A nurse is caring for a client whose current bag of total parenteral nutrition (TPN) has finished infusing, and the next bag is not yet available. Which of the following fluids should the nurse prepare to administer?

Pernicious anemia is a condition caused by a deficiency of intrinsic factor, preventing the absorption of dietary Vitamin B12(cyanocobalamin). Because the oral route is ineffective in these clients, B12 must be administered via parenteral or nasal routes to bypass the gastrointestinal tract. This therapy is essential for erythropoiesisand preventing irreversible neurological damage.

Rationale:

A.Using a nasal decongestant shortly before administering nasal cyanocobalamin is not recommended because it can alter the absorption of the vitamin by constricting the nasal vasculature. The client should be taught to avoid hot foods or liquids immediately before or after administration as well. If the client has a significant upper respiratory infection, they may need to switch to an intramuscular injection temporarily.

B.Nasal cyanocobalamin is typically administered once per week in a single nostril for maintenance therapy in clients with pernicious anemia. This schedule ensures a consistent supply of Vitamin B12 to maintain adequate red blood cell production and nerve health. The nurse must emphasize the weekly schedule to ensure the client remains compliant and avoids a return of hematologic symptoms.

C.There is no clinical requirement for a client to lie down for 1 hour after using nasal cyanocobalamin. The medication is absorbed through the nasal mucosa quite efficiently while the client is in a normal upright position. Instructing the client to lie down for such an extended period is unnecessary and would place an undue burden on their daily routine without improving drug efficacy.

D.Pernicious anemia is a chronic, lifelong condition because the lack of intrinsic factor cannot be cured. Therefore, Vitamin B12 replacement therapy must be continued for the duration of the client's life, not just for 6 months. Stopping the medication will eventually lead to a recurrence of megaloblastic anemia and potentially permanent damage to the spinal cord and peripheral ne

Inject 5 units of air into the NPH insulin vial.

Inject 15 units of air into the regular insulin vial.

Withdraw 15 units of medication from the regular insulin vial.

Withdraw 5 units of medication from the NPH insulin vial.

Brief Introduction:

Insulin mixturepreparation requires a specific sequence to prevent cross-contamination of vials and ensure dosage accuracy. Regular insulinis a short-acting, clear solution, while NPH insulinis an intermediate-acting, cloudy suspension. Maintaining the "clear before cloudy" withdrawal rule is a critical safety standard in clinical pharmacology to avoid contaminating the fast-acting clear vial with the protein-binding agents found in the NPH suspension.

Rationale:

A. Injecting 15 units of air into the regular insulinvial is the second step in the sequence. After the NPH vial has been pressurized with air, the needle is withdrawn and inserted into the clear vial. This ensures that the clear insulin vial is ready for immediate withdrawal without needing to re-enter the cloudy vial later, which maintains the chemical purityof the short-acting insulin.

B. Withdrawing 5 units of medication from the NPH insulinvial is the final step of the procedure. Because NPH contains protamine, any accidental backflow into the regular vial would alter the clear insulin's pharmacokinetic properties. By withdrawing the cloudy insulin last, the nurse ensures the integrity of the fast-acting dose, which is essential for managing postprandial glucose spikes.

C. Withdrawing 15 units of medication from the regular insulinvial occurs after air has been injected into both vials. The clear insulin is always drawn up first into the syringe to ensure that no cloudy suspensionenters the clear vial. This order is a standard nursing competency designed to prevent the modification of the onset and peak action of the clear insulin dose.

D. Injecting 5 units of air into the NPH insulinvial is the initial step in preparing a mixed dose. Vials are sealed vacuum environments; therefore, air equal to the dose must be injected to allow for the easy displacement of fluid. Starting with the cloudy vialfor air injection (without the needle touching the solution) allows the nurse to then move to the clear vial for the withdrawal phase.