Week 7 Parenteral Nutrition NCLEX Questions

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1. 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.
2. 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.
3. 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
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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.
4. 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.
5. 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 hyper-
glycemia 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.
6. 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 in-
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sertion 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.
7. 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 different 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.
8. 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.
9. 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
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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 effectiveness 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 effects of PN.
10. The nurse is caring for a group of adult clients on an acute care med-
ical-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 chemother-
apy: 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.
11. 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,

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a noninvasive blood pressure monitor is not the most essential piece of equipment
needed for this procedure.
12. 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 effective in minimizing
the risk of hypoglycemia.
13. 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 difference 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.
14. 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 hy-
pervolemia. Signs of hypervolemia include increased blood pressure, crackles on
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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.
15. 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.
16. 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.

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