Editing Nutrition – RN Practice Questions (section)

==Question 5==
The nurse is caring for a client receiving TPN. Which nursing actions are appropriate? '''Select all that apply.'''
# Change the administration set and filter every 24 hours.
# Monitor capillary blood glucose every 4 to 6 hours.
# Infuse the solution using an electronic infusion pump.
# Increase the infusion rate to catch up if the infusion falls behind schedule.
# Add ordered potassium chloride to the TPN bag at the bedside.
# Assess the central catheter insertion site each shift for redness and drainage.

'''Answer:''' 1, 2, 3, and 6.

''Rationale:'' TPN is a hypertonic, nutrient-rich solution that supports rapid bacterial growth, so the bag, tubing, and filter are changed every 24 hours with strict aseptic technique and the insertion site is assessed every shift for signs of catheter-related bloodstream infection. Hyperglycemia is the most common metabolic complication, so glucose is checked every 4 to 6 hours, at least initially. An infusion pump is required because rate variation destabilizes glucose. Option 4 is unsafe: "catching up" delivers a sudden dextrose bolus and causes hyperglycemia and osmotic diuresis; the rate is never increased to make up lost volume. Option 5 is unsafe: additives are compounded by pharmacy under a laminar flow hood, and adding drugs at the bedside risks contamination and precipitation.