NCLEX: Nursing Pharmacology

NCLEX: Nursing Pharmacology

NCLEX: Nursing Pharmacology

1. Question
A 2-year-old child is receiving temporary total parenteral nutrition (TPN) through a central venous line. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child, which one would be a priority at this time?

A. Use aseptic technique during dressing changes.
B. Maintain central line catheter integrity.
C. Monitor serum glucose levels.
D. Check results of liver function tests.

Correct Answer: C. Monitor serum glucose levels

Monitor serum glucose levels. Hyperglycemia may occur during the first day or 2 as the child adapts to the high-glucose load of the TPN solution. Thus, a chief nursing responsibility is blood glucose testing. Total parenteral nutrition (TPN), also known as parenteral nutrition (PN) is a form of nutritional support given completely via the bloodstream, intravenously with an IV pump. TPN administers proteins, carbohydrates, fats, vitamins, and minerals. It aims to prevent and restore nutritional deficits, allowing bowel rest while supplying adequate caloric intake and essential nutrients, and removing antigenic mucosal stimuli (Perry et al., 2014).

Option A:

With proper care, a central catheter can be maintained for several days or even weeks for the delivery of TPN. Apply strict aseptic technique during insertion, care, and maintenance. Frequently assess the CVC site for redness, tenderness, or drainage. Notify the health care provider of any signs and symptoms of infection.

Option B:

Strict asepsis is to be observed during the placement of the catheter. A chest radiograph should be taken prior to the commencement of feeding to confirm the position of the catheter-tip and to exclude traumatic pneumothorax, the commonest complication related to catheter placement.

Option D:

Review lab values for increases and decreases out of the normal range. Lab values include CBC, electrolytes, calcium, magnesium, phosphorus, potassium, glucose, albumin, BUN (blood urea nitrogen), creatinine, triglycerides, and transferrin.