solid food today. The ongoing solution rate has been 100 mL/hour. The nurse anticipates that which prescription regarding the PN solution will accompany the diet prescription? 1. Discontinue the PN. 2. Decrease PN rate to 50 mL/hour. 3. Start 0.9% normal saline at 25 mL/hour. 4. Continue current in...
1. A client is being weaned from parenteral nutrition (PN) and is expected to
begin taking solid food today. The ongoing solution rate has been 100
mL/hour. The nurse anticipates that which prescription regarding the PN
solution will accompany the diet prescription?
1.
Discontinue the PN.
2.
Decrease PN rate to 50 mL/hour.
3.
Start 0.9% normal saline at 25 mL/hour.
4.
Continue current infusion rate prescriptions for PN.: Decrease PN rate to 50
mL/hour.
When a client begins eating a regular diet after a period of receiving PN, the PN is
decreased gradually. PN that is discontinued abruptly can cause hypoglycemia.
Clients often have anorexia after being without food for some time, and the
digestive tract also is not used to producing the digestive enzymes that will be
needed. Gradually decreasing the infusion rate allows the client to remain
adequately nourished during the transition to a normal diet and prevents the
occurrence of hypoglycemia. Even before clients are started on a solid diet, they
are given clear liquids followed by full liquids to further ease the transition. A
solution of normal saline does not provide the glucose needed during the
transition of discontinuing the PN and could cause the client to experience
hypoglycemia.
2. The nurse is preparing to change the parenteral nutrition (PN) solution
bag and tubing. The client's central venous line is located in the right
subclavian vein. The nurse asks the client to take which essential action
during the tubing change?
1.
Breathe normally.
2.
Turn the head to the right.
, Saunders NCLEX Critical Care
3.
Exhale slowly and evenly.
4.
Take a deep breath, hold it, and bear down.: Take a deep breath, hold it, and
bear down.
The client should be asked to perform the Valsalva maneuver during tubing
changes. This helps avoid air embolism during tubing changes. The nurse asks
the client to take a deep breath, hold it, and bear down. If the intravenous line is
on the right, the client turns his or her head to the left. This position increases
intrathoracic pressure. Breathing normally and exhaling slowly and evenly are
inappropriate and could enhance the potential for an air embolism during the
tubing change.
3. A client with parenteral nutrition (PN) infusing has disconnected the
tubing from the central line catheter. The nurse assesses the client and
suspects an air embolism. The nurse should immediately place the client in
which position?
1.
On the left side, with the head lower than the feet
2.
On the left side, with the head higher than the feet
3.
On the right side, with the head lower than the feet
4.
On the right side, with the head higher than the feet: On the left side, with the
head lower than the feet
Air embolism occurs when air enters the catheter system, such as when the
system is opened for intravenous (IV) tubing changes or when the IV tubing
disconnects. Air embolism is a critical situation; if it is suspected, the client should
be placed in a left side-lying position. The head should be lower than the feet. This
position is used to minimize the effect of the air traveling as a bolus to the lungs by
trapping it in the right side of the heart. The positions in the remaining options are
inappropriate if an air embolism is suspected.
, Saunders NCLEX Critical Care
4. Which nursing action is essential prior to initiating a new prescription for
500 mL of fat emulsion (lipids) to infuse at 50 mL/hour?
1.
Ensure that the client does not have diabetes.
2.
Determine whether the client has an allergy to eggs.
3.
Add regular insulin to the fat emulsion, using aseptic technique.
4.
Contact the health care provider (HCP) to have a central line inserted for fat
emulsion infusion.: Determine whether the client has an allergy to eggs.
The client beginning infusions of fat emulsions must be first assessed for known
allergies to eggs to prevent anaphylaxis. Egg yolk is a component of the solution
and provides emulsification. The remaining options are unnecessary and are not
related specifically to the administration of fat emulsion.
5. The nurse monitors the client receiving parenteral nutrition (PN) for
complications of the therapy and should assess the client for which
manifestations of hyperglycemia?
1.
Fever, weak pulse, and thirst
2.
Nausea, vomiting, and oliguria
3.
Sweating, chills, and abdominal pain
4.
Weakness, thirst, and increased urine output: Weakness, thirst, and increased
urine output
The high glucose concentration in PN places the client at risk for hyperglycemia.
Signs of hyperglycemia include excessive thirst, fatigue, restlessness, confusion,
weakness, Kussmaul respirations, diuresis, and coma when hyperglycemia is
, Saunders NCLEX Critical Care
severe. If the client has these symptoms, the blood glucose level should be
checked immediately. The remaining options do not identify signs specific to
hyperglycemia. 6. The nurse is changing the central line dressing of a client
receiving parenteral nutrition (PN) and notes that the catheter insertion site
appears reddened. The nurse should next assess which item?
1.
Client's temperature
2.
Expiration date on the bag
3.
Time of last dressing change
4.
Tightness of tubing connections: Client's temperature
Redness at the catheter insertion site is a possible indication of infection. The
nurse would next assess for other signs of infection. Of the options given, the
temperature is the next item to assess. The tightness of tubing connections should
be assessed each time the PN is checked; loose connections would result in
leakage, not skin redness. The expiration date on the bag is a viable option, but
this also should be checked at the time the solution is hung and with each shift
change. The time of the last dressing change should be checked with each shift
change.
7. The nurse is preparing to hang fat emulsion (lipids) and notes that fat
globules are visible at the top of the solution. The nurse should take which
action?
1.
Roll the bottle of solution gently.
2.
Obtain a different bottle of solution.
3.
Shake the bottle of solution vigorously.
4.
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