Elsiver NCLEX Critical Care (Answered
2022/2023) 100%
A client is being weaned from parenteral nutrition (PN) and is expected to begin
taking solid food today. The ongoing solution rate has been 100 mL/hour. The
nurse anticipates that which prescription regarding the PN solution will
accompany the diet prescription?
1.
Discontinue the PN.
2.
Decrease PN rate to 50 mL/hour.
3.
Start 0.9% normal saline at 25 mL/hour.
4.
Continue current infusion rate prescriptions for PN.
Decrease PN rate to 50 mL/hour.
When a client begins eating a regular diet after a period of receiving PN, the PN is
decreased gradually. PN that is discontinued abruptly can cause hypoglycemia. Clients
often have anorexia after being without food for some time, and the digestive tract also
is not used to producing the digestive enzymes that will be needed. Gradually
decreasing the infusion rate allows the client to remain adequately nourished during the
transition to a normal diet and prevents the occurrence of hypoglycemia. Even before
clients are started on a solid diet, they are given clear liquids followed by full liquids to
further ease the transition. A solution of normal saline does not provide the glucose
needed during the transition of discontinuing the PN and could cause the client to
experience hypoglycemia.
The nurse is preparing to change the parenteral nutrition (PN) solution bag and
tubing. The client's central venous line is located in the right subclavian vein. The
nurse asks the client to take which essential action during the tubing change?
1.
Breathe normally.
2.
Turn the head to the right.
3.
Exhale slowly and evenly.
4.
Take a deep breath, hold it, and bear down.
Take a deep breath, hold it, and bear down.
The client should be asked to perform the Valsalva maneuver during tubing changes.
,This helps avoid air embolism during tubing changes. The nurse asks the client to take
a deep breath, hold it, and bear down. If the intravenous line is on the right, the client
turns his or her head to the left. This position increases intrathoracic pressure.
Breathing normally and exhaling slowly and evenly are inappropriate and could enhance
the potential for an air embolism during the tubing change.
A client with parenteral nutrition (PN) infusing has disconnected the tubing from
the central line catheter. The nurse assesses the client and suspects an air
embolism. The nurse should immediately place the client in which position?
1.
On the left side, with the head lower than the feet
2.
On the left side, with the head higher than the feet
3.
On the right side, with the head lower than the feet
4.
On the right side, with the head higher than the feet
On the left side, with the head lower than the feet
Air embolism occurs when air enters the catheter system, such as when the system is
opened for intravenous (IV) tubing changes or when the IV tubing disconnects. Air
embolism is a critical situation; if it is suspected, the client should be placed in a left
side-lying position. The head should be lower than the feet. This position is used to
minimize the effect of the air traveling as a bolus to the lungs by trapping it in the right
side of the heart. The positions in the remaining options are inappropriate if an air
embolism is suspected.
Which nursing action is essential prior to initiating a new prescription for 500 mL
of fat emulsion (lipids) to infuse at 50 mL/hour?
1.
Ensure that the client does not have diabetes.
2.
Determine whether the client has an allergy to eggs.
3.
Add regular insulin to the fat emulsion, using aseptic technique.
4.
Contact the health care provider (HCP) to have a central line inserted for fat
emulsion infusion.
Determine whether the client has an allergy to eggs.
The client beginning infusions of fat emulsions must be first assessed for known
allergies to eggs to prevent anaphylaxis. Egg yolk is a component of the solution and
provides emulsification. The remaining options are unnecessary and are not related
specifically to the administration of fat emulsion.
,The nurse monitors the client receiving parenteral nutrition (PN) for
complications of the therapy and should assess the client for which
manifestations of hyperglycemia?
1.
Fever, weak pulse, and thirst
2.
Nausea, vomiting, and oliguria
3.
Sweating, chills, and abdominal pain
4.
Weakness, thirst, and increased urine output
Weakness, thirst, and increased urine output
The high glucose concentration in PN places the client at risk for hyperglycemia. Signs
of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness,
Kussmaul respirations, diuresis, and coma when hyperglycemia is severe. If the client
has these symptoms, the blood glucose level should be checked immediately. The
remaining options do not identify signs specific to hyperglycemia.
The nurse is changing the central line dressing of a client receiving parenteral
nutrition (PN) and notes that the catheter insertion site appears reddened. The
nurse should next assess which item?
1.
Client's temperature
2.
Expiration date on the bag
3.
Time of last dressing change
4.
Tightness of tubing connections
Client's temperature
Redness at the catheter insertion site is a possible indication of infection. The nurse
would next assess for other signs of infection. Of the options given, the temperature is
the next item to assess. The tightness of tubing connections should be assessed each
time the PN is checked; loose connections would result in leakage, not skin redness.
The expiration date on the bag is a viable option, but this also should be checked at the
time the solution is hung and with each shift change. The time of the last dressing
change should be checked with each shift change.
The nurse is preparing to hang fat emulsion (lipids) and notes that fat globules
are visible at the top of the solution. The nurse should take which action?
, 1.
Roll the bottle of solution gently.
2.
Obtain a different bottle of solution.
3.
Shake the bottle of solution vigorously.
4.
Run the bottle of solution under warm water.
Obtain a different bottle of solution.
Fat emulsion (lipids) is a white, opaque solution administered intravenously during
parenteral nutrition therapy to prevent fatty acid deficiency. The nurse should examine
the bottle of fat emulsion for separation of emulsion into layers of fat globules or for the
accumulation of froth. The nurse should not hang a fat emulsion if any of these are
observed and should return the solution to the pharmacy. Therefore, the remaining
options are inappropriate actions.
A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse
notifies the health care provider (HCP), and the HCP initially prescribes that the
solution and tubing be changed. What should the nurse do with the discontinued
materials?
1.
Discard them in the unit trash.
2.
Return them to the hospital pharmacy.
3.
Save them for return to the manufacturer.
4.
Prepare to send them to the laboratory for culture.
Prepare to send them to the laboratory for culture.
When the client who is receiving PN develops a fever, a catheter-related infection
should be suspected. The solution and tubing should be changed, and the discontinued
materials should be cultured for infectious organisms per HCP prescription. The other
options are incorrect. Because culture for infectious organisms is necessary, the
discontinued materials are not discarded or returned to the pharmacy or manufacturer.
A client has been discharged to home on parenteral nutrition (PN). With each
visit, the home care nurse should assess which parameter most closely in
monitoring this therapy?
1.
Pulse and weight
2.
Temperature and weight
3.
2022/2023) 100%
A client is being weaned from parenteral nutrition (PN) and is expected to begin
taking solid food today. The ongoing solution rate has been 100 mL/hour. The
nurse anticipates that which prescription regarding the PN solution will
accompany the diet prescription?
1.
Discontinue the PN.
2.
Decrease PN rate to 50 mL/hour.
3.
Start 0.9% normal saline at 25 mL/hour.
4.
Continue current infusion rate prescriptions for PN.
Decrease PN rate to 50 mL/hour.
When a client begins eating a regular diet after a period of receiving PN, the PN is
decreased gradually. PN that is discontinued abruptly can cause hypoglycemia. Clients
often have anorexia after being without food for some time, and the digestive tract also
is not used to producing the digestive enzymes that will be needed. Gradually
decreasing the infusion rate allows the client to remain adequately nourished during the
transition to a normal diet and prevents the occurrence of hypoglycemia. Even before
clients are started on a solid diet, they are given clear liquids followed by full liquids to
further ease the transition. A solution of normal saline does not provide the glucose
needed during the transition of discontinuing the PN and could cause the client to
experience hypoglycemia.
The nurse is preparing to change the parenteral nutrition (PN) solution bag and
tubing. The client's central venous line is located in the right subclavian vein. The
nurse asks the client to take which essential action during the tubing change?
1.
Breathe normally.
2.
Turn the head to the right.
3.
Exhale slowly and evenly.
4.
Take a deep breath, hold it, and bear down.
Take a deep breath, hold it, and bear down.
The client should be asked to perform the Valsalva maneuver during tubing changes.
,This helps avoid air embolism during tubing changes. The nurse asks the client to take
a deep breath, hold it, and bear down. If the intravenous line is on the right, the client
turns his or her head to the left. This position increases intrathoracic pressure.
Breathing normally and exhaling slowly and evenly are inappropriate and could enhance
the potential for an air embolism during the tubing change.
A client with parenteral nutrition (PN) infusing has disconnected the tubing from
the central line catheter. The nurse assesses the client and suspects an air
embolism. The nurse should immediately place the client in which position?
1.
On the left side, with the head lower than the feet
2.
On the left side, with the head higher than the feet
3.
On the right side, with the head lower than the feet
4.
On the right side, with the head higher than the feet
On the left side, with the head lower than the feet
Air embolism occurs when air enters the catheter system, such as when the system is
opened for intravenous (IV) tubing changes or when the IV tubing disconnects. Air
embolism is a critical situation; if it is suspected, the client should be placed in a left
side-lying position. The head should be lower than the feet. This position is used to
minimize the effect of the air traveling as a bolus to the lungs by trapping it in the right
side of the heart. The positions in the remaining options are inappropriate if an air
embolism is suspected.
Which nursing action is essential prior to initiating a new prescription for 500 mL
of fat emulsion (lipids) to infuse at 50 mL/hour?
1.
Ensure that the client does not have diabetes.
2.
Determine whether the client has an allergy to eggs.
3.
Add regular insulin to the fat emulsion, using aseptic technique.
4.
Contact the health care provider (HCP) to have a central line inserted for fat
emulsion infusion.
Determine whether the client has an allergy to eggs.
The client beginning infusions of fat emulsions must be first assessed for known
allergies to eggs to prevent anaphylaxis. Egg yolk is a component of the solution and
provides emulsification. The remaining options are unnecessary and are not related
specifically to the administration of fat emulsion.
,The nurse monitors the client receiving parenteral nutrition (PN) for
complications of the therapy and should assess the client for which
manifestations of hyperglycemia?
1.
Fever, weak pulse, and thirst
2.
Nausea, vomiting, and oliguria
3.
Sweating, chills, and abdominal pain
4.
Weakness, thirst, and increased urine output
Weakness, thirst, and increased urine output
The high glucose concentration in PN places the client at risk for hyperglycemia. Signs
of hyperglycemia include excessive thirst, fatigue, restlessness, confusion, weakness,
Kussmaul respirations, diuresis, and coma when hyperglycemia is severe. If the client
has these symptoms, the blood glucose level should be checked immediately. The
remaining options do not identify signs specific to hyperglycemia.
The nurse is changing the central line dressing of a client receiving parenteral
nutrition (PN) and notes that the catheter insertion site appears reddened. The
nurse should next assess which item?
1.
Client's temperature
2.
Expiration date on the bag
3.
Time of last dressing change
4.
Tightness of tubing connections
Client's temperature
Redness at the catheter insertion site is a possible indication of infection. The nurse
would next assess for other signs of infection. Of the options given, the temperature is
the next item to assess. The tightness of tubing connections should be assessed each
time the PN is checked; loose connections would result in leakage, not skin redness.
The expiration date on the bag is a viable option, but this also should be checked at the
time the solution is hung and with each shift change. The time of the last dressing
change should be checked with each shift change.
The nurse is preparing to hang fat emulsion (lipids) and notes that fat globules
are visible at the top of the solution. The nurse should take which action?
, 1.
Roll the bottle of solution gently.
2.
Obtain a different bottle of solution.
3.
Shake the bottle of solution vigorously.
4.
Run the bottle of solution under warm water.
Obtain a different bottle of solution.
Fat emulsion (lipids) is a white, opaque solution administered intravenously during
parenteral nutrition therapy to prevent fatty acid deficiency. The nurse should examine
the bottle of fat emulsion for separation of emulsion into layers of fat globules or for the
accumulation of froth. The nurse should not hang a fat emulsion if any of these are
observed and should return the solution to the pharmacy. Therefore, the remaining
options are inappropriate actions.
A client receiving parenteral nutrition (PN) suddenly develops a fever. The nurse
notifies the health care provider (HCP), and the HCP initially prescribes that the
solution and tubing be changed. What should the nurse do with the discontinued
materials?
1.
Discard them in the unit trash.
2.
Return them to the hospital pharmacy.
3.
Save them for return to the manufacturer.
4.
Prepare to send them to the laboratory for culture.
Prepare to send them to the laboratory for culture.
When the client who is receiving PN develops a fever, a catheter-related infection
should be suspected. The solution and tubing should be changed, and the discontinued
materials should be cultured for infectious organisms per HCP prescription. The other
options are incorrect. Because culture for infectious organisms is necessary, the
discontinued materials are not discarded or returned to the pharmacy or manufacturer.
A client has been discharged to home on parenteral nutrition (PN). With each
visit, the home care nurse should assess which parameter most closely in
monitoring this therapy?
1.
Pulse and weight
2.
Temperature and weight
3.
