The nurse is caring for a client receiving a TPN Infusion running at 54.2 mL/hr and there is only 25 mL remaining in the bag. The next Infusion bag has not been brought to the unit. Which action would be appropriate?

Notify the physician immediately.

Notify the pharmacy when the bag is empty

Decrease the rate to 27.1 mL/hr until the new bag is brought to the unit

Hang a bag of D10W at the current rate until the new bag arrives

Answer and Explanation

The Correct Answer is C

C. Decrease the rate to 27.1 mL/hr until the new bag is brought to the unit: This option is a suitable approach to conserve the remaining TPN solution until the new bag arrives. By halving the infusion rate, the remaining volume of TPN will last longer, ensuring the client continues to receive some nutrition and fluid support while awaiting the delivery of the new bag.
A. While it's important to inform the healthcare team about the low volume of TPN remaining, it may not require immediate physician intervention unless the situation worsens or alternative actions need to be taken.
B. Notifying the pharmacy when the bag is empty is a reasonable action, as they can prepare and deliver the next infusion bag promptly. However, it does not address the immediate need for fluid and nutrition replacement.
D. D10W (dextrose 10% in water) can help prevent hypoglycemia and provide some energy, but it does not provide the full nutritional support that TPN does. However, it can be a reasonable short- term measure while waiting for the replacement TPN bag.

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Correct Answer is B

Explanation

B. Rebound tenderness on abdominal palpation: Rebound tenderness, where pain increases upon release of pressure during abdominal palpation, is a classic sign of peritonitis, which can occur due to a peptic ulcer perforation. It indicates irritation of the peritoneum, the lining of the abdominal cavity, which can occur when stomach contents leak into the peritoneal cavity.
A. Numbness in the legs is not typically associated with perforation of a peptic ulcer. Perforation of a peptic ulcer usually presents with localized abdominal symptoms rather than symptoms in the legs.
C. Projectile vomiting of undigested food is not typically associated with perforation of a peptic ulcer. It is more commonly seen in conditions such as pyloric stenosis or gastrointestinal obstruction.
D. Jaundice, a yellow discoloration of the skin and sclera, is not typically associated with perforation of a peptic ulcer.

A. hemoglobin 7.8 B. blood pressure = 118/78 C. occult blood in stool D. epigastric pain that is worse on palpation

Correct Answer is A

Explanation

A. Hemoglobin 7.8: This finding indicates a low hemoglobin level, which suggests significant blood loss, likely due to the actively bleeding peptic ulcer. Hemoglobin levels below normal can indicate anemia, and a level of 7.8 is particularly concerning. This finding should be immediately reported to the physician because it suggests ongoing bleeding and the need for intervention to stabilize the client's hemoglobin levels and prevent further complications such as hypovolemic shock.
B. Blood pressure = 118/78: This blood pressure reading falls within the normal range for most adults. While monitoring blood pressure is important, this finding alone may not be immediately concerning in the context of a bleeding peptic ulcer.
C. The presence of occult blood in the stool suggests gastrointestinal bleeding, which is consistent with the actively bleeding peptic ulcer. While this finding is significant, it may not require immediate reporting to the physician as it is expected in the context of the client's condition.
D. Epigastric pain is a common symptom of peptic ulcer disease, and worsening pain on palpation may indicate peritonitis or perforation, which are serious complications of peptic ulcers. However, if the pain is severe or associated with signs of peritonitis it should be promptly reported to the physician for further evaluation and management.

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The nurse is caring for a client receiving a TPN Infusion running at 54.2 mL/hr and there is only 25 mL remaining in the bag. The next Infusion bag has not been brought to the unit. Which action would be appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has a history of peptic ulcer disease and is being admitted to the hospital with clinical manifestations of a perforation. Which finding by the nurse would best Indicate that perforation has occurred?

Correct Answer is B

Explanation

The nurse is caring for a client who has a peptic ulcer that is actively bleeding. Which finding would the nurse Immediately report to the physician?

Correct Answer is A

Explanation

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