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:

Accepted Answer

Total nutrient admixture (TNA) consists of a combination of fats, carbohydrates, and proteins. This solution is used to provide complete nutrition when a client is unable to tolerate enteral feeding. Platelets, plasma, white blood cells, electrolytes, and trace elements are not typically included in TNA solutions. Heparin may be added to TNA to prevent coagulation, but it is not a component of the solution itself.

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?

Accepted Answer

Clients receiving TPN may experience a deficiency in vitamin K due to lack of intestinal absorption. Intramuscular administration of vitamin K may be necessary to prevent bleeding complications. Heparin is not typically administered weekly and is used for different purposes. Zinc and biotin may be included in the TPN solution or given orally, but they do not require weekly intramuscular administration.

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?

Accepted Answer

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?

Accepted Answer

The client is exhibiting signs of a transfusion reaction which can be life-threatening. The nurse should immediately stop the lipid infusion and notify the physician. The client's vital signs should also be assessed, but this should not be the first action taken. Pain medication and bronchodilators are not appropriate interventions for a transfusion reaction. If the transfusion reaction is severe, the IV may need to be discontinued, but this would be determined by the physician.

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?

Accepted Answer

A fatty acid deficiency can be corrected with a lipid emulsion, which contains essential fatty acids that the body cannot produce on its own. Therefore, option C is the most appropriate choice. Option A, protein, is not directly related to a fatty acid deficiency. Option B, 10% dextrose, is a type of sugar solution and does not contain essential fatty acids. Option D, trace elements, may be important in overall nutritional support but is not specific to correcting a fatty acid deficiency.

Question 6

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

Accepted Answer

Peripheral parenteral nutrition should contain a low concentration of dextrose (usually 10%) and a low concentration of amino acids (usually 3.5%). Higher concentrations of dextrose and amino acids can cause irritation to the peripheral veins and should only be administered through a central line. Choice A and D have high concentrations of dextrose, and choice C has a high concentration of both dextrose and amino acids.

Question 7

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

Accepted Answer

PN has an osmolarity greater than 600 mOsm, which can cause irritation and damage to peripheral veins. Therefore, it is administered via a central catheter that empties directly into the larger vessels of the circulatory system. Options A, C, and D are incorrect statements about PN.

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?

Accepted Answer

Regular insulin, heparin, and multivitamin preparations (including vitamin B12) can be safely added to total parenteral nutrition (TPN) solutions. Iron and vitamin K are not typically added to TPN due to stability and compatibility issues. Cimetidine and NPH insulin are also not commonly added to TPN solutions.

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:

Accepted Answer

Parenteral proteins are usually supplied as synthetic crystalline amino acids, which are easier to absorb by the body, especially for emaciated clients who have difficulty processing oral food intake. Casein amino acids (B) are usually found in dairy products, while immunoglobulins (C) are antibodies that help fight infections. Albumin (D) is a protein found in blood plasma and is used to treat certain medical conditions, but it is not commonly used in parenteral nutrition.

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?

Accepted Answer

Heparin is added to TPN solutions to decrease the incidence of subclavian vein thrombosis, which can occur due to the high osmolarity and viscosity of TPN solutions. It works by preventing the formation of blood clots, which can block the flow of blood through the veins. It is not added to enhance blood glucose levels, thin the TPN solution, or 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?

Accepted Answer

Calorie count is the best indicator for continued need of additional nutritional support. It reflects the amount of energy consumed by the client and is a direct measure of the client's intake. Intake and output, serum electrolytes, and trace element levels may provide useful information, but they are not as specific to the client's nutritional status as calorie count.

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:

Accepted Answer

The desirable client outcome of total PN therapy is weight gain of 1/2 lb/day. This indicates that the client is receiving adequate nutrition and the body is able to use it to build tissue. A capillary blood glucose level of 160 mg/dL is high and indicates hyperglycemia, which is not a desirable outcome. A serum sodium level of 127 mEq/L is low and indicates hyponatremia, which is also not a desirable outcome. A serum cholesterol level of 225 mg/dL is high and indicates hyperlipidemia, which is not necessarily a desirable outcome.

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.

Accepted Answer

PICCs eliminate the pain of frequent venipunctures, decrease the risk for pneumothorax and air embolism on insertion, and preserve the peripheral vascular system in the upper extremity. Although some clients may feel uneasy about having a catheter inserted into their body, PICCs cause less body image disturbance than other central venous access devices such as tunneled or implanted ports.

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?

Accepted Answer

Lipid emulsions can be given concurrently with parenteral nutrition (PN) through the same I.V. administration set, often as part of a total nutrient admixture or through a Y-connector if compatibility has been established. Blood, platelets, and intravenous piggyback medications should not be administered through the same line as PN due to the risk of reactions and incompatibilities.

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)?

Accepted Answer

Total nutrition admixtures (three-in-one) contain lipids that can be trapped by filters with a pore size smaller than 1.2 µm, so a 1.2 µm filter is the best choice to avoid filter clogging and ensure safe and effective administration of PN.

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?

Accepted Answer

Lipids should be infused in the same line as the TPN, between the filter and the injection port to prevent incompatibilities and to ensure all medications are delivered to the patient. Using a separate injection port can increase the risk of infection and using a 0.45-micron filter is insufficient for lipids and can lead to filter clogging.

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?

Accepted Answer

During times of stress, carbohydrate metabolism is radically altered. The body uses glucose as the primary source of energy, and the liver releases glucose into the bloodstream to maintain normal blood sugar levels. The body also increases its use of glycogen stores for energy, leading to decreased glycogen stores over time. This can result in a breakdown of muscle tissue to provide amino acids for gluconeogenesis, but protein metabolism is not as radically altered as carbohydrate metabolism during times of stress. Fat metabolism may also be altered, but not to the same extent as carbohydrate metabolism. Vitamin C is not directly related to metabolism during times of stress.

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:

Accepted Answer

PN is typically hypertonic, meaning it has a higher concentration of nutrients and electrolytes than the client's blood. This requires administration through a central line to prevent irritation and damage to peripheral veins.

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.

Accepted Answer

A comprehensive nutritional assessment should include a dietary history, which involves gathering information about the client's eating habits, food preferences, and food allergies. Anthropometric measurements, such as weight, height, body mass index (BMI), and waist circumference, are important indicators of the client's nutritional status. A physical examination can reveal signs of malnutrition, such as muscle wasting or dry, scaly skin. A CT scan of the abdomen is not a routine component of a nutritional assessment and is usually reserved for specific medical conditions.

Quiz 12: Parenteral Nutrition