatment; this client does not require immediate priority.
D. A 60-year-old client with a serum potassium of 3.2 mEq/L and heart palpitations: A potassium level of 3.2 mEq/L indicates hypokalemia, which can cause serious cardiac issues and symptoms like palpitations. This client requires urgent attention to address the potential risk of cardiac complications.

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Orders were written for a client to be weaned off of total parenteral nutrition (TPN) and started on a low-residue diet. The TPN solution has been infusing at a continuous rate of 90 ml/hr for three weeks. Which of the following orders should the nurse anticipate next?

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