Electrolytes Question #39
A client who is NPO is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? (Select all that apply)
- Place the solution on an IV pump at the prescribed rate.
- Monitor blood glucose every six (6) hours.
- Weigh the client weekly, first thing in the morning.
- Change the IV tubing every three (3) days.
- Monitor intake and output every shift.
The correct answer is A, B, & E. Total parenteral nutrition (TPN) is a hypertonic solution given to provide nutritional support to a client who is unable or cannot receive food and fluids by mouth. Because the solution contains 50% dextrose, the client is monitored to ensure that the pancreas is adapting to the high glucose levels, and is administered via a pump to prevent too rapid of an infusion as it has enough calories, proteins, lipids, electrolytes, and trace elements to sustain life. And both intake and output are monitored to observe for fluid balance. The client should be weighed daily. The tubing is changed every 24 hours.
NCLEX TIP: When answering select all that apply (SATA) questions, look at each answer option and ask yourself if the response is true or false. When looking at the questions, watch for any negative NCLEX words, which will lead the nurse to do the “wrong” tasks. These words may include always, never, ever, no, don’t, do not, etc. Always remember the ABC’s and Maslow’s hierarchy. Common words and phrases in the question should always be noted, and note when to delegate and not to delegate. Never delegate a nursing task that requires an order, requires a higher intervention, or the client is unstable. A