TPN questions

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1. A nurse is reviewing the medical record for a client with a nursing diag-
nosis of Altered nutrition: Less than body requirements. Which assessment
data is the best indicator for continued need of additional nutritional sup-
port?
A Intake and output

B Calorie count

C Serum electrolytes

D Trace element levels: B

The best indicator of whether a client is taking in adequate oral nourishment
following TPN is a calorie count. This gives an idea of the total calories consumed
and the distribution of the client's diet in terms of protein, fat, and carbohydrate.
Intake and output is useful as a measure of fluid balance, and the laboratory studies
previously identified give an indication of electrolyte balance.
2. 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.: A
Protein is a body-building nutrient that promotes tissue growth, repair, and the
replacement of body cells. Parenteral proteins are elemental, providing a synthetic
crystalline amino acid that does not cause an antigenic reaction.
3. 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

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D carbohydrates, proteins, and heparin.: B
TNA are systems that hold combinations of dextrose, amino acids, and fat emul-
sions in one container. It is also referred to as all-in-one or three-in-one.
4. 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: C

Heparin doses of 100 to 300 units/L have been ordered to decrease the incidence
of subclavian vein thrombosis.
5. 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.: A

Cyclic TPN is used for long-term stabilized clients. Cyclic TPN is not routinely used
for short-term therapy, and after clients receive cyclic TPN, there is no need to
escalate or taper doses, because the glucose response has been stabilized.
6. 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 Fats

B Proteins

C Carbohydrates

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D Vitamin C: C
The major purpose of carbohydrates is to provide energy. During the critical
phase of illness or injury, carbohydrate metabolism is radically altered; thus,
hyperglycemia is a hallmark of stress.
7. A nurse is caring for a client receiving TPN. In addition to multiple vitamins,
which medication might be anticipated that the nurse administer intramus-
cularly on a weekly basis?

A Heparin 1000 units

B Vitamin K 5 mg

C Zinc 2.5 mg

D Biotin 60 mg: B
Heparin, zinc, and biotin can be added to the TPN solution. Vitamin K cannot be
administered intravenously, so it must be given intramuscularly.
8. 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-mm filter: C

Lipids should be run below the filter to prevent the removal of essential elements.
Lipids should be run only through a special 1.2-mm lipid filter.
9. 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
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D Atonic: B
Solutions that provided total nutrients for the client must be administered through
a central line because of the osmolarity of the solution. Solutions with dextrose
percentages greater than 10% are hypertonic and must be administered by central
line. Most PN contains 50% dextrose.
10. 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: A

The only medications that can be added to nutritional support for compatibility are
regular insulin, heparin, or an H2 inhibitor.
11. 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.: B

The nurse should stop the infusion of lipids and notify the physician because the
client is having an adverse reaction to the lipids.
12. A client is to receive peripheral parenteral nutrition. Which solutions can
be administered peripherally?

A 20% dextrose and 8.5% amino acids

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B 10% dextrose and 3.5% amino acids

C 50% dextrose and 7% amino acids

D 50% dextrose and 3.5% amino acids: B

The solution of 10% dextrose and 3.5% amino acids may be administered peripher-
ally. The other solutions must be administered through a central catheter because
of the osmolarity of dextrose solutions greater than 10%.
13. 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.: A

Nutritional status should improve with total PN, as evidenced by a consistent weight
gain. Option 2 is incorrect because the normal blood glucose level should be
between 60 and 120 mg/dL. Option 3 indicates hyponatremia. Option 4 indicates
an elevated cholesterol value.
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 Vitamin K 5 mg

C Zinc 2.5 mg

D Biotin 60 mg: D
Fat emulsions are administered concurrently with total PN (TPN) and are filtered
with a special 1.2-mm filter. Blood and blood products should not be given through
the same line as TPN because they could coat the inner lumen of the catheter,
restricting flow of the TPN. Medications are not routinely administered concurrently
with TPN because they could be incompatible.
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15. 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 cor-
rect this deficiency?

A Protein

B 10% dextrose

C Lipid emulsion

D Trace elements: C
Fats are delivered by infusion as lipid emulsions.
16. 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: C
When lipids are added to nutritional support or administered by piggyback, they
must be filtered with a 1.2-µm filter because of the fat molecules of the solution.
17. 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.: B

Solutions that provided total nutrients for the client must be administered through a
central catheter because of the osmolarity greater than 600 mOsm. Solutions with
dextrose percentages more than 10% are hypertonic and must be administered
by central catheter. Most TPN solutions contain 50% dextrose.
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18. 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: B C D

The advantages of a PICC include eliminating the pain associated with frequent
venipuncture, decreasing the risk for pneumothorax and air embolism, and pre-
serving the peripheral vascular system of the upper extremities. Because PICCs
are external, they do have potential for causing concerns for the client regarding
body image
19. As part of a client's health history, a nurse performs a nutritional as-
sessment 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: A B C

Dietary history, anthropometric measurements, and physical examination are all
components of the nutritional assessment, along with medical and social history,
energy tests, bone radiology tests, and laboratory tests. CT does not provide
information needed for nutritional support.
20. The client is NPO and is receiving total parenteral nutrition (TPN) via a
subclavian line. Which precautions should the nurse implement? SELECT
ALL THAT APPLY.

A Place the solution on an IV pump at the prescribed rate.

B Monitor blood glucose every six (6) hours.

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C Weigh the client weekly,, first thing in the morning.

D Change the IV every three (3) days.

E Monitor intake and output every shift.: A B E

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