Exam 1 TPN Lewis questions and
answers,. 100% verified.
The patient has parenteral nutrition infusing with amino acids and dextrose. In report, the oncoming
nurse is told that the tubing, the bag, and the dressing were changed 22 hours ago. What care should
the nurse coming on be prepared to do (select all that apply)?
a. Give the patient insulin.
b. Check amount of feeding left in the bag.
c. Check that the next bag has been ordered.
d. Check the insertion site and change the tubing.
e. Check the label to ensure ingredients and solution are as ordered. - ✔✔Correct answer: b,c,e
Rationale: The nurse should check the amount of feeding left in the bag, and that the next bag has been
ordered to be sure the solution will not run out before the next bag is available. Parenteral nutrition
solutions are only good for 24 hours and usually take some time for the pharmacy to mix for each
patient. The label on the bag should be checked to ensure that the ingredients and solution are what
was ordered. The patient would only receive insulin if the patient is experiencing hyperglycemia and was
receiving sliding scale insulin or had diabetes mellitus. The insertion site should be checked, but the
tubing is only changed every 72 hours unless lipids are being used.
Which assessment should the nurse prioritize in the care of a patient who has recently begun receiving
parenteral nutrition (PN)?
a. Skin integrity and bowel sounds
b. Electrolyte levels and daily weights
c. Auscultation of the chest and tests of blood coagulability
d. Peripheral vascular assessment and level of consciousness (LOC) - ✔✔Correct answer: b
Rationale: The use of PN necessitates frequent and thorough assessments. Key focuses of these
assessments include daily weights and close monitoring of electrolyte levels. Assessments of bowel
sounds, integument, peripheral vascular system, LOC, chest sounds, and blood coagulation may be
variously performed, but close monitoring of fluid and electrolyte balance supersedes these in
importance.
, A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral
nutrition (PN). Which principle should guide the nurse's administration of the patient's nutrition?
a. Administration of PN requires clean technique
.b. Central PN requires rapid dilution in a large volume of blood
.c. Peripheral PN delivery is preferred over the use of a central line.
d. Only water-soluble medications may be added to the PN by the nurse. - ✔✔B
Rationale: Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is
an excellent medium for microbial growth, aseptic technique is necessary during administration.
Administration through a central line is preferred over the use of peripheral PN, and the nurse may not
add any medications to PN.
An older patient was admitted with a fractured hip after being found on the floor of her home. She was
extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding
would be of most concern to the nurse?
a. Blood glucose level of 125 mg/dL
b. Serum phosphate level of 1.9 mg/dL
c. White blood cell count of 10,500/µL
d. Serum potassium level of 4.6 mEq/L - ✔✔B
Rationale: Refeeding syndrome can occur if a malnourished patient is started on aggressive nutritional
support. Hypophosphatemia (serum phosphate level less than 2.4 mg/dL) is the hallmark of refeeding
syndrome and could result in cardiac dysrhythmias, respiratory arrest, and neurologic problems. An
increase in the blood glucose level is expected during the first few days after PN is started. The goal is to
maintain a glucose range of 110 to 150 mg/dL. An elevated white blood cell count (greater than
11,000/µL) could indicate an infection. Normal serum potassium levels are between 3.5 and 5.0 mEq/L.
Priority Decision: The nurse is caring for a patient receiving 1000 mL of parenteral nutrition solution over
24 hours. When it is time to change the solution, 150 mL remain in the bottle. What is the most
appropriate action by the nurse?
a. Hang the new solution and discard the unused solution.
answers,. 100% verified.
The patient has parenteral nutrition infusing with amino acids and dextrose. In report, the oncoming
nurse is told that the tubing, the bag, and the dressing were changed 22 hours ago. What care should
the nurse coming on be prepared to do (select all that apply)?
a. Give the patient insulin.
b. Check amount of feeding left in the bag.
c. Check that the next bag has been ordered.
d. Check the insertion site and change the tubing.
e. Check the label to ensure ingredients and solution are as ordered. - ✔✔Correct answer: b,c,e
Rationale: The nurse should check the amount of feeding left in the bag, and that the next bag has been
ordered to be sure the solution will not run out before the next bag is available. Parenteral nutrition
solutions are only good for 24 hours and usually take some time for the pharmacy to mix for each
patient. The label on the bag should be checked to ensure that the ingredients and solution are what
was ordered. The patient would only receive insulin if the patient is experiencing hyperglycemia and was
receiving sliding scale insulin or had diabetes mellitus. The insertion site should be checked, but the
tubing is only changed every 72 hours unless lipids are being used.
Which assessment should the nurse prioritize in the care of a patient who has recently begun receiving
parenteral nutrition (PN)?
a. Skin integrity and bowel sounds
b. Electrolyte levels and daily weights
c. Auscultation of the chest and tests of blood coagulability
d. Peripheral vascular assessment and level of consciousness (LOC) - ✔✔Correct answer: b
Rationale: The use of PN necessitates frequent and thorough assessments. Key focuses of these
assessments include daily weights and close monitoring of electrolyte levels. Assessments of bowel
sounds, integument, peripheral vascular system, LOC, chest sounds, and blood coagulation may be
variously performed, but close monitoring of fluid and electrolyte balance supersedes these in
importance.
, A patient who has suffered severe burns in a motor vehicle accident will soon be started on parenteral
nutrition (PN). Which principle should guide the nurse's administration of the patient's nutrition?
a. Administration of PN requires clean technique
.b. Central PN requires rapid dilution in a large volume of blood
.c. Peripheral PN delivery is preferred over the use of a central line.
d. Only water-soluble medications may be added to the PN by the nurse. - ✔✔B
Rationale: Central PN is hypertonic and requires rapid dilution in a large volume of blood. Because PN is
an excellent medium for microbial growth, aseptic technique is necessary during administration.
Administration through a central line is preferred over the use of peripheral PN, and the nurse may not
add any medications to PN.
An older patient was admitted with a fractured hip after being found on the floor of her home. She was
extremely malnourished and started on parenteral nutrition (PN) 3 days ago. Which assessment finding
would be of most concern to the nurse?
a. Blood glucose level of 125 mg/dL
b. Serum phosphate level of 1.9 mg/dL
c. White blood cell count of 10,500/µL
d. Serum potassium level of 4.6 mEq/L - ✔✔B
Rationale: Refeeding syndrome can occur if a malnourished patient is started on aggressive nutritional
support. Hypophosphatemia (serum phosphate level less than 2.4 mg/dL) is the hallmark of refeeding
syndrome and could result in cardiac dysrhythmias, respiratory arrest, and neurologic problems. An
increase in the blood glucose level is expected during the first few days after PN is started. The goal is to
maintain a glucose range of 110 to 150 mg/dL. An elevated white blood cell count (greater than
11,000/µL) could indicate an infection. Normal serum potassium levels are between 3.5 and 5.0 mEq/L.
Priority Decision: The nurse is caring for a patient receiving 1000 mL of parenteral nutrition solution over
24 hours. When it is time to change the solution, 150 mL remain in the bottle. What is the most
appropriate action by the nurse?
a. Hang the new solution and discard the unused solution.
