Nclexrn Quiz: Tpn Care And Metabolic Monitoring
20 questions · exam conditions
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Tpn Care And Metabolic MonitoringQuestion 1 of 20

A 49-year-old client with severe pancreatitis is receiving TPN via central line: dextrose 25%, amino acids 5%, electrolytes, vitamins at 90 mL/hr; lipids 20% over 12 hours. The nurse notes the TPN solution appears cloudy with visible particles in the tubing. The client is stable and afebrile. What is the nurse's PRIORITY action for a client receiving TPN?

Delegate to assistive personnel to gently shake the bag to mix the contents
Flush the central line with heparin to clear the particles
Stop the infusion and replace the tubing and solution per policy; do not infuse the contaminated-appearing TPN
Increase the infusion rate to reduce the time the solution is hanging
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Nclexrn Quiz: Tpn Care And Metabolic Monitoring

Practice Tpn Care And Metabolic Monitoring in Nclexrn with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

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This quiz focuses on Tpn Care And Metabolic Monitoring, giving you a quick way to practice the rules, question types, and explanations that matter most for Nclexrn.

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Question 1

A 49-year-old client with severe pancreatitis is receiving TPN via central line: dextrose 25%, amino acids 5%, electrolytes, vitamins at 90 mL/hr; lipids 20% over 12 hours. The nurse notes the TPN solution appears cloudy with visible particles in the tubing. The client is stable and afebrile. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Delegate to assistive personnel to gently shake the bag to mix the contents
  2. Flush the central line with heparin to clear the particles
  3. Stop the infusion and replace the tubing and solution per policy; do not infuse the contaminated-appearing TPN (correct answer)
  4. Increase the infusion rate to reduce the time the solution is hanging
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is contaminated TPN solution posing infection or embolism risks. Stopping the infusion and replacing tubing/solution is the highest priority to avoid infusing particles. Increasing rate worsens exposure; shaking may not resolve; flushing doesn't address source, addressing misconceptions about visual inspections. Prioritizing client safety involves discarding suspect solutions. Decision-making in TPN care emphasizes sterility checks. A transferable nursing strategy is to inspect TPN bags for clarity before hanging and report anomalies to pharmacy.

Question 2

A 5-year-old child (history: necrotizing enterocolitis as an infant) has short bowel syndrome and is receiving TPN via a central venous catheter. The TPN is infusing continuously at 40 mL/hr and contains dextrose 15%, amino acids 3%, electrolytes, vitamins, and trace elements; lipids 20% infuse over 20 hours daily. The child has a temperature of 38.5°C (101.3°F) and is irritable; the catheter site appears normal. Which assessment finding indicates a complication of TPN therapy?

  1. Fever and irritability in a child with a central line receiving TPN (correct answer)
  2. Heart rate 110/min while crying during assessment
  3. Capillary refill 2 seconds and warm extremities
  4. Urine output 1 mL/kg/hr
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is infection in pediatric clients with central lines for TPN. Fever and irritability indicate the highest priority as they suggest central line infection despite normal site appearance. Heart rate 110/min while crying is expected; capillary refill 2 seconds and urine output 1 mL/kg/hr are normal, countering misconceptions about vital sign variations. Prioritizing client safety involves early sepsis recognition. Decision-making in TPN care focuses on age-specific assessments. A transferable nursing strategy is to monitor for subtle infection signs like behavioral changes in children on TPN.

Question 3

A 62-year-old client with a history of type 2 diabetes and hypertension is postoperative day 2 after bowel resection for obstruction and is receiving total parenteral nutrition (TPN) via a central venous catheter because bowel sounds are absent. Current data: temperature 38.6°C (101.5°F), heart rate 112/min, blood pressure 104/62 mm Hg, and the central line insertion site is erythematous with purulent drainage. The TPN is infusing continuously at 75 mL/hr and contains dextrose 20%, amino acids 5%, and lipids 20% (separate piggyback over 12 hr). Which assessment finding indicates a complication of TPN therapy?

  1. Blood glucose 168 mg/dL (9.3 mmol/L) 2 hours after starting the infusion
  2. Urine output 40 mL/hr with clear, pale-yellow urine
  3. Mild thirst and dry mouth after being NPO for 48 hours
  4. Erythema and purulent drainage at the central line insertion site with fever (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is infection at the central line site, a common and serious complication of TPN administration. Erythema and purulent drainage with fever indicate the highest priority as they suggest central line-associated bloodstream infection, requiring immediate intervention to prevent sepsis. Blood glucose of 168 mg/dL is mildly elevated but expected with TPN and not critical; urine output of 40 mL/hr is normal; mild thirst and dry mouth are common after being NPO and not indicative of complication, addressing misconceptions about dehydration versus infection signs. Prioritizing client safety involves vigilant monitoring of the insertion site for signs of infection. Decision-making in TPN care emphasizes early recognition of complications like infection to avoid systemic spread. A transferable nursing strategy is to perform daily site assessments and adhere to sterile technique during dressing changes to minimize infection risk.

Question 4

A 54-year-old client with severe pancreatitis is receiving continuous TPN via central venous catheter because oral intake is not tolerated. The TPN is running at 90 mL/hr (dextrose 25%, amino acids 5%, electrolytes, vitamins) and lipids 20% are scheduled over 12 hours nightly. Current labs: alkaline phosphatase 220 U/L (elevated), total bilirubin 3.1 mg/dL (elevated), AST 88 U/L (elevated), ALT 96 U/L (elevated); the client reports pruritus and has scleral icterus. Which assessment finding indicates a complication of TPN therapy?

  1. Weight gain of 0.3 kg (0.7 lb) over 24 hours
  2. Capillary blood glucose 156 mg/dL (8.7 mmol/L) before breakfast
  3. Mild nausea after receiving opioid analgesics
  4. Scleral icterus with rising bilirubin and liver enzymes (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is hepatotoxicity, a complication from prolonged TPN use causing cholestasis and liver enzyme elevation. Scleral icterus with rising bilirubin and liver enzymes indicates the highest priority as it suggests TPN-induced liver dysfunction needing intervention. Blood glucose 156 mg/dL is mildly elevated but manageable; mild nausea may relate to medications, not TPN; weight gain of 0.3 kg is minimal and expected, countering misconceptions about normal versus pathological changes. Prioritizing client safety involves monitoring liver function tests regularly. Decision-making in TPN care focuses on minimizing long-term organ damage. A transferable nursing strategy is to cycle TPN infusions and monitor for signs of liver stress to prevent hepatobiliary complications.

Question 5

A 67-year-old client is receiving TPN after bowel surgery via central venous catheter. The TPN is infusing at 75 mL/hr and contains dextrose 20%, amino acids 5%, electrolytes, vitamins, and trace elements. A new order is written: "Administer TPN through a peripheral IV in the forearm until central line is replaced." The nurse should QUESTION which TPN order?

  1. Monitor capillary blood glucose every 6 hours while on TPN
  2. Use an infusion pump for continuous administration
  3. Administer the current TPN formulation through a peripheral IV (correct answer)
  4. Change TPN tubing per facility policy
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is phlebitis and osmolarity risks with hypertonic TPN. Administering through peripheral IV should be questioned as TPN requires central access to avoid vein damage. Monitoring glucose, using pumps, and changing tubing are standard and appropriate, countering misconceptions about access routes. Prioritizing client safety involves proper administration sites. Decision-making in TPN care focuses on vascular access guidelines. A transferable nursing strategy is to confirm central line placement before initiating TPN to prevent peripheral complications.

Question 6

A 53-year-old client is postoperative after bowel surgery and receiving TPN via central line due to ileus. The TPN is infusing at 65 mL/hr (dextrose 20%, amino acids 5%, electrolytes, vitamins). The nurse receives a new order to abruptly discontinue TPN now that the client is tolerating clear liquids. The client's recent capillary blood glucose values have been 160–210 mg/dL (8.9–11.7 mmol/L). The nurse should QUESTION which TPN order?

  1. Begin advancing oral diet as tolerated per postoperative protocol
  2. Flush the central line per policy after TPN is discontinued
  3. Continue capillary blood glucose monitoring during transition off TPN
  4. Abruptly discontinue TPN now that clear liquids are tolerated (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is rebound hypoglycemia from sudden TPN cessation. Abruptly discontinuing TPN should be questioned as it risks low glucose in clients with recent hyperglycemia. Advancing diet, continuing monitoring, and flushing lines are appropriate during transitions, countering misconceptions about rapid weaning. Prioritizing client safety involves gradual tapering. Decision-making in TPN care focuses on metabolic stability during discontinuation. A transferable nursing strategy is to reduce TPN rate over hours while advancing enteral intake to prevent hypoglycemia.

Question 7

A 58-year-old client with Crohn's disease is postoperative after small bowel resection and is receiving TPN via a central line due to high-output nasogastric suction. The TPN is infusing at 85 mL/hr with dextrose 20%, amino acids 5%, electrolytes, vitamins, and trace elements. Current labs: phosphorus 1.6 mg/dL (low; typical 2.5–4.5 mg/dL), magnesium 1.4 mg/dL (low; typical 1.7–2.2 mg/dL), potassium 3.1 mEq/L (low). The client is weak and has new paresthesias. Which lab value requires IMMEDIATE intervention for a client on TPN?

  1. Calcium 9.0 mg/dL
  2. Chloride 102 mEq/L
  3. Phosphorus 1.6 mg/dL (low) (correct answer)
  4. Hemoglobin 11.2 g/dL
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is hypophosphatemia, a metabolic imbalance from refeeding syndrome in malnourished clients on TPN. Phosphorus 1.6 mg/dL requires immediate intervention as it can cause weakness, paresthesias, and respiratory failure. Calcium 9.0 mg/dL, chloride 102 mEq/L, and hemoglobin 11.2 g/dL are normal and not urgent, addressing misconceptions that all low labs are equally critical in TPN. Prioritizing client safety involves correcting phosphate deficits promptly. Decision-making in TPN care emphasizes preventing refeeding syndrome through gradual initiation. A transferable nursing strategy is to monitor electrolytes closely in the first week of TPN and supplement as needed to avoid imbalances.

Question 8

A 44-year-old client with severe pancreatitis is receiving TPN via a PICC: dextrose 25%, amino acids 5%, electrolytes, vitamins at 90 mL/hr; lipids 20% over 12 hours. The nurse notes the PICC dressing is loose and damp, and the insertion site is tender. The client is afebrile. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Document the finding and recheck the site at the end of shift before deciding whether to act.
  2. Perform sterile dressing change and assess the site for infection or catheter complications. (correct answer)
  3. Delegate to assistive personnel to reinforce the dressing with tape and document the intervention.
  4. Flush the PICC with normal saline to relieve tenderness and maintain catheter patency.
Explanation: The priority is to reestablish a sterile barrier at the PICC insertion site. A loose, damp dressing with tenderness suggests possible contamination or early infection, even without fever; performing a sterile dressing change and assessing the site for infection or catheter complications directly addresses that risk. Documenting and rechecking at the end of shift delays essential action and does not protect the site. Delegating to assistive personnel to reinforce with tape is outside their scope and does not allow a nursing assessment of the insertion site. Flushing with normal saline may maintain line patency but does nothing to correct the loose dressing or evaluate the tender site, and can introduce organisms if the barrier is broken. Therefore, sterile dressing change with site assessment is the single best answer.

Question 9

A 64-year-old client with a history of heart failure is receiving TPN via central line after bowel surgery. The TPN (dextrose 20%, amino acids 5%, electrolytes) is infusing at 95 mL/hr. Assessment: new crackles in both lung bases, oxygen saturation 90% on 2 L nasal cannula, jugular venous distention, and weight gain of 1.8 kg (4 lb) in 24 hours; urine output is 25 mL/hr. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Slow the TPN infusion to keep-vein-open rate without a provider order
  2. Draw a blood culture from the central line to evaluate for infection
  3. Delegate to the assistive personnel to obtain daily weights for the next 3 days
  4. Assess for fluid overload, maintain airway/oxygenation, and notify the provider of suspected volume overload (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is fluid overload, a risk in heart failure clients receiving high-volume TPN. Assessing for overload, maintaining airway, and notifying the provider is the highest priority to prevent pulmonary edema. Slowing without order violates policy; delegating weights is not immediate; blood cultures address infection, not overload, addressing misconceptions about volume management. Prioritizing client safety involves monitoring intake/output and lung sounds. Decision-making in TPN care emphasizes adjusting rates for comorbidities. A transferable nursing strategy is to weigh clients daily and report gains over 1 kg to avoid fluid-related complications.

Question 10

A 56-year-old client is receiving TPN after bowel surgery via central venous catheter. The TPN is infusing at 70 mL/hr (dextrose 20%, amino acids 5%, electrolytes, vitamins). The client reports tingling around the mouth and muscle cramps; Chvostek sign is present. Labs: calcium 7.1 mg/dL (low; typical 8.5–10.5 mg/dL), magnesium 1.3 mg/dL (low). Which lab value requires IMMEDIATE intervention for a client on TPN?

  1. Blood urea nitrogen 22 mg/dL
  2. Calcium 7.1 mg/dL (low) with neuromuscular irritability (correct answer)
  3. White blood cell count 10,200/mm³
  4. Sodium 137 mEq/L
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is hypocalcemia, a refeeding syndrome complication in TPN. Calcium 7.1 mg/dL with neuromuscular irritability requires immediate intervention to prevent tetany or seizures. BUN 22 mg/dL, sodium 137 mEq/L, and WBC 10,200/mm³ are normal and lower priority, countering misconceptions about lab monitoring. Prioritizing client safety involves electrolyte replacement. Decision-making in TPN care focuses on symptom correlation with labs. A transferable nursing strategy is to assess for Chvostek sign and supplement calcium early in malnourished clients.

Question 11

A 63-year-old client with severe pancreatitis is receiving TPN via a PICC: dextrose 25%, amino acids 5%, electrolytes, vitamins, trace elements at 85 mL/hr; lipids 20% over 12 hours. The client has new fever 38.7°C (101.7°F), chills, and tachycardia 118/min shortly after starting a new TPN bag; the catheter site is clean and dry. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Stop the TPN infusion and notify the provider; prepare to obtain ordered blood cultures per protocol. (correct answer)
  2. Ask assistive personnel to apply a new sterile dressing to the PICC site while continuing to monitor the client.
  3. Decrease the TPN infusion rate to half and reassess the client's fever, chills, and tachycardia in 30 minutes.
  4. Document the findings as an expected response because TPN can cause transient fever and chills during an infusion.
Explanation: The correct priority is to stop the TPN infusion, notify the provider, and prepare to obtain ordered blood cultures. The client's new fever, chills, and tachycardia after starting a new TPN bag are warning signs of possible contamination or catheter-related bloodstream infection; continuing to infuse at a lower rate still exposes the client to the suspect solution and delays the workup. A dressing change is not indicated because the site is clean and dry, and it does not address the systemic signs. Documenting the findings as expected would be unsafe because the TPN may cause a reaction, but a new fever with chills must be evaluated as a serious complication rather than dismissed. Stopping the infusion and pursuing blood cultures is the priority that protects client safety.

Question 12

A 9-year-old child with short bowel syndrome is receiving long-term TPN at home: 1,200 mL over 12 hours nightly (dextrose 15%, amino acids 3%, electrolytes, vitamins, trace elements) with 20% lipids 3 times per week. During a clinic visit, the child's weight has decreased by 1.5 kg (3.3 lb) in 1 month and height percentile has dropped; the caregiver reports the child "sometimes skips" the infusion on weekends. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Encourage an increased oral intake of high-fiber foods to promote bowel adaptation and decrease reliance on TPN
  2. Delegate to office staff to schedule a 6-month follow-up and obtain a dietitian referral for the growth delay
  3. Assess adherence barriers and reinforce the prescribed infusion schedule to prevent malnutrition and growth failure (correct answer)
  4. Request an order to discontinue TPN because the child is school-aged and can be transitioned to an age-appropriate oral diet
Explanation: The child's weight loss and falling height percentile, together with skipped weekend infusions, point to underdelivery of TPN. The nurse's first action is to explore why the prescribed schedule is not being followed and reinforce it, because untreated nonadherence leads to malnutrition and growth failure. Encouraging high-fiber foods does not replace TPN and may worsen short-bowel symptoms. Delegating a 6-month follow-up delays needed nutritional monitoring and never addresses the missed infusions. Requesting TPN discontinuation because the child is school-aged ignores the ongoing medical need; age is not a reason to stop therapy. The priority is to identify adherence barriers before making other plans.

Question 13

A 33-year-old client on home TPN for malabsorption (history of ulcerative colitis with colectomy) infuses 1,800 mL over 10 hours nightly via central line (dextrose 18%, amino acids 5%, electrolytes, vitamins). The client reports the pump alarmed overnight, so the client turned it off for several hours and then restarted it at a faster rate to "catch up." Morning blood glucose is 54 mg/dL (3.0 mmol/L) with diaphoresis. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Schedule weekly weight checks to assess nutritional status and to track hydration and electrolyte balance over time
  2. Ask the client to demonstrate sterile dressing change technique and to verify proper central line site care
  3. Delegate to a family member to monitor the pump settings nightly and verify the infusion rate
  4. Treat hypoglycemia immediately per protocol and instruct the client not to change infusion rates without guidance (correct answer)
Explanation: The client's diaphoresis and blood glucose of 54 mg/dL indicate hypoglycemia, most likely from turning off the TPN and then restarting it at a faster rate. The priority is to correct the low glucose immediately with the hypoglycemia protocol, then teach the client that changing the infusion rate without guidance is unsafe and can cause rebound hypoglycemia. Scheduling weekly weight checks is useful for long-term nutritional assessment but does not address the current emergency or the unsafe rate change. Asking for a dressing change demonstration is relevant to infection prevention but not to glucose stabilization or pump management. Delegating pump monitoring to a family member is not the priority and does not correct the client's misunderstanding about rate changes. The best action combines immediate treatment with explicit teaching to prevent recurrence. In TPN care, acute metabolic complications take precedence over routine monitoring and skill checks.

Question 14

A 56-year-old client with Crohn disease is postoperative after small-bowel resection and is receiving TPN through a PICC. The order reads: TPN at 70 mL/hr with dextrose 25%, amino acids 5%, and electrolytes; 20% lipid emulsion 500 mL over 4 hours daily. The client has a history of hypertriglyceridemia; current triglycerides are 420 mg/dL (normal <150), and the client reports new shortness of breath during the lipid infusion. The nurse should QUESTION which TPN order?

  1. Electrolytes included in the TPN formulation
  2. TPN infusion at 70 mL/hr via PICC line
  3. Amino acids 5% included in the TPN formulation
  4. 20% lipid emulsion 500 mL over 4 hours daily (correct answer)
Explanation: This question tests TPN care and metabolic monitoring clinical judgment, specifically recognizing contraindications for lipid administration. The priority concern is the rapid infusion of lipids in a client with hypertriglyceridemia (420 mg/dL) who is experiencing dyspnea during infusion, suggesting fat overload syndrome. The order for 500 mL of 20% lipids over 4 hours exceeds safe infusion rates and should be questioned, as lipids should typically infuse over 12-24 hours, especially with elevated triglycerides. The TPN rate, amino acids, and electrolytes are all appropriate components of therapy. The decision-making principle is that lipid infusion rates must be carefully monitored in clients with hypertriglyceridemia to prevent fat overload syndrome. The transferable nursing strategy is to monitor triglyceride levels before and during lipid therapy and recognize that dyspnea during lipid infusion may indicate fat overload requiring immediate intervention.

Question 15

A 44-year-old client with severe pancreatitis is receiving TPN via a central venous catheter at 85 mL/hr (dextrose 25%, amino acids 5%, electrolytes, vitamins, trace elements) and 20% lipids 250 mL over 12 hours. On day 10 of therapy, the client reports generalized itching and has mild jaundice; labs show total bilirubin 3.1 mg/dL (normal 0.2–1.2), alkaline phosphatase 210 U/L (normal 44–147), and AST/ALT mildly elevated. Which assessment finding indicates a complication of TPN therapy?

  1. Mild tachycardia after ambulation
  2. Total bilirubin 3.1 mg/dL with new jaundice (correct answer)
  3. Receiving trace elements in the TPN formulation
  4. Glucose 152 mg/dL after a stress response
Explanation: This question tests TPN care and metabolic monitoring clinical judgment, focusing on recognizing TPN-associated liver dysfunction. The priority concern is hepatic dysfunction evidenced by elevated bilirubin (3.1 mg/dL), jaundice, itching, and elevated liver enzymes after 10 days of TPN therapy, indicating TPN-associated cholestasis. While mild tachycardia after activity is expected, trace elements are necessary components of TPN, and glucose of 152 mg/dL is acceptable during stress, the liver dysfunction represents a serious complication requiring intervention. The decision-making principle is that new-onset jaundice and elevated liver enzymes in clients on long-term TPN indicate hepatic complications requiring evaluation and possible TPN modification. The transferable nursing strategy is to monitor liver function tests weekly in clients on TPN longer than 2 weeks and recognize that jaundice, itching, and elevated bilirubin suggest TPN-related cholestasis.

Question 16

A 68-year-old client with recent bowel surgery is receiving TPN through a central line at 75 mL/hr (dextrose 20%, amino acids 5%, electrolytes) with 20% lipids 250 mL over 12 hours. The client suddenly becomes confused and diaphoretic; bedside glucose is 42 mg/dL. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Stop the TPN infusion and start 0.9% sodium chloride at the same rate
  2. Administer IV dextrose per protocol and recheck glucose in 15 minutes (correct answer)
  3. Obtain a complete metabolic panel before intervening
  4. Delegate repeat blood glucose measurement to unlicensed assistive personnel
Explanation: This question tests TPN care and metabolic monitoring clinical judgment, specifically managing acute hypoglycemia during TPN therapy. The priority concern is severe hypoglycemia (glucose 42 mg/dL) with neurological symptoms (confusion) and sympathetic response (diaphoresis), requiring immediate intervention to prevent seizures or loss of consciousness. Administering IV dextrose per protocol and rechecking glucose in 15 minutes is the highest priority to rapidly correct the dangerously low blood sugar. Stopping TPN without dextrose replacement would worsen hypoglycemia, obtaining labs delays urgent treatment, and delegation is inappropriate for this critical situation. The decision-making principle is that symptomatic hypoglycemia during TPN therapy requires immediate IV dextrose administration to prevent neurological complications. The transferable nursing strategy is to never abruptly stop TPN without ensuring alternative glucose source, as the high dextrose content can cause rebound hypoglycemia.

Question 17

A 28-year-old client with short bowel syndrome is preparing for discharge on home TPN after multiple bowel resections. The client will infuse TPN nightly via a tunneled central venous catheter: 2,000 mL over 12 hours (dextrose 20%, amino acids 5%, electrolytes, vitamins, trace elements) using an infusion pump; 20% lipid emulsion is infused 3 nights per week. Which assessment finding indicates a complication of TPN therapy during a home health visit?

  1. Dressing is dry and intact with no redness at the catheter site
  2. Weight gain of 0.2 kg (0.4 lb) over 1 week
  3. Client reports mild hunger before starting the nightly infusion
  4. Fever 38.3°C (100.9°F) with chills occurring during the infusion (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is infection, a common complication in home TPN via central lines. Fever with chills during infusion indicates the highest priority as it suggests line sepsis needing prompt evaluation. Mild hunger is expected; intact dressing is positive; minimal weight gain is normal, countering misconceptions about benign symptoms. Prioritizing client safety involves teaching infection signs. Decision-making in TPN care focuses on home monitoring education. A transferable nursing strategy is to instruct clients to report fevers immediately and seek care to prevent systemic infections.

Question 18

A 59-year-old client with diabetes is receiving TPN after bowel surgery via central line. The current TPN contains dextrose 25%, amino acids 5%, electrolytes, vitamins at 85 mL/hr; regular insulin is added to the bag per order. The client's capillary blood glucose trends upward from 180 to 320 mg/dL (10.0 to 17.8 mmol/L) over 6 hours. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Encourage the client to ambulate to lower blood glucose
  2. Delegate to assistive personnel to recheck the blood glucose at the next scheduled time
  3. Stop the TPN immediately to prevent further hyperglycemia
  4. Verify the infusion rate and implement the prescribed hyperglycemia management protocol (e.g., supplemental insulin) and notify the provider as indicated (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is hyperglycemia in diabetic clients on high-dextrose TPN. Verifying rate, implementing protocol, and notifying is the highest priority to manage rising glucose safely. Stopping TPN risks malnutrition; delegating rechecks delays; ambulation is insufficient, addressing misconceptions about non-pharmacologic control. Prioritizing client safety involves insulin protocols. Decision-making in TPN care emphasizes glucose trends. A transferable nursing strategy is to add insulin to TPN and monitor frequently in diabetics.

Question 19

A 47-year-old client is receiving TPN via a central line after bowel surgery. The TPN (dextrose 25%, amino acids 5%, electrolytes, vitamins) is infusing at 75 mL/hr. The current bag will be empty in 30 minutes, and the replacement bag has not arrived from pharmacy. The client's blood glucose is 110 mg/dL (6.1 mmol/L), and vital signs are stable. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Delegate to the assistive personnel to obtain a fingerstick blood glucose every hour
  2. Decrease the TPN rate by half for 30 minutes, then stop the infusion
  3. Stop the infusion and flush the line with normal saline to keep it patent
  4. Hang 10% dextrose in water at the same rate until the next TPN bag is available (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is preventing hypoglycemia when TPN supply is delayed. Hanging 10% dextrose at the same rate is the highest priority to maintain glucose levels and avoid rebound effects. Stopping and flushing risks hypoglycemia; decreasing rate is inadequate; delegating glucose checks delays prevention, addressing misconceptions about interruption protocols. Prioritizing client safety involves bridging with dextrose solutions. Decision-making in TPN care emphasizes continuity of nutrition. A transferable nursing strategy is to anticipate delays and have dextrose available to prevent metabolic disruptions.

Question 20

A 51-year-old client with ulcerative colitis is receiving TPN via a central line after bowel surgery. The TPN is infusing at 80 mL/hr and contains dextrose 25%, amino acids 5%, electrolytes, vitamins, and trace elements; lipids are infused separately. The client's capillary blood glucose is 58 mg/dL (3.2 mmol/L), and the client is diaphoretic and confused. What is the nurse's PRIORITY action for a client receiving TPN?

  1. Notify the provider that the TPN dextrose concentration is too high
  2. Recheck the blood glucose in 15 minutes to confirm the reading
  3. Delegate to the assistive personnel to provide a high-carbohydrate snack
  4. Stop the TPN infusion and administer intravenous dextrose per protocol (correct answer)
Explanation: This question tests clinical judgment in TPN care and metabolic monitoring. The priority concern is hypoglycemia, resulting from abrupt TPN interruption or high insulin response. Stopping the TPN and administering IV dextrose is the highest priority to rapidly correct low glucose and prevent neuroglycopenic symptoms. Rechecking glucose delays treatment; notifying about dextrose concentration is not immediate; delegating snacks is inappropriate for IV TPN clients, countering misconceptions about oral interventions. Prioritizing client safety involves preventing rebound hypoglycemia. Decision-making in TPN care focuses on gradual tapering. A transferable nursing strategy is to monitor glucose hourly during TPN transitions and have dextrose ready for low readings.