Deck 12: Parenteral Nutrition

Question 1

A physician orders a total nutrient admixture (TNA) solution for a client diagnosed with severe anorexia nervosa. A nurse administers the solution knowing that TNA consists of a combination of:

A) platelets, plasma, and white blood cells.
B) fats, carbohydrates, and proteins.
C) fats, electrolytes, and trace elements.
D) carbohydrates, proteins, and heparin.

Answer 1

B

Question 2

A nurse is caring for a client receiving TPN. In addition to multiple vitamins, which medication might be anticipated that the nurse administer intramuscularly on a weekly basis?

A) Heparin 1000 units
B) Vitamin K 5 mg
C) Zinc 2.5 mg
D) Biotin 60 $\mu$ g

Answer 2

Vitamin K 5 mg

Question 3

A clinical nurse specialist is conducting an in-service for critical-care nurses regarding the administration of cyclic TPN. Which key point should be included in the in-service?

A) It is indicated for clients receiving continuous, stabilized TPN.
B) It is indicated for short-term parenteral nutrition.
C) It must be escalated to maintain rate
D) The dose must be tapered to avoid abrupt changes in glucose levels.

Answer 3

A

Question 4

A client with pancreatitis has an order to receive parenteral nutrition with lipid infusions three times a week. The first transfusion of lipids is started slowly, but after a few minutes, the client reports back pain and becomes dyspneic. Which action should be taken by the nurse?

A) Take the client's vital signs.
B) Stop the infusion of lipids and notify the physician.
C) Give the client PRN pain medication and his bronchodilator.
D) Discontinue the I.V.

Question 5

A nurse is caring for a client who is diagnosed with a fatty acid deficiency. Which order should the nurse anticipate receiving from a physician to correct this deficiency?

A) Protein
B) 10% dextrose
C) Lipid emulsion
D) Trace elements

Question 6

A client is to receive peripheral parenteral nutrition. Which solutions can be administered peripherally?

A) 20% dextrose and 8.5% amino acids
B) 10% dextrose and 3.5% amino acids
C) 50% dextrose and 7% amino acids
D) 50% dextrose and 3.5% amino acids

Question 7

A nurse administers total parenteral nutrition (PN) to a client via a central catheter because PN has:

A) An osmolarity equal to blood plasma.
B) An osmolarity greater than 600 mOsm.
C) An osmolarity less than 300 mOsm.
D) A pH between 5 and 9.

Question 8

A physician orders total parenteral nutrition for a critically ill client. Which medication/supplement may be safely added to the client's total parenteral solution?

A) Regular insulin, heparin, and H2 inhibitors
B) Iron, vitamin K, and cimetidine
C) Iron, heparin, and neutral protamine Hagedorn (NPH) insulin
D) Regular insulin, vitamin K, and H2 inhibitors

Question 9

A physician orders parenteral proteins for a client who is emaciated. A nurse orders the proteins from the pharmacy knowing that parenteral proteins are supplied as:

A) synthetic crystalline amino acids.
B) casein amino acids.
C) immunoglobulins.
D) albumin.

Question 10

A nurse is instructed to add heparin to a client's TPN per a physician's order. What is the purpose of adding heparin to a TPN solution?

A) To enhance blood glucose levels
B) To thin the TPN solution so that it easily infuses
C) To decrease the incidence of subclavian vein thrombosis
D) To prevent gastric ulcers

Question 11

A nurse is reviewing the medical record for a client with a nursing diagnosis of Altered nutrition: Less than body requirements. Which assessment data is the best indicator for continued need of additional nutritional support?

A) Intake and output
B) Calorie count
C) Serum electrolytes
D) Trace element levels

Question 12

A nurse is evaluating a client who has been receiving parenteral nutrition (PN). The nurse should identify a desirable client outcome of total PN therapy as:

A) weight gain of 1/2 lb/day.
B) capillary blood glucose level of 160 mg/dL.
C) serum sodium level of 127 mEq/L.
D) serum cholesterol level 225 mg/dL.

Question 13

A physician orders the peripherally inserted central catheter (PICC) team to insert a PICC for a client who is scheduled for chemotherapy. Which are advantages of PICCs? SELECT ALL THAT APPLY.

A) Causes less body image disturbance
B) Eliminates the pain of frequent venipunctures
C) Decreases risk for pneumothorax and air embolism on insertion
D) Preserves peripheral vascular system in the upper extremity

Question 14

A nurse prepares to hang an infusion of parenteral nutrition (PN). Which fluids can be given concurrently through the same I.V. administration set as the PN?

A) Blood
B) Platelets
C) Intravenous piggyback medications
D) Lipid emulsions

Question 15

A nurse is preparing to infuse a parenteral nutrition (PN) admixture. Which filter should be used with total nutrition admixtures (three-in-one)?

A) 0.22 µm
B) 1.0 µm
C) 1.2 µm
D) 170 µm

Question 16

A client has a triple-lumen tunneled catheter and is receiving PN with daily infusions of lipids, as well as several other I.V. medications. How should a nurse infuse the lipids?

A) Into an injection port separate from the TPN solution
B) In the same line as the TPN, between the filter and the injection port
C) In the same line as the TPN, between the filter and the TPN solution
D) Using a 0.45- $\mu$ m filter

Question 17

A nurse is caring for a critically ill client who has been admitted to an intensive care unit. The nurse monitors the client's nutritional status. During times of stress, which element of metabolism is radically altered?

A) Protein
B) Fat
C) Carbohydrate
D) Vitamin C

Question 18

A physician orders parenteral nutrition (PN) for a critically ill client. The client's PN is administered through a central line because PN is:

A) isotonic.
B) hypertonic.
C) hypotonic.
D) atonic.

Question 19

As part of a client's health history, a nurse performs a nutritional assessment of the client. Which components should be included in the nurse's nutritional assessment? SELECT ALL THAT APPLY.

A) Dietary history
B) Anthropometric measurements
C) Physical examination
D) Computerized tomography (CT) scan of the abdomen