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 anticipated that which prescription regarding PN 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 prescription for PN
2. Rationale- 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 beng 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. Breath normally
2. Turn the head to the right
3. Exhale slowly and evenly
4. Take a deep breath, hold it, and bear down.
4. Rationale- 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 is 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
1. Rationale- 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
2. Rationale-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 to the administration of fat emulsion.
A client is receiving parenteral nutrition (PN). The nurse monitors the client 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
4. Rationale-The high glucose concentration in PN places the client at risk for hyperglycemia. Signs of hyperglycemia include excessive thirst, fatigue,
restlessness, confusion, weakness, Kussmaul's 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 of the bag
3. Time of last dressing change
4. Tightness of tubing connections
1. Rationale- 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 connection 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. Rolls the bottle of solution gently
2. Obtains a dif ferent bottle of solution
3. Shakes the bottle of solution vigorously
4. Runs the bottle of solution under warm water .
2. Rationale- 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. Send them to the laboratory for culture
4. Save them for return to the manufacturer
3. Rationale- 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. 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. Pulse and blood pressure
4. Temperature and blood pressure
2. Rationale-The client receiving PN at home should have her or his temperature monitored as a means of detecting infection, which is a potential
complication of this therapy . An infection also could result in sepsis because the catheter is in a blood vessel. The client's weight is monitored as a
measure of the ef fectiveness of this nutritional therapy and to detect hypervolemia. The pulse and blood pressure are important parameters to assess, but
they do not relate specifically to the ef fects of PN.
The nurse is caring for a group of adult clients on an acute care medical-surgical nursing unit. The nurse understands that
which client would be the least likely candidate for parenteral nutrition (PN)?
1. A 66 year-old client with extensive burns
2. A 42 year-old client who has had an open cholecystectomy
3. A 27 year-old client with severe exacerbation of Crohn's disease
4. A 35 year-old client with persistant nausea and vomiting from chemotherapy
2. Rationale- Parenteral nutrition is indicated in clients whose gastrointestinal tracts are not functional or must be rested, cannot take in a diet enterally for
extended periods, or have increased metabolic need. Examples of these conditions include those clients with burns, exacerbation of Chron's disease, and
persistent nausea and vomiting due to chemotherapy . Other clients would be those who have had extensive surgery , have multiple fractures, are septic, or
have advanced cancer or acquired immunodeficiency syndrome. The client with the open cholecystectomy is not a candidate because this client would
resume a regular diet within a few days following surgery . The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line of an assigned client.
The nurse should obtain which most essential piece of equipment before hanging the solution?
1. Urine test strips
2. Blood glucose meter
3. Electronic infusion pump
4. Noninvasive blood pressure monitor
3. Rationale- The nurse obtains an electronic infusion pump before hanging a PN solution. Because of the high glucose content, use of an infusion pump
is necessary to ensure that the solution does not infuse too rapidly or fall behind. Because the client's blood glucose level is monitored every 4 to 6 hours
during administration of PN, a blood glucose meter also will be needed, but this is not the most essential item needed before hanging the solution. Urine
test strips (to measure glucose) rarely are used because of the advent of blood glucose monitoring. Although the blood pressure will be monitored, a
noninvasive blood pressure monitor is not the most essential piece of equipment needed for this procedure.
The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an
assigned client is empty . Which solution readily available on the nursing unit should the nurse hang until another PN
solution is mixed and delivered to the nursing unit?
1. 5% dextrose in water
2. 10% dextrose in water
3. 5% dextrose in Ringer's lactate
4. 5% dextrose in 0.9% sodium chloride
2. Rationale- The client is at risk for hypoglycemia; therefore the solution containing the highest amount of glucose should be hung until the new PN
solution becomes available. Because PN solutions contain high glucose concentrations, the 10% dextrose in water solution is the best of the choices
presented. The solution selected should be one that minimizes the risk of hypoglcemia. The remaining options will not be as ef fective in minimizing the risk
of hypoglycemia.
The nurse monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 1 hour behind.
Which action should the nurse take?
1. Adjust the infusion rate to catch up over the next hour
2. Increase the infusion rate to catch up over the next two hours
3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate
4. Adjust the infusion rate to run wide open until the solution is back on time
3. Rationale- The nurse should not increase the rate of a fat emulsion to make up the dif ference if the infusion timing falls behind. Doing so could place the
client at risk for fat overload. In addition, increasing the rate suddenly can cause fluid overload. The same principle (not increasing the rate) applies to PN
or any intravenous (IV) infusion. Therefore the remaining options are incorrect.
A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next
assess the client for the presence of which condition?
1. Thirst
2. Polyuria
3. Decreased blood pressure
4. Crackles on auscultation of the lungs
4. Rationale- Optimal weight gain when the client is receiving PN is 1 to 2lb/week. The client who has a weight gain of 5lb/week while receiving PN is likely
to have fluid retention. This can result in hypervolemia. Signs of hypervolemia include increased blood pressure, crackles on lung auscultation, a bounding
pulse, jugular vein distention, headache, and weight gain more than desired. Thirst and polyuria are associated with hyperglycemia. A decreased blood
pressure is likely to be noted in deficient fluid volume.
The nurse is caring for a restless client who is beginning nutritional therapy with parenteral nutrition (PN). The nurse
should plan to ensure that which action is taken to prevent the client from sustaining injury?
1. Calculate daily intake and output
2. Monitor the temperature once daily
3. Secure all connections in the PN system
4. Monitor blood glucose levels every 12 hours
3. Rationale- The nurse should plan to secure all connection tubing (tape is used per agency protocol). This helps prevent the restless client from pulling
the connections accidentally . The nurse should also monitor intake and output, but this does not relate specifically to a risk for injury presented in the
question. In addition, the client's temperature and blood glucose levels are monitored more frequently that the time frames identified in the options to
detect signs of infection and hyperglycemia, respectively . A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased
blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally . The nurse determines that the client is
experiencing which complications of PN therapy?
1. Sepsis
2. Air embolism
3. Hypervolemia
4. Hyperglycemia
3. Rationale- Hypervolemia is a critical situation and occurs from excessive fluid administration or administration of fluid too rapidly . Clients with cardiac,
renal, or hepatic dysfunction are also at increased risk. The client's signs and symptoms presented in the question are consistent with hypervolemia. The
increased intravascular volume increases the blood pressure, whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The
increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles. The signs and symptoms presented in
the question do not indicate sepsis, air embolism, or hyperglycemia.
solution rate has been 100 ml/hour. The nurse anticipated that which prescription regarding PN 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 prescription for PN
2. Rationale- 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 beng 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. Breath normally
2. Turn the head to the right
3. Exhale slowly and evenly
4. Take a deep breath, hold it, and bear down.
4. Rationale- 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 is 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
1. Rationale- 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
2. Rationale-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 to the administration of fat emulsion.
A client is receiving parenteral nutrition (PN). The nurse monitors the client 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
4. Rationale-The high glucose concentration in PN places the client at risk for hyperglycemia. Signs of hyperglycemia include excessive thirst, fatigue,
restlessness, confusion, weakness, Kussmaul's 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 of the bag
3. Time of last dressing change
4. Tightness of tubing connections
1. Rationale- 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 connection 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. Rolls the bottle of solution gently
2. Obtains a dif ferent bottle of solution
3. Shakes the bottle of solution vigorously
4. Runs the bottle of solution under warm water .
2. Rationale- 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. Send them to the laboratory for culture
4. Save them for return to the manufacturer
3. Rationale- 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. 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. Pulse and blood pressure
4. Temperature and blood pressure
2. Rationale-The client receiving PN at home should have her or his temperature monitored as a means of detecting infection, which is a potential
complication of this therapy . An infection also could result in sepsis because the catheter is in a blood vessel. The client's weight is monitored as a
measure of the ef fectiveness of this nutritional therapy and to detect hypervolemia. The pulse and blood pressure are important parameters to assess, but
they do not relate specifically to the ef fects of PN.
The nurse is caring for a group of adult clients on an acute care medical-surgical nursing unit. The nurse understands that
which client would be the least likely candidate for parenteral nutrition (PN)?
1. A 66 year-old client with extensive burns
2. A 42 year-old client who has had an open cholecystectomy
3. A 27 year-old client with severe exacerbation of Crohn's disease
4. A 35 year-old client with persistant nausea and vomiting from chemotherapy
2. Rationale- Parenteral nutrition is indicated in clients whose gastrointestinal tracts are not functional or must be rested, cannot take in a diet enterally for
extended periods, or have increased metabolic need. Examples of these conditions include those clients with burns, exacerbation of Chron's disease, and
persistent nausea and vomiting due to chemotherapy . Other clients would be those who have had extensive surgery , have multiple fractures, are septic, or
have advanced cancer or acquired immunodeficiency syndrome. The client with the open cholecystectomy is not a candidate because this client would
resume a regular diet within a few days following surgery . The nurse is preparing to hang the first bag of parenteral nutrition (PN) solution via the central line of an assigned client.
The nurse should obtain which most essential piece of equipment before hanging the solution?
1. Urine test strips
2. Blood glucose meter
3. Electronic infusion pump
4. Noninvasive blood pressure monitor
3. Rationale- The nurse obtains an electronic infusion pump before hanging a PN solution. Because of the high glucose content, use of an infusion pump
is necessary to ensure that the solution does not infuse too rapidly or fall behind. Because the client's blood glucose level is monitored every 4 to 6 hours
during administration of PN, a blood glucose meter also will be needed, but this is not the most essential item needed before hanging the solution. Urine
test strips (to measure glucose) rarely are used because of the advent of blood glucose monitoring. Although the blood pressure will be monitored, a
noninvasive blood pressure monitor is not the most essential piece of equipment needed for this procedure.
The nurse is making initial rounds at the beginning of the shift and notes that the parenteral nutrition (PN) bag of an
assigned client is empty . Which solution readily available on the nursing unit should the nurse hang until another PN
solution is mixed and delivered to the nursing unit?
1. 5% dextrose in water
2. 10% dextrose in water
3. 5% dextrose in Ringer's lactate
4. 5% dextrose in 0.9% sodium chloride
2. Rationale- The client is at risk for hypoglycemia; therefore the solution containing the highest amount of glucose should be hung until the new PN
solution becomes available. Because PN solutions contain high glucose concentrations, the 10% dextrose in water solution is the best of the choices
presented. The solution selected should be one that minimizes the risk of hypoglcemia. The remaining options will not be as ef fective in minimizing the risk
of hypoglycemia.
The nurse monitoring the status of a client's fat emulsion (lipid) infusion and notes that the infusion is 1 hour behind.
Which action should the nurse take?
1. Adjust the infusion rate to catch up over the next hour
2. Increase the infusion rate to catch up over the next two hours
3. Ensure that the fat emulsion infusion rate is infusing at the prescribed rate
4. Adjust the infusion rate to run wide open until the solution is back on time
3. Rationale- The nurse should not increase the rate of a fat emulsion to make up the dif ference if the infusion timing falls behind. Doing so could place the
client at risk for fat overload. In addition, increasing the rate suddenly can cause fluid overload. The same principle (not increasing the rate) applies to PN
or any intravenous (IV) infusion. Therefore the remaining options are incorrect.
A client receiving parenteral nutrition (PN) in the home setting has a weight gain of 5 lb in 1 week. The nurse should next
assess the client for the presence of which condition?
1. Thirst
2. Polyuria
3. Decreased blood pressure
4. Crackles on auscultation of the lungs
4. Rationale- Optimal weight gain when the client is receiving PN is 1 to 2lb/week. The client who has a weight gain of 5lb/week while receiving PN is likely
to have fluid retention. This can result in hypervolemia. Signs of hypervolemia include increased blood pressure, crackles on lung auscultation, a bounding
pulse, jugular vein distention, headache, and weight gain more than desired. Thirst and polyuria are associated with hyperglycemia. A decreased blood
pressure is likely to be noted in deficient fluid volume.
The nurse is caring for a restless client who is beginning nutritional therapy with parenteral nutrition (PN). The nurse
should plan to ensure that which action is taken to prevent the client from sustaining injury?
1. Calculate daily intake and output
2. Monitor the temperature once daily
3. Secure all connections in the PN system
4. Monitor blood glucose levels every 12 hours
3. Rationale- The nurse should plan to secure all connection tubing (tape is used per agency protocol). This helps prevent the restless client from pulling
the connections accidentally . The nurse should also monitor intake and output, but this does not relate specifically to a risk for injury presented in the
question. In addition, the client's temperature and blood glucose levels are monitored more frequently that the time frames identified in the options to
detect signs of infection and hyperglycemia, respectively . A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased
blood pressure, bounding pulse, jugular vein distention, and crackles bilaterally . The nurse determines that the client is
experiencing which complications of PN therapy?
1. Sepsis
2. Air embolism
3. Hypervolemia
4. Hyperglycemia
3. Rationale- Hypervolemia is a critical situation and occurs from excessive fluid administration or administration of fluid too rapidly . Clients with cardiac,
renal, or hepatic dysfunction are also at increased risk. The client's signs and symptoms presented in the question are consistent with hypervolemia. The
increased intravascular volume increases the blood pressure, whereas the pulse rate increases as the heart tries to pump the extra fluid volume. The
increased volume also causes neck vein distention and shifting of fluid into the alveoli, resulting in lung crackles. The signs and symptoms presented in
the question do not indicate sepsis, air embolism, or hyperglycemia.
