Pharmacology A Patient-Centered Nursing Process Approach Test Bank Version 2022, 11th Edition 1-58 Chapters.

13. The nurse is preparing to discontinue total parenteral nutrition (TPN) therapy for a patient who has been receiving TPN for several days. The nurse will contact the provider to discuss an order for a. antibiotics. b. intravenous insulin. c. intravenous dextrose. d. nasogastric feedings. ANS: C Abruptly discontinuing TPN can lead to hypoglycemia. Patients should receive dextrose solution for 12 to 24 hours after TPN is discontinued to prevent this reaction. Antibiotics are used when signs of infection are observed. Intravenous insulin would compound hypoglycemia. Nasogastric feedings are indicated if the patient needs continued feeding therapy and has an intact GI tract. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Planning | Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition 14. The nurse is caring for a patient with severe burns who will begin receiving total parenteral nutrition (TPN). The patient asks why TPN is necessary. The nurse explains that TPN is used for which reason? a. To minimize pulmonary complications b. To prevent hyperglycemia and fluid overload c. To promote wound healing and maintain cell integrity d. To restore fluid and electrolyte imbalance ANS: C TPN is indicated for patients with severe burns. TPN enhances wound healing and provides the nutrients necessary to prevent cellular catabolism. While some pulmonary complications, such as aspiration pneumonia, do not occur with TPN, there is a risk of air embolism. Hyperglycemia and fluid overload may occur. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention: Patient Teaching MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition 15. The nurse is caring for a non-obese, non-critically ill adult who weighs 60 kg and is scheduled to begin receiving total parenteral nutrition (TPN). Prior to initiating TPN therapy, the nurse reviews the orders. What would be an appropriate energy intake for this patient? a. 1,800 cal/day b. 300 cal/day c. 3,600 cal/day d. 5,000 cal/day ANS: A The recommended energy intake is 25 to 35 cal/kg/day in a nonobese patient. Because this patient weighs 60 kg, a recommended energy intake would be between 1,500 to 2,100 cal/day. Adjustments to the TPN solution may be made based on patient-specific considerations. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition 16. The nurse is caring for a patient who is receiving total parenteral nutrition (TPN). The patient reports nausea, headache, and thirst. The nurse will contact the provider to discuss which of the following? a. Giving acetaminophen for headache pain b. Obtaining a blood glucose level c. Ordering an antiemetic to prevent vomiting d. Starting intravenous dextrose ANS: B This patient shows signs of hyperglycemia, which is a common adverse effect of TPN. The nurse should request an order for blood glucose testing. Symptoms should not be treated without first determining the underlying cause. Dextrose is given to prevent and/or treat hypoglycemia, but the patients blood glucose should be determined first. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition 17. The nurse is caring for a patient who is being treated with total parenteral nutrition (TPN). The patient is experiencing chest pain, and the nurse observes shortness of breath and coughing along with cyanosis. The nurse understands that this patient may be experiencing which condition? a. Air embolism b. Pneumonia c. Pneumothorax d. Pulmonary edema ANS: A Patients receiving TPN are at risk for air embolism and will report chest pain and be dyspneic with coughing and cyanosis. Patients with pneumonia will have cough and abnormal breath sounds. Patients with pneumothorax will have unilateral absent breath sounds and respiratory distress. Patients with pulmonary edema will have crackles and dyspnea. DIF: Cognitive Level: Applying (Application) TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort: Nutrition 18. A patient receiving total parenteral nutrition (TPN) begins having cough and dyspnea. The nurse auscultates rales and notes neck vein engorgement and weight gain. The nurse suspects that the patient is experiencing which condition? a. Air embolism b. Fluid overload c. Pneumonia d. Pneumothorax ANS: B