Orders were written for a client to be weaned off of total parenteral nutrition (TPN) and started on a low-residue diet. The TPN solution has been infusing at a continuous rate of 90 ml/hr for three weeks. Which of the following orders should the nurse anticipate next?

Decrease the TPN rate to 60 ml/hr

Replace TPN infusion with an intravenous dextrose solution

Begin infusion of 0.9% normal saline at 30 ml/hr

Discontinue TPN infusion

Answer and Explanation

The Correct Answer is B

A. Decrease the TPN rate to 60 ml/hr: Gradually decreasing the TPN rate is a common practice, but it is typically done in conjunction with transitioning to another form of nutrition, not as a standalone order.
B. Replace TPN infusion with an intravenous dextrose solution: This is the correct choice. When weaning off TPN, it is important to prevent hypoglycemia by replacing the TPN with a dextrose solution to maintain blood glucose levels while transitioning to oral or enteral feeding.
C. Begin infusion of 0.9% normal saline at 30 ml/hr: While saline may be used for hydration, it does not address the need to manage blood glucose levels during the transition from TPN.
D. Discontinue TPN infusion: Discontinuing TPN abruptly can lead to complications such as hypoglycemia. It is important to gradually taper off TPN while replacing it with a dextrose solution.

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Correct Answer is D

Explanation

A. Intraosseous line: Intraosseous lines are used for emergency situations when peripheral access is not available, and are not suitable for long-term chemotherapy administration due to the risk of complications and discomfort.
B. Intrathecal catheter: Intrathecal catheters are used for delivering medication directly into the spinal canal. They are not suitable for systemic chemotherapy administration, which requires vascular access.
C. Peripheral intravenous line: Peripheral intravenous lines are typically used for short-term treatments. They are not ideal for long-term chemotherapy because they need frequent replacement, and the veins can become damaged from prolonged use of chemotherapeutic agents.
D. Subcutaneous implantable port: A subcutaneous implantable port is the best option for long-term chemotherapy. It is implanted under the skin, reducing the risk of infection, and provides a stable and reliable access point for repeated treatments over several months.

A. 0.45% Sodium Chloride B. 10% dextrose in water C. 5% dextrose in water D. 0.9% Sodium Chloride

Correct Answer is D

Explanation

A. 0.45% Sodium Chloride: This is a hypotonic solution, which is not appropriate for a client with normal serum osmolality (290 mOsm/kg). It may cause fluid shifts that are not desirable in this context.
B. 10% dextrose in water: This hypertonic solution is generally used for providing calories rather than correcting fluid imbalance and is not suitable for initial rehydration in this scenario.
C. 5% dextrose in water: This solution is isotonic in the bag but becomes hypotonic in the body. It is not the best choice for rehydrating a client with normal serum osmolality and significant fluid loss.
D. 0.9% Sodium Chloride: This isotonic solution is appropriate for rehydration in a client with normal serum osmolality. It helps restore extracellular fluid volume without causing fluid shifts, making it ideal for this situation.

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Orders were written for a client to be weaned off of total parenteral nutrition (TPN) and started on a low-residue diet. The TPN solution has been infusing at a continuous rate of 90 ml/hr for three weeks. Which of the following orders should the nurse anticipate next?

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Naxlex Comprehensive Predictor Exams

A client with leukemia is expected to require chemotherapy for several months. Which type of IV line will best meet the client's needs?

Correct Answer is D

Explanation

A client with dry skin and mucous membranes is weak, has orthostatic blood pressure changes, and has decreased urine output. The serum osmolality is 290 mOsm/kg. What IV fluid should the nurse anticipate being prescribed for this client?

Correct Answer is D

Explanation

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