Editing Nutrition – RN Practice Questions (section)

==Question 1==
A client is receiving total parenteral nutrition (TPN) through a tunneled central catheter. The nurse discovers that the bag has been empty for an unknown period and no replacement bag is available from the pharmacy. Which action should the nurse take first?
# Flush the catheter with normal saline and clamp it until the new bag arrives.
# Hang 10% dextrose in water at the same rate the TPN was infusing.
# Increase the rate of the client's maintenance intravenous fluids to compensate.
# Obtain a capillary blood glucose and continue to monitor without intervention.

'''Answer:''' 2. Hang 10% dextrose in water at the same rate the TPN was infusing.

''Rationale:'' TPN delivers a large, continuous dextrose load, and the pancreas responds with sustained endogenous insulin secretion. Abrupt cessation leaves that circulating insulin unopposed and produces rebound hypoglycemia, which can progress to seizures and loss of consciousness. Hanging 10% dextrose in water at the same rate maintains the carbohydrate delivery until TPN resumes, and the provider is then notified. Option 1 stops all dextrose and causes the very problem to be avoided. Option 3 delivers isotonic fluid with little or no dextrose in most cases and does not protect glucose. Option 4 correctly identifies the risk but does nothing to prevent harm; monitoring alone is not an adequate intervention when a preventive action is available.