The nurse is preparing to hang the client's next bag of Total Parenteral Nutrition (TPN) and observes fat globules rising to the top of the solution. What action should the nurse take?

Run the bag under warm water to melt the globules.

Call the pharmacy to get a new bag of TPN.

Do nothing, as fat globules are expected to rise to the top of the TPN solution.

Roll the bag of solution gently to redistribute the fat.

Answer and Explanation

The Correct Answer is B

Choice A Reason
Running the bag under warm water to melt the globules is not recommended. Applying heat could compromise the sterility and integrity of the solution. TPN solutions are carefully balanced and sterile, and any manipulation involving temperature changes could lead to contamination or nutrient degradation.

Choice B Reason
Observing fat globules at the top of the TPN solution is a sign that the emulsion may be compromised. The nurse should not administer this TPN solution and should call the pharmacy for a replacement. TPN solutions should be homogenous with no visible separation or fat globules to ensure the patient receives the correct nutrition and to prevent complications.

Choice C Reason
Doing nothing is not an appropriate action. Fat globules indicate that the solution has separated, which can lead to an unstable emulsion and potential harm if infused. The nurse's responsibility is to ensure the safety and efficacy of the treatment, which includes verifying that TPN solutions are properly mixed.

Choice D Reason
Rolling the bag gently to redistribute the fat is not a safe practice. While gentle agitation can be used for some medications, it is not appropriate for TPN solutions with visible fat globules. This could further destabilize the emulsion and does not address the underlying issue of separation.

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Correct Answer is D

Explanation

Choice a reason:
Warming the hands with water before testing is actually a recommended practice. It helps increase blood flow to the fingertips, making it easier to get a sufficient blood sample for testing. Cold hands can restrict blood flow, leading to difficulty in obtaining a blood sample and potentially inaccurate results.

Choice b reason:
Alternating fingers for blood glucose testing is also a recommended practice. It helps prevent soreness and calluses on the fingers from repeated pricks. Using different fingers or different sides of the same finger can help reduce pain and potential damage to the skin.

Choice c reason:
Choosing the center of the finger pad as a puncture site is not recommended. The sides of the fingertips are preferred because they have fewer nerve endings, making the process less painful. The center of the finger pad has a denser nerve supply and can lead to more discomfort during the test.

Choice d reason:
A random blood glucose result of 115 mg/dL is slightly above the normal range for non-diabetics, which is typically between 70 to 99 mg/dL when fasting. For someone with diabetes, this result might be considered within a target range, depending on individual treatment goals set by healthcare providers. However, it's important to note that a single glucose reading does not provide a complete picture of glucose control. An A1C test, which reflects average blood glucose levels over the past 2-3 months, is also necessary to assess overall glucose management.

A. Apply cool compresses to the affected limb every six hours. B. Place a soft pillow under the affected knee. C. Promote bedrest for 24 hours. D. Encourage increased fluid intake.

Correct Answer is D

Explanation

Choice A Reason
Applying cool compresses to the affected limb can help reduce swelling and provide pain relief. However, it's important to follow the surgeon's specific postoperative orders, as the application of cold can vary depending on the surgical technique and patient's condition.

Choice B Reason
Placing a soft pillow under the knee is not recommended after total knee replacement surgery. This position can lead to decreased range of motion and contractures. The knee should be kept in a more extended position to promote healing and mobility.

Choice C Reason
Promoting bedrest for an extended period is not typically advised following knee replacement surgery. Early mobilization is important to prevent complications such as deep vein thrombosis and to encourage circulation and healing. The duration of bedrest should be as per the surgeon's protocol.

Choice D Reason
Encouraging increased fluid intake is important after surgery to prevent dehydration, promote kidney function, and ensure adequate blood volume and circulation. Proper hydration is essential for healing and can help with the metabolism of medications used during and after surgery.

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The nurse is preparing to hang the client's next bag of Total Parenteral Nutrition (TPN) and observes fat globules rising to the top of the solution. What action should the nurse take?

Nursing Test Bank

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