Nurse Russell is preparing to give a total parenteral nutrition using a central line. Place the following steps for administration in the correct order?
1. Connect the tubing to the central line.
2. Regulate the electric infusion pump at the ordered rate.
3. Maintain aseptic technique when handling the injection cap.
4. Check the solution for cloudiness, particles, or a change in color.
5. Prime the IV tubing through an infusion pump.
6. Select and flush the correct tubing and filter.
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Solution
4, 6, 5, 3, 1, and 2.
Nurse Spencer is caring for an anorexic client who is having total parenteral nutrition solution for the first time. Which of the following assessments requires the most immediate attention?
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Solution
Blood glucose of 210 mg/dl.
Total parenteral nutrition formula contains dextrose range from 5% to 70%. A blood glucose level of 210mg/dl is considered high.
A nurse is caring for a combative client who is ordered to have a nutritional therapy using parenteral nutrition (PN). The nurse should plan which of the following measures to prevent the client from injury?
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Solution
Secure all connections in the parenteral system.
The nurse should plan to secure all connections in the tubing. This will prevent the client from pulling the connections apart.
A client receiving parenteral nutrition (PN) complains of shortness of breath and shoulder pain. A nurse notes that the client has an increased pulse rate. The nurse determines that the client is experiencing which complication of PN therapy?
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Solution
Pneumothorax.
Pneumothorax might happen during a parenteral therapy due to inexact catheter placement. In order to prevent this, the nurse obtains a chest x-ray after insertion of the catheter to ensure proper catheter placement.
A nurse observes the client receiving fat emulsions is having hives. A nurse reviews the client’s history and note in which of the following may cause about by the complaint of the client?
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Solution
Allergy to an egg.
Fat emulsions (lipids) contain egg yolk phospholipids and should not be given to clients with egg allergies.
A 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 ask the client to take which essential action during the tube change?
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Solution
Inhale deeply, hold it, and bear down.
The client should be asked to perform the Valsalva maneuver during tubing changes. This helps avoid air embolism during tube changes. The nurse asks the client to take a deep breath, hold it, and bear down.
Option A is incorrect because if the intravenous line is on the right, the client turns his or head to the left. This position increases intrathoracic pressure.
Options C and D can cause the potential for an air embolism during the tube change.
A client receiving parenteral nutrition (PN) complains of a headache. A nurse notes that the client has a bounding pulse, jugular distension, and weight gain greater than desired. The nurse determines that the client is experiencing which complication of PN therapy?
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Solution
Hypervolemia.
The client’s sign and symptoms are consistent with hypervolemia. This happen when the client receives excessive fluid administration or administration of fluid too rapidly.
A nurse is changing the central line dressing of a client receiving parenteral nutrition (PN) and notes that there are redness and drainage at the insertion site. The nurse next assesses which of the following?
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Solution
Client’s temperature.
Redness at the catheter insertion site is a possible sign of infection. The nurse would next assess for other signs of infection. Of the options given, the temperature is the next item to assess.
A client is receiving parenteral nutrition (PN) suddenly is having a fever. A nurse notifies the physician and the physician initially prescribes that the solution and tubing be changed. The nurse should do which of the following with the discontinued materials?
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Solution
Send them to the laboratory for culture.
When the client who is receiving PN has a high temperature, a catheter-related infection should be suspected. The solution and tubing should be changed, and the discontinued materials should be cultured for an infectious organism.
A nurse is caring for a group of clients on a medical-surgical nursing unit. The nurse recognizes that which of the following clients would be the least likely candidate for parenteral nutrition?
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Solution
A 59-year old client who had an appendectomy.
The client with an appendectomy is not a candidate because this client would resume a regular diet within a few days following the surgery.
Options A, B, and D are incorrect because parenteral nutrition is indicated in these clients since their gastrointestinal tracts are not functional or who cannot take in a diet enterally for extended periods.