The nurse is providing care to a patient admitted with an exacerbation of Crohn's disease and a history of diabetes. The patient is receiving total parenteral nutrition (TPN) through a central venous access device. Which intervention will the nurse implement while caring for this patient?

Administer lipid injectable emulsion with TPN every day based on albumin results.

Disconnect IV tubing and add regular insulin to TPN bag based on the sliding scale results.

Maintain aseptic technique when changing tubing or parenteral nutrition bag.

Administer dextrose infusion through a separate tubing three hours before discontinuing TPN.

Answer and Explanation

The Correct Answer is C

Choice A reason: Administering lipid injectable emulsion with TPN every day based on albumin results is not the priority intervention. While lipid emulsions may be part of TPN, the focus should be on maintaining aseptic technique to prevent infection.

Choice B reason: Disconnecting IV tubing and adding regular insulin to the TPN bag based on sliding scale results is not appropriate. Insulin should be administered separately, and aseptic technique must be maintained to prevent contamination.

Choice C reason: Maintaining aseptic technique when changing tubing or the parenteral nutrition bag is crucial for preventing infection. Patients receiving TPN through a central venous access device are at high risk for infections, and strict aseptic technique is essential.

Choice D reason: Administering dextrose infusion through separate tubing three hours before discontinuing TPN is not a standard practice. The focus should be on proper administration and infection control practices.

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Correct Answer is A

Explanation

Choice A reason: The ABG results of pH 7.21, PaCO2 36, HCO3 14 indicate metabolic acidosis, which is common in patients with end-stage kidney disease (ESKD). In ESKD, the kidneys lose their ability to excrete acid and maintain bicarbonate levels, leading to an accumulation of acid in the blood. This condition results in a low pH (acidic), normal PaCO2 (as the respiratory system attempts to compensate), and low HCO3 (bicarbonate).

Choice B reason: The ABG results of pH 7.50, PaCO2 29, HCO3 22 indicate respiratory alkalosis, which is not typically associated with ESKD. Respiratory alkalosis occurs when there is excessive exhalation of carbon dioxide, leading to a higher pH (alkaline). This condition is more likely to be seen in situations such as hyperventilation, anxiety, or certain lung diseases.

Choice C reason: The ABG results of pH 7.47, PaCO2 45, HCO3 33 indicate metabolic alkalosis, which is not typically associated with ESKD. Metabolic alkalosis occurs when there is an excess of bicarbonate or a loss of acid. This condition can result from factors such as vomiting, diuretic use, or excessive antacid consumption. It is not a common finding in patients with ESKD.

Choice D reason: The ABG results of pH 7.31, PaCO2 48, HCO3 24 indicate respiratory acidosis, which is not typically associated with ESKD. Respiratory acidosis occurs when there is an accumulation of carbon dioxide due to impaired respiratory function. This condition is more likely to be seen in chronic obstructive pulmonary disease (COPD) or other respiratory disorders. It is not a common finding in patients with ESKD.

A. Always use a low flow device such as a nasal cannula or simple face mask. B. Correct the PaO2 to a normal level as quickly as possible using mechanical ventilation. C. Use continuous positive airway pressure (CPAP) to maintain PaCO2 greater than 50 mmHg. D. Increase the PaO2 to an acceptable level at the lowest oxygen concentration possible.

Correct Answer is D

Explanation

Choice A reason: Always using a low flow device such as a nasal cannula or simple face mask is not necessarily appropriate for all patients. The choice of device should be based on the patient's oxygen needs and clinical status.

Choice B reason: Correcting the PaO2 to a normal level as quickly as possible using mechanical ventilation is not appropriate in most cases. Rapid correction of oxygen levels can lead to complications such as oxygen toxicity. Mechanical ventilation is used in severe cases but is not the first line of treatment for most patients.

Choice C reason: Using continuous positive airway pressure (CPAP) to maintain PaCO2 greater than 50 mmHg is incorrect. CPAP is used to maintain open airways and improve oxygenation but is not used to target specific PaCO2 levels.

Choice D reason: Increasing the PaO2 to an acceptable level at the lowest oxygen concentration possible is the most appropriate guideline. This approach aims to correct hypoxemia without causing oxygen toxicity. The goal is to achieve adequate oxygenation while minimizing the risk of adverse effects from high oxygen concentrations.

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The nurse is providing care to a patient admitted with an exacerbation of Crohn's disease and a history of diabetes. The patient is receiving total parenteral nutrition (TPN) through a central venous access device. Which intervention will the nurse implement while caring for this patient?

Nursing Test Bank

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