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Which intervention is most important for the practical nurse (PN) to implement for a client who is receiving total parenteral nutrition (TPN)?

Collect fingerstick glucose levels

Implement bleeding precautions.

Obtain daily weights

Check urine for albumin

Answer and Explanation

The Correct Answer is A

The correct answer is Choice A:

Collect fingerstick glucose levels.

Choice A rationale:

When a client is receiving total parenteral nutrition (TPN), it means they are receiving nutrients directly into the bloodstream, bypassing the digestive system. TPN often contains high levels of glucose, which can lead to hyperglycemia. Regular monitoring of blood glucose levels are crucial to detect and manage hyperglycemia effectively, especially in clients at risk for diabetes or those with impaired glucose metabolism.

Choice B rationale:

Implementing bleeding precautions (Choice B) is important for clients on anticoagulant therapy or with bleeding disorders. However, it is not the most important intervention for a client receiving TPN. Monitoring glucose levels takes precedence in this case.

Choice C rationale:

Obtaining daily weights is an important intervention to assess fluid balance and nutritional status in clients receiving TPN. However, it is not the most critical intervention compared to monitoring glucose levels to prevent complications of hyperglycemia.

Choice D rationale:

Checking urine for albumin is important in assessing kidney function and detecting proteinuria. While it is a valid nursing intervention, it is not the most important consideration for a client on TPN. Monitoring glucose levels is of higher priority.

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Correct Answer is B

Explanation

The correct answer is choice B. Notify the charge nurse of the client's concerns about surgery. Choice A rationale:

Reminding the client that the consent has already been obtained does not address the client's current fears and uncertainty about undergoing the surgery. It may come across as dismissive and unsupportive of the client's emotional needs.

Choice B rationale:

This is the correct answer because notifying the charge nurse of the client's concerns about surgery allows the nursing team to provide the necessary support and address the client's emotional needs appropriately. The charge nurse can assess the client's anxiety level, discuss the procedure, and involve the healthcare provider if needed to ensure the client is well-

informed and comfortable with their decision. Choice C rationale:

Documenting the client's expressed concerns about the surgery is essential for accurate documentation but does not provide the immediate support and intervention the client may require.

Choice D rationale:

Encouraging the client to continue with the scheduled surgery without addressing their fears and uncertainty may not be appropriate. The client's emotional well-being should be a priority, and they should feel supported in their decision-making process.

A. Administer a prescribed PRN stool softener. B. Encourage client to ambulate more frequently. C. Recommend increasing high fiber foods daily. D. Determine the client's usual bowel pattern.

Correct Answer is D

Explanation

Determine the client's usual bowel pattern.

Choice A rationale:

Administering a prescribed PRN stool softener may be necessary if the client is experiencing constipation, but it is not the first action the PN should implement. Before administering any medication, the PN should gather more information to make an informed decision.

Choice B rationale:

Encouraging the client to ambulate more frequently can be beneficial for promoting bowel movements, but it is not the first action to implement. The PN should first assess the client's bowel pattern to determine if there is a deviation from their usual routine.

Choice C rationale:

Recommending increasing high fiber foods daily can also help with constipation, but it is not the first action to take. The PN should assess the client's current bowel pattern to better understand the situation.

Choice D rationale:

Determining the client's usual bowel pattern is the first action the PN should take. This assessment will help establish a baseline and identify any deviations that might indicate a potential issue, which can then guide further interventions.

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Which intervention is most important for the practical nurse (PN) to implement for a client who is receiving total parenteral nutrition (TPN)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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