Question 1

The nurse is caring for a patient who is receiving PN.As part of therapy, the patient undergoes routine bedside glucose monitoring that reveals which expected outcome?

Accepted Answer

For PN to be used safely, its administration must be closely monitored.Special care is necessary to maintain blood glucose levels in the normal range.Higher glucose levels are often associated with cardiovascular events, general infection, systemic sepsis, acute renal failure, and death.

Question 2

A 72-year-old patient is admitted to the hospital with a medical diagnosis of intestinal failure.Which intervention should the nurse include in the plan of care to deliver nutritional needs?

Accepted Answer

In situations where partial or complete intestinal failure has occurred and oral nutrition or enteral tube feeding is not possible, parenteral nutrition (PN) is the therapy of choice.When a patient's gastrointestinal (GI) tract is functional, clinicians assess the patient and choose the best method of delivering nutritional needs, which may include enteral feeding, parenteral feeding, or a combination of both.

Question 3

The patient has been receiving PN but has not been given lipid emulsion therapy.The nurse notices that the patient is developing dry, scaly skin, his wound is healing more slowly than expected, and he is anemic.Which condition should the nurse anticipate as a potential problem?

Accepted Answer

A nutritional regimen without adequate fatty acids leads to essential fatty acid deficiency (EFAD), characterized by dry, scaly skin, sparse hair growth, impaired wound healing, decreased resistance to stress, increased susceptibility to respiratory tract infection, anemia, thrombocytopenia, and liver function abnormalities.

Question 4

The nurse has been caring for a patient who has had a central venous catheter in place.The patient complains of sudden chest pain and difficulty breathing.Which assessment finding warrants immediate intervention by the nurse?

Accepted Answer

Symptoms of pneumothorax include sudden chest pain, difficulty breathing, decreased breath sounds, cessation of normal chest movement on the affected side, and tachycardia.Symptoms of exit site infection include erythema, tenderness, induration, or purulence within 2 cm of the skin at the exit site.Symptoms of catheter-related sepsis include isolation of the same microorganism from a blood culture and catheter segment, with the patient showing fever, chills, malaise, and elevated white blood cell count.Symptoms of hyperglycemia include excessive thirst, urination, blood glucose greater than 160 mg/100 mL, and confusion.

Question 5

To detect a common untoward effect of interrupting a PN infusion, the nurse should assess the patient for development of which symptom?

Accepted Answer

Do not interrupt a PN infusion.This infusion maintains a continuous supply of nutrients and prevents a hypoglycemic reaction.Fever could be caused by systemic infection.Chest pain could be caused by air embolism.Localized infection can occur at the exit site or tunnel.

Question 6

A patient on PN has gained 4 lbs over a 24-hour period.Given this weight gain, which interpretation by the nurse is most accurate?

Accepted Answer

Weight gain greater than 1 lb/day indicates fluid retention.The patient's ideal weight gain is usually between 1 and 2 lb/wk.Weight is an indicator of the patient's nutritional status and determines fluid volume.A nutritional regimen without adequate fatty acids leads to EFAD, characterized by dry, scaly skin, sparse hair growth, impaired wound healing, decreased resistance to stress, increased susceptibility to respiratory tract infection, anemia, thrombocytopenia, and liver function abnormalities.

Question 7

The nurse is caring for a patient who is receiving parenteral nutrition (PN).The nurse realizes that PN is associated with which of the following risks? (Select all that apply.)

Accepted Answer

Use of PN in the perioperative patient is controversial, and although benefits are more likely in the severely malnourished, evidence has shown little effect of PN in preventing mortality.PN creates risks.It has been associated with catheter-related bloodstream infection, noninfective complications such as pneumothorax, increased hospital length of stay, and liver disease.

Question 8

For patients receiving PN, ___________ provide supplemental kilocalories and prevent essential fatty acid deficiencies.

Accepted Answer

The answer of For patients receiving PN, ___________ provide supplemental...

Question 9

The patient will be going home on PN.The patient and his family education will need to perform which of the following care steps? (Select all that apply.)

Accepted Answer

The patient and family caregiver will need to learn to monitor the patient's weight, blood glucose levels, and intake and output. They will also need to know how to perform catheter care and dressing changes.Home-based PN can be managed to allow the patient a reasonable amount of mobility and limiting activity should not be required.

Question 10

If PN must be discontinued suddenly, hang __________ in water at the same infusion rate to prevent hypoglycemia.

Accepted Answer

The answer of If PN must be discontinued suddenly, hang...

Question 11

The nurse is caring for a patient receiving PN.In planning the patient's care for the day, which nursing assessment is most essential?

Accepted Answer

Since the need for PN is usually associated with conditions that result in electrolyte instability, maintaining electrolyte balance during therapy is crucial.Monitor the patient's electrolyte levels (potassium, magnesium, and phosphorus) for low serum levels which may indicate a risk for arrhythmias and muscle weakness, Patient's at risk may require having electrolyte panels done several times a day.While it is necessary to monitor the patient's weight and temperature and be alert for signs of infection at the insertion site, the biggest risk to the patient is electrolyte instability.

Question 12

A patient had surgery 1 week ago, has not been eating his meals, and states that he has no appetite.The nurse assesses that the patient has been progressively losing weight.Which intervention has the highest priority?

Accepted Answer

Frequently, the nurse will be the first to identify risk factors, such as progressive weight loss, restricted or limited fluid intake, intolerance to enteral feedings, increased energy need (burns, sepsis, and trauma), and being NPO (nothing by mouth) for 3 or more days.The first sign of a developing problem is a pattern of a decline in oral food intake and reduced appetite.Assessment provides information for consulting with the nutritional support team and the physician in an effort to initiate appropriate PN.Force-feeding the patient may only lead to worse issues, especially if the patient has a nonfunctioning intestinal system.

Question 13

During IV administration of fat ( lipid ) emulsions, the patient voices complaints.Which complaint indicates to the nurse that the patient is experiencing a complication associated with the administration?

Accepted Answer

Fever, chills, and malaise are symptoms of catheter-related sepsis.

Question 14

The patient has been ordered to receive parenteral nutrition but will require the nutritional therapy to continue for several months.Which route is most important for the nurse to consider?

Accepted Answer

The ideal method to administer PN over an extended period is through a central venous catheter, which allows for higher concentration of nutrients.

Question 15

The nurse is managing the care of a patient receiving PN.Which assessment finding indicates potential septicemia?

Accepted Answer

Know the patient's recent temperature range.Patients with peripheral or central intravenous (IV) lines are susceptible to septicemia; elevated temperature can be an early indicator of a bacterial process.Hypoglycemia causes the patient to be shaky, dizzy, nervous, and anxious; the patient senses hunger and has a blood sugar level less than 80 mg/100 mL.Air embolism results in sudden respiratory distress, shortness of breath, coughing, chest pain, and decreased blood pressure.Hyperglycemia leads to excessive thirst.

Question 16

Which assessment should a nurse expect to see for a patient receiving PN?

Accepted Answer

The patient's ideal weight gain is usually between 1 and 2 pounds per week.Serum electrolytes are out of normal range.This may indicate movement of electrolytes in response to infusion of fluids and glucose.The electrolyte levels in the solution may need to be adjusted.Serum glucose levels should be less than 200 mg/100 mL.

Quiz 32: Parenteral Nutrition