Chapter 32: Parenteral Nutrition Nursing School Test Banks

MULTIPLE CHOICE

1. 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?

a.

Enteral

b.

Parenteral

c.

A combination of enteral and parenteral

d.

Oral

ANS: B

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 patients 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.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 796-797

OBJ: Identify patients who are candidates for parenteral nutrition.

TOP: Parenteral Nutrition KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2. 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?

a.

Second intravenous line

b.

Enteral feeding tube

c.

Central venous access device

d.

Parenteral feeding tube

ANS: C

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

DIF: Cognitive Level: Analysis REF: Text reference: p. 800

OBJ: Describe factors influencing the selection of appropriate sites for administering parenteral nutrition. TOP: Central Lines

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. 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?

a.

Lower than normal blood glucose to determine adequate tolerance for PN

b.

Slightly higher than normal blood glucose to meet increased cellular needs

c.

Slightly higher than normal blood glucose to prevent infection or systemic sepsis

d.

Normal blood glucose to prevent associated complications

ANS: D

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.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 798-799

OBJ: Discuss risks associated with parenteral nutrition. TOP: Blood Sugar Control

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

4. 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?

a.

Encouraging the patient to eat

b.

Force-feeding the patient

c.

Consulting with the nutritional support team

d.

Being aware that the patient will come around when hungry

ANS: C

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.

DIF: Cognitive Level: Analysis REF: Text reference: pp. 799-801

OBJ: Identify patients who are candidates for parenteral nutrition.

TOP: Nutritional Support Team KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

5. 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?

a.

Excess linoleic acid

b.

Omega-6 fatty acid excess

c.

Essential fatty acid deficiency

d.

Electrolyte instability

ANS: C

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.

DIF: Cognitive Level: Analysis REF: Text reference: p. 799

OBJ: Identify complications of PN without adequate fatty acids.

TOP: Essential Fatty Acid Deficiency (EFAD)

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

6. 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?

a.

Fever, chills, and malaise

b.

Low temperature, chills, and headache

c.

Fever, flushing, and muscle relaxation

d.

Low temperature, muscle aches, and dyspnea

ANS: A

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

DIF: Cognitive Level: Analysis REF: Text reference: p. 804

OBJ: Identify complications r/t intolerance to fat emulsion. TOP: Lipid Infusion

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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

a.

Weight gain of 1 to 2 pounds per week

b.

Serum calcium level of 10 mEq/L

c.

Serum potassium level of 2.8 mEq/L

d.

Serum glucose level of more than 200 mg/100 mL

ANS: A

The patients 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.

DIF: Cognitive Level: Analysis REF: Text reference: p. 802

OBJ: Demonstrate appropriate nursing care for the patient receiving parenteral nutrition.

TOP: Weight Gain KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity

8. 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?

a.

Increased nutrition from the patients parenteral infusions

b.

Decreased linoleic acid intake

c.

Increased fluid loss

d.

Fluid retention

ANS: D

Weight gain greater than 1 lb/day indicates fluid retention. The patients ideal weight gain is usually between 1 and 2 lb/wk. Weight is an indicator of the patients 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.

DIF: Cognitive Level: Analysis REF: Text reference: p. 803

OBJ: Demonstrate appropriate nursing care for the patient receiving parenteral nutrition.

TOP: Fluid Retention KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity

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

a.

Fever

b.

Chest pain

c.

Erythema and induration

d.

Shaking and dizziness

ANS: D

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.

DIF: Cognitive Level: Application REF: Text reference: p. 803

OBJ: Demonstrate appropriate nursing care for the patient receiving parenteral nutrition.

TOP: Complications of Parenteral Nutrition

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

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

a.

Shakiness and dizziness

b.

Chest pain/hypotension

c.

Increased thirst

d.

Increased temperature

ANS: D

Know the patients 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.

DIF: Cognitive Level: Analysis REF: Text reference: p. 803

OBJ: Demonstrate appropriate nursing care and use of safety precautions when caring for a patient receiving PN. TOP: Complications of Parenteral Nutrition

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

11. 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?

a.

Exit site infection

b.

Catheter-related sepsis

c.

Pneumothorax

d.

Hyperglycemia

ANS: C

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.

DIF: Cognitive Level: Application REF: Text reference: p. 798

OBJ: Discuss risks associated with parenteral nutrition.

TOP: Complications of Central Parenteral Nutrition

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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

a.

Electrolyte levels

b.

Weight

c.

Temperature

d.

Condition of insertion site

ANS: A

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

DIF: Cognitive Level: Application REF: Text reference: pp. 799-800

OBJ: Discuss risks associated with parenteral nutrition. TOP: Assessment/Planning

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. 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.)

a.

Decreased mortality

b.

Bloodstream infection

c.

Pneumothorax

d.

Decreased length of stay

e.

Liver disease

ANS: B, C, E

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.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 796 |Text reference: p. 798

OBJ: Discuss risks associated with parenteral nutrition.

TOP: Parenteral Nutrition Complications

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. 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.)

a.

Monitor the patients weight.

b.

Monitor the patients serum glucose levels.

c.

Measure the patients intake and output.

d.

Perform catheter care.

e.

Limit the patients activity.

ANS: A, B, C, D

The patient and family caregiver will need to learn to monitor the patients 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.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 804

OBJ: Discuss risks associated with parenteral nutrition. TOP: Quality of Life

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

COMPLETION

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

ANS:

lipids

Lipids provide supplemental kilocalories and prevent essential fatty acid deficiencies.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 797 |Text reference: p. 799

OBJ: Identify measures used to prevent complications of central parenteral nutrition.

TOP: Lipids KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

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

ANS:

5% dextrose

The 5% dextrose solution will maintain the fluid and electrolyte balance of the patient until either the PN therapy may be restarted or gradually withdrawn.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 802

OBJ: Identify measures used to prevent complications of central parenteral nutrition.

TOP: Lipids KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

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