A nurse is planning to administer total parenteral nutrition (TPN) to a client who is malnourished. Which of the following actions should the nurse plan to take? (Select all that apply.)

Remove the solution from the refrigerator 1 hr before infusing.

Increase the rate of the infusion as needed to keep it on schedule.

Weigh the client every other day.

Change the client's TPN catheter tubing every 72 hr.

Infuse TPN through a central venous line.

Answer and Explanation

Correct Answer : A,E

A. Remove the solution from the refrigerator 1 hr before infusing: Allowing the TPN solution to warm to room temperature helps reduce the risk of vein irritation and discomfort. Cold solutions can cause venospasm or systemic reactions when infused into the bloodstream.
B. Increase the rate of the infusion as needed to keep it on schedule: TPN must be administered at a consistent prescribed rate. Increasing the rate without orders can lead to hyperglycemia, fluid overload, or metabolic complications. Any delays should be reported to the healthcare provider.
C. Weigh the client every other day: Daily weight monitoring is essential in TPN therapy to assess fluid balance and nutritional status. Weighing the client only every other day may delay the recognition of fluid overload or dehydration.
D. Change the client's TPN catheter tubing every 72 hr: TPN tubing should be changed every 24 hours to reduce the risk of catheter-related bloodstream infections. Extending beyond this time frame increases the likelihood of microbial contamination.
E. Infuse TPN through a central venous line: Due to its high glucose and osmolarity content, TPN must be administered via a central line to prevent phlebitis and allow for rapid, well-tolerated infusion. Peripheral administration is not suitable for long-term TPN.

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Correct Answer is ["A","B","C","D"]

Explanation

Preschooler unable to bear weight on legs when walking: This is a concerning physical limitation in a child of this age and suggests a possible musculoskeletal or nutritional disorder. In vitamin D deficiency, it may indicate bone pain or weakness due to poor mineralization, requiring prompt evaluation and intervention.
Preschooler refuses all dairy products: Dairy products are a primary source of dietary calcium and often fortified with vitamin D, both essential for healthy bone development. A prolonged lack of dairy in a young child's diet can lead to nutritional deficiencies, particularly if the overall diet is limited or unbalanced.
Legs are bowed bilaterally: Bowed legs in a preschool-aged child are a classic sign of rickets, a condition resulting from vitamin D deficiency. This skeletal deformity reflects impaired bone development and mineralization and warrants immediate medical follow-up to prevent further complications.
Vitamin D 5 ng/mL (25 to 80 ng/mL): This level is critically low and indicates a severe vitamin D deficiency. Such a deficiency impairs calcium absorption, leading to weakened bones and increasing the risk for rickets, fractures, and long-term skeletal issues if not corrected.

A. Elevate the head of the bed. B. Attach the barrel of the syringe to the tube after removing the plunger. C. Insert air into the tube before pulling back gastric contents. D. Flush the tube with 30 mL water.

Correct Answer is A

Explanation

A. Elevate the head of the bed: Raising the head of the bed to at least 30 to 45 degrees is the first and most essential action to reduce the risk of aspiration during enteral feeding. This position helps ensure that the formula flows into the stomach by gravity and minimizes the potential for reflux of gastric contents into the lungs, which can lead to aspiration pneumonia.
B. Attach the barrel of the syringe to the tube after removing the plunger: This step is necessary for gravity-based enteral feeding when using a syringe. However, it should only be done after confirming tube placement and ensuring the patient is positioned properly. Attaching the syringe before proper safety precautions increases the risk of aspiration.
C. Insert air into the tube before pulling back gastric contents: Injecting air into the gastrostomy tube is part of the verification process to confirm tube placement, often followed by aspirating gastric contents. While this is important, it is not the very first action. The client's head must be elevated first to ensure safety before any manipulation of the tube begins.
D. Flush the tube with 30 mL water: Flushing is necessary to ensure tube patency and to prevent blockage before and after feedings. However, it is not the first step in the procedure. Elevating the head of the bed comes before flushing to prevent aspiration during any subsequent feeding or fluid administration.

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A nurse is planning to administer total parenteral nutrition (TPN) to a client who is malnourished. Which of the following actions should the nurse plan to take? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is ["A","B","C","D"]

Explanation

A nurse is initiating an intermittent enteral feeding for a client who has a new gastrostomy tube. Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

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