A client is receiving total parenteral nutrition (TPN) via a subclavian central line, and the solution bag is nearly empty. The next bag of TPN is not available from the pharmacy. Which action should the nurse implement until the fluid arrives?

Slow the infusion rate and catch up the rate when the next TPN solution arrives.

Flush the central line with a heparin solution and cap the subclavian access.

Start 1,000 mL of 0.9% sodium chloride and monitor the serum glucose levels.

Follow the TPN with a 10% dextrose solution at the current rate of infusion.

Answer and Explanation

The Correct Answer is C

A. Slow the infusion rate and catch up the rate when the next TPN solution arrives. Slowing the

infusion rate may not provide adequate nutrition to the client, and catching up the rate later could lead to complications such as hyperglycemia or hypoglycemia.
B.   Flush the central line with a heparin solution and cap the subclavian access. Flushing the central line with heparin and capping the access would not provide the client with nutrition and could increase the risk of line occlusion.

C.   Start 1,000 mL of 0.9% sodium chloride and monitor the serum glucose levels. Starting 0.9% sodium chloride (normal saline) provides hydration and helps maintain electrolyte balance until the next bag of TPN is available. Monitoring serum glucose levels is essential to ensure that the client's glucose levels remain within the target range.
D.   Follow the TPN with a 10% dextrose solution at the current rate of infusion. Administering a 10% dextrose solution could lead to hyperglycemia, especially if the client does not require additional glucose. It is important to maintain appropriate glucose levels while awaiting the next bag of TPN.

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Correct Answer is B

Explanation

A. Determine pH value of specimen. While pH testing can help confirm gastric placement of the NGT, the appearance of cloudy green fluid suggests a different issue that should be addressed first.
B. Send fluid specimen to the laboratory. Cloudy green fluid aspirated from the NGT suggests possible infection or contamination and should be sent to the laboratory for analysis to determine the presence of pathogens or other abnormalities.
C. Withdraw the NGT and reinsert. This may be necessary if placement is incorrect, but the cloudy green fluid suggests a potential issue beyond placement.
D. Connect the NGT to wall suction. Suctioning should not be initiated until the nature of the aspirated fluid is determined. If the fluid is infected, suctioning it could spread pathogens or cause further complications.

A. Advise the PN that waist circumference measurements are valuable to assess fluid retention but not obesity. B. Tell the PN that this assessment technique should be performed by the nurse. C. Review the measurement obtained by the PN and compare with ideal measurements for this client. D. Instruct the PN to measure the client's waist circumference every 8 hours to assess for changes.

Correct Answer is C

Explanation

A. Advise the PN that waist circumference measurements are valuable to assess fluid retention but not obesity. This statement is incorrect. Waist circumference is a valuable measure for assessing abdominal obesity and related health risks.

B. Tell the PN that this assessment technique should be performed by the nurse. Measuring waist circumference is within the scope of practice for a practical nurse and does not need to be performed by a registered nurse.
C. Review the measurement obtained by the PN and compare with ideal measurements for this client. This action ensures that the measurement is accurate and provides an opportunity to educate the client about the significance of waist circumference in relation to obesity and associated health risks.
D. Instruct the PN to measure the client's waist circumference every 8 hours to assess for changes. Waist circumference does not change significantly over such a short period and does not need to be measured this frequently.

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A client is receiving total parenteral nutrition (TPN) via a subclavian central line, and the solution bag is nearly empty. The next bag of TPN is not available from the pharmacy. Which action should the nurse implement until the fluid arrives?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While assessing placement of a nasogastric tube (NGT), the nurse aspirates cloudy green fluid into a syringe. Which intervention should the nurse implement?

Correct Answer is B

Explanation

The charge nurse observes a practical nurse (PN) measuring the waist circumference of a client who has expressed a concern about health problems related to obesity. Which action should the nurse implement?

Correct Answer is C

Explanation

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