A critical care nurse is caring for a client diagnosed with acute pancreatitis. The nurse knows this client should be started on parenteral nutrition (PN) after what indications?
5% deficit in body weight compared to pre-illness weight and increased caloric need.
Significant risk of aspiration coupled with decreased level of consciousness.
Calorie deficit and muscle wasting combined with low electrolyte levels.
Inability to take in adequate oral food or fluids within 7 days.
The Correct Answer is D
Choice A rationale
A 5% deficit in body weight and increased caloric need alone do not warrant the initiation of parenteral nutrition (PN). PN is typically reserved for situations where oral or enteral feeding is not feasible or safe.
Choice B rationale
Significant risk of aspiration and decreased level of consciousness may necessitate alternative feeding methods, such as enteral feeding via a nasogastric or gastrostomy tube. PN is considered when enteral feeding is not possible.
Choice C rationale
Calorie deficit, muscle wasting, and low electrolyte levels indicate malnutrition, but PN is initiated when other feeding methods are inadequate or unsafe.
Choice D rationale
Inability to take in adequate oral food or fluids within 7 days is a clear indication for initiating PN. This ensures the patient receives essential nutrients and prevents further deterioration of their nutritional status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The nurse should check the equipment first when an ICP reading of 0 mm Hg is noted, as this may indicate equipment malfunction. An accurate ICP reading is critical for assessing and managing intracranial pressure to ensure the client's safety.
Choice B rationale
Continuing the assessment without checking the equipment may lead to incorrect conclusions based on a potentially faulty reading. It’s crucial to ensure the accuracy of the equipment before proceeding.
Choice C rationale
Documenting the reading as an effective treatment outcome without verifying its accuracy can be dangerous. An ICP reading of 0 mm Hg is unusual and warrants equipment verification.
Choice D rationale
Contacting the health care provider to review the care plan is premature until the equipment has been checked to rule out a false reading, ensuring the nurse provides accurate information.
Correct Answer is A
Explanation
Choice A rationale
The brain stem controls vital functions, including respiration. Damage to the brain stem, especially the medulla oblongata, can impair respiratory control, leading to the need for mechanical ventilation.
Choice B rationale
The parietal lobe is responsible for sensory processing and does not directly influence respiratory functions. Damage here would more likely affect sensation and spatial awareness.
Choice C rationale
The occipital lobe is primarily responsible for visual processing. Injury to this area would result in visual deficits rather than impaired respiration.
Choice D rationale
The frontal lobe is involved in cognitive functions, voluntary movement, and speech production, but it does not control respiration. Damage here would affect higher cognitive functions and motor planning.
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