A patient is admitted with severe malnutrition. A central venous catheter is placed in the right subclavian vein and total parenteral nutrition (TPN) is started. What medical interventions may be initiated with the onset of hyperglycemia?

Adding insulin to the TPN

Discontinuing the infusion

Weaning from the TPN over a 6-hour period

Starting an infusion of 0.9% normal saline

Answer and Explanation

The Correct Answer is A

A. Insulin can be added to the TPN to control blood sugar levels. TPN often leads to hyperglycemia, and insulin is commonly added to the solution to regulate glucose levels.
B. Discontinuing the infusion would not address the hyperglycemia and would risk nutrient deficiencies.
C. Weaning from TPN may be indicated when discontinuing the nutrition support, but it is not a direct intervention for hyperglycemia.
D. Starting an infusion of 0.9% normal saline would not address the hyperglycemia directly and may not be effective in managing the glucose levels.

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Correct Answer is C

Explanation

A. Sodium Bicarbonate is incorrect as it is not a first-line treatment for VF. It may be considered in cases of severe acidosis or hyperkalemia.
B. Amiodarone is incorrect as it is used as an antiarrhythmic, but epinephrine is administered first during cardiac arrest to increase perfusion.
C. Epinephrine is correct because it is the first-line drug given in ventricular fibrillation that persists after defibrillation. It increases coronary and cerebral perfusion and enhances the effectiveness of subsequent defibrillation attempts.
D. Lidocaine is incorrect as it is an antiarrhythmic that may be considered after epinephrine and amiodarone, but it is not the first choice.

A. Request a consultation by the facility's Ethics Committee B. Rely on other medical interventions to support the client's needs related to the drop-in hemoglobin C. Discuss at length the impact refusing the blood transfusion on the client's prognosis D. Relay the decision until it's apparent the hemoglobin level is dropping even lower E. Ask that other members of the client's immediate family provide insight regarding the client's view on blood transfusions F. Arrange for a Jehovah's Witness clergy member to discuss the situation with the client's father G. Apply to the court system to arbitrate the conflict

Correct Answer is ["A","G"]

Explanation

A. Requesting a consultation by the facility's Ethics Committee is appropriate because it can provide guidance in resolving the ethical conflict between the parents' differing views and the principle of autonomy for the child.
B. Relying on other medical interventions to support the client's needs related to the drop-in hemoglobin is not correct. While alternative treatments may be considered, this would not resolve the ethical conflict regarding the blood transfusion and does not directly address the dilemma between the parents.
C. Discussing at length the impact refusing the blood transfusion on the client's prognosis is not the best initial step. Although it may be helpful to provide this information, the core issue here is parental disagreement and religious beliefs, which should be addressed through legal or ethical consultations rather than simply offering further explanations.
D. Relaying the decision until it's apparent the hemoglobin level is dropping even lower is not appropriate. Delaying the decision may jeopardize the patient's life and does not respect the urgency of the situation or resolve the parental conflict.
E. Asking that other members of the client's immediate family provide insight regarding the client's view on blood transfusions is not the most effective option. While family members may have insight, this does not resolve the conflict between the parents and may not be legally binding.
F. Arranging for a Jehovah's Witness clergy member to discuss the situation with the client's father may provide some guidance, but it is unlikely to resolve the legal and ethical conflict about the blood transfusion. A clergy member's intervention is helpful in supporting religious beliefs but does not address the medical or legal implications of the decision.
G. Applying to the court system to arbitrate the conflict may be necessary if the parents cannot reach a consensus and if the medical team believes that the life-saving treatment should proceed. The court can make decisions based on the best interests of the child, particularly when there is a disagreement between parents.

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A patient is admitted with severe malnutrition. A central venous catheter is placed in the right subclavian vein and total parenteral nutrition (TPN) is started. What medical interventions may be initiated with the onset of hyperglycemia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse and the other members of the team are caring for a client in the ED who converted to ventricular fibrillation (VF). The client was defibrillated unsuccessfully and the client remains in VF. Which medication should the nurse be prepared to administer?

Correct Answer is C

Explanation

Correct Answer is ["A","G"]

Explanation

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