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

a) Collect fingerstick glucose levels. Correct

Collecting fingerstick glucose levels is the most important intervention for the PN to implement for a client who is receiving TPN. TPN is a method of feeding that bypasses the gastrointestinal tract and provides all the nutritional needs of the body through a vein. TPN contains a high concentration of glucose, which can cause hyperglycemia or ﬂuctuations in blood sugar levels. Therefore, it is essential to monitor the client's glucose levels frequently and adjust the infusion rate or insulin administration accordingly.

b) Implement bleeding precautions.

Implementing bleeding precautions is not the most important intervention for the PN to implement for a client who is receiving TPN. Bleeding precautions are measures to prevent or minimize bleeding in clients who have a high risk of hemorrhage due to conditions such as thrombocytopenia, coagulopathy, or anticoagulant therapy. TPN does not directly increase the risk of bleeding, although it may aﬀect the liver function and clotting factors in some cases². Therefore, bleeding precautions are not a priority for a client who is receiving TPN.

c) Obtain daily weights.

Obtaining daily weights is not the most important intervention for the PN to implement for a client who is receiving TPN. Obtaining daily weights is a way to monitor the client's ﬂuid balance, nutritional status, and response to therapy. TPN can cause ﬂuid overload, dehydration, or electrolyte imbalances in some cases²⁵. Therefore, obtaining daily weights is important, but not as important as monitoring glucose levels.

d) Check urine for albumin.

Checking urine for albumin is not the most important intervention for the PN to implement for a client who is receiving TPN. Checking urine for albumin is a way to detect proteinuria, which is an indicator of kidney damage or disease. TPN does not directly cause kidney problems, although it may aﬀect the renal function and urine output in some cases². Therefore, checking urine for albumin is not a priority for a client who is receiving TPN.

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Correct Answer is B

Explanation

Choice A reason: Advances in surgical techniques and procedures have improved the quality of life and survival rates for many patients, but they are not the main factor for the increase in life expectancy in the twentieth century.

Choice B reason: Sanitation and other public health activities, such as vaccination, safe water supply, sewage disposal, and food safety, have reduced the incidence and mortality of infectious diseases, which were the leading causes of death in the past. These activities have had a significant impact on increasing life expectancy in the twentieth century.

Choice C reason: Technology increases in the field of medical laboratory research have enabled better diagnosis and treatment of diseases, but they are not the primary reason for the increase in life expectancy in the twentieth century.

Choice D reason: Use of antibiotics to fight infections has saved many lives and prevented complications from bacterial diseases, but they are not the most important factor for the increase in life expectancy in the twentieth century. Moreover, antibiotics were not widely available until after World War II, which means they did not contribute much to the increase in life expectancy before that perioD.

A. Plan to have the client lay down for 1 hr after meals. B. Instruct the client to use pursed-lip breathing. C. Encourage the client to use the upper chest for respiration. D. Restrict the client's fluid intake to less than 1 Vday.

Correct Answer is B

Explanation

Choice A rationale:

Planning to have the client lay down for 1 hour after meals is not an appropriate intervention for a client with COPD. It may increase the risk of aspiration and worsen their breathing difficulties.

Choice C rationale:

Encouraging the client to use the upper chest for respiration is not the best approach for a client with COPD. Pursed-lip breathing helps improve oxygen exchange and decreases air trapping, which is more effective in managing COPD.

Choice D rationale:

Restricting the client's fluid intake to less than 1 Vday is not a suitable intervention for a client with COPD. Dehydration can lead to thicker mucus, making it harder to breathe

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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)?

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