A nurse is making initial rounds at the beginning of the shift and notice that the parenteral nutrition (PN) bag of an assigned client is empty. Which of the following solutions readily available on the nursing unit should the nurse hang until another PN solution is mixed and delivered to the nursing unit?
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Solution
10% dextrose in water.
The client is at risk of hypoglycemia. Hence the nurse will hang a solution that has the highest amount of glucose until the new parenteral nutrition solution becomes readily available.
A client is receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse next assesses the client to identify the presence of which of the following?
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Solution
Crackles upon auscultation of the lungs.
Normally, the weight gain of a client receiving PN is about 1-2 pound a week. A weight gain of five (5) pounds over a week indicates a client is experiencing fluid retention that can result to hypervolemia. Signs of hypervolemia includes weight gain more than desired, headache, jugular vein distention, bounding pulse, and crackles on lung auscultation.
Option A: Hypertension, not hypotension is expected.
Options C and D are associated with hyperglycemia.
A client is being weaned off from parenteral nutrition (PN) and is given a go-signal to take a regular diet. The ongoing solution rate has been 120ml/hr. A nurse expects that which of the following prescriptions regarding the PN solution will accompany the diet order?
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Solution
Decrease the PN rate to 60ml/hr.
When a client begins eating a regular diet after a period of receiving PN, the PN is decreased slowly. PN that is terminated abruptly will cause hypoglycemia. Gradually decreasing the infusion rate allows the client to remain sufficiently nourished during the transition to a normal diet and prevents an episode of hypoglycemia.
A nurse is caring a client who disconnected the tubing of the parenteral nutrition from the central line catheter. A nurse suspects an occurrence of an air embolism. Which of the following is an appropriate position for the client in this kind of situation?
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Solution
On the left side, with head lower than the feet.
Air embolism happens because of the entry of air into the catheter system. If it occurs, the client should be placed in a left-side-lying position with the head be lower than the feet. This position will lessen the effect of the air traveling as a bolus to the lungs by trapping it on the right side of the heart.
A client is receiving nutrition via parenteral nutrition (PN). A nurse assess the client for complications of the therapy and assesses the client for which of the following signs of hyperglycemia?
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Solution
Thirst, blurred vision, and diuresis.
Signs of hyperglycemia include excessive thirst, fatigue, restlessness, blurred vision, confusion, weakness, Kussmaul’s respirations, diuresis, and coma when hyperglycemia is severe.
Option A are signs of infection.
Option B are signs of hyperthyroidism.
Option C are signs of hypothyroidism.
A nurse is preparing to hang a fat emulsion (lipids) and observes some visible fat globules at the top of the solution. The nurse ensure to do which of the following actions?
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Solution
Take another bottle of solution.
Fat emulsions are used as dietary supplements for patients who are unable to get enough fat in their diet, usually because of certain illnesses or recent surgery. The nurse should examine the bottle of fat emulsion for separation of emulsion into layers or fat globules or the accumulation of froth. The nurse should not hang a fat emulsion if any of these observed and should return the solution to the pharmacy.
A nurse is conducting a follow-up home visit to a client who has been discharged with a parenteral nutrition(PN). Which of the following should the nurse most closely monitor in this kind of therapy?
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Solution
Temperature and weight.
The client’s temperature is monitored to identify signs of infection which is one of the complications of this therapy. While the weight is monitored to detect hypervolemia and to determine the effectiveness of this nutritional therapy.
A nurse is preparing to hang the initial bag of the parenteral nutrition (PN) solution via the central line of a malnourished client. The nurse ensure the availability of which medical equipment before hanging the solution?
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Solution
Infusion pump.
The nurse should prepare an infusion pump prior hanging a parenteral solution. The use of an infusion pump is important to make sure that the solution does not infuse too quickly or delayed since the parenteral nutrition has a high glucose content.
Option A: A glucometer is also needed since the client’s glucose level is monitored every 4 to 6 hours, but it is not an essential item needed.
Options B and C are not used before hanging a PN solution.
A nurse is monitoring the status of a client’s fat emulsion (lipid) infusion and notes that the infusion is 2 hours delay. The nurse should do which of the following actions?
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Solution
Make sure the infusion rate is infusing at the ordered rate.
The nurse should maintain the prescribed rate of a fat emulsion even if the infusion’s time consume is behind.
Options A, C, and D are incorrect since increasing the rate will potentially cause a fluid overload.
A patient receiving parenteral nutrition is administered via the following routes except:
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Solution
PEG tube.
Percutaneous endoscopic gastrostomy (PEG tube) is inserted into a person’s stomach through the abdominal wall that is used to provide a means of feeding when oral intake is not adequate. While Parenteral nutrition bypasses the digestive system by the administration to the bloodstream.