NCLEX-RN QUESTION AND ANSWERS WITH RATIONALES 2023

NCLEX-RN QUESTION AND ANSWERS WITH RATIONALES 2023 Physiological Integrity: Pharmacological & Parenteral Therapies Questions 1. When you are monitoring your client who is now started on an intravenous antibiotic for an infection, you notice that the client is exhibiting signs of anaphylaxis. What is your first priority intervention? A. Stop the intravenous flow B. Slow down the intravenous flow C. Notify the doctor D. Begin CPR Correct Response: A Your first priority intervention is to immediately stop the flow of the intravenous antibiotic because it is highly likely that the signs of anaphylaxis have occurred as the result of the client’s adverse effect to this antibiotic. The next thing that you would do is assess the client to determine their physical status and to provide necessary emergency measures, including CPR, if it is indicated. Later, you would notify the doctor about this adverse reaction. 2. The best way to determine whether or not a medication is compatible with a particular intravenous fluid is to: A. Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for color changes B. Refer to a compatibility chart C. Call the doctor and ask if the medication is compatible with the particular intravenous fluid D. Mix a small amount of the medication in a small amount of the intravenous fluid and then examine this mixture for any precipitates Correct Response: B The best way to determine whether or not a medication is compatible for a particular intravenous fluid is to refer to a compatibility chart. Although, at times, incompatibility can be evidenced with changes such as those related to color changes and the formation of a cloudy solution or obvious precipitate, at other times incompatibility may not be noticeable. For this reason, nurses must refer to a compatibility or incompatibility chart before they mix medications or medications and solutions. Lastly, there is no need to call the doctor for compatibilities when you have, and should use, a compatibility chart. 3. One of the primary purposes of a formal medication reconciliation is to: A. Prevent polypharmacy B. Conserve financial resources C. Prevent interactions D. Prevent allergies Correct Response: C The medication reconciliation process to insure that the nurse is aware of all medications that the client is taking, some of which may have been ordered by a physician other than the client’s primary care doctor and some of which are over the counter or alternative therapies that the client has added. The complete and current list of medications is then reviewed by the nurse and possible interactions are identified and addressed with the client. Although this medication reconciliation process can also save costs by eliminating unnecessary medications, particularly when the client is taking multiple medications (polypharmacy), this is not a primary purpose. Lastly, medications that the client is allergic to should never be given, therefore, these medications should not appear during the medication reconciliation process; they should never have been given to or taken by the client. 4. Your pregnant client has a new order for a medication. What principle should you apply to this new medication? A. The fact that drugs classified as categories C, D and X are contraindicated for women who are pregnant. B. The fact that drugs classified as categories A, B and C are contraindicated for women who are pregnant. C. The fact that drugs classified as categories C, D and E are contraindicated for women who are pregnant. D. The fact that drugs classified as categories C, D and Z are contraindicated for women who are pregnant. Correct Response: A Drugs classified as categories C, D and X are contraindicated for women who are pregnant because of the risks associated with these categories in terms of the developing fetus when these medications cross the placental barrier. 5. What are the nursing implications associated with administering blood and blood products to a client who has a blood type of B negative? A. The nurse must be knowledgeable about the fact that this client has A and B agglutinins and lacks the Rh factor B. The nurse must be knowledgeable about the fact that this client has B and O agglutinins and lacks the Rh factor C. The nurse must be knowledgeable about the fact that this client has B agglutinins and lacks the Rh factor D. The nurse must be knowledgeable about the fact that this client has A agglutinins and lacks the Rh factor Correct Response: D The nurse must be knowledgeable about the fact that this client has A agglutinins and they lack the Rh factor. Type A blood has B agglutinins; type B blood has A agglutinins, type AB blood has no antibodies, or agglutinins, and type O blood has both A and B agglutinins. People also have a rhesus, or Rh, factor antigen or the lack of it. Clients with an Rh positive blood, which is the vast majority of people, have Rh positive blood and people without the Rh factor antigen have Rh negative blood. 6. Select the complication of a blood transfusion that is accurately paired with its preventive measure. A. Hemolysis: Typing and cross matching the blood and checking for ABO compatibility prior to administration B. Hemolysis: Insuring that the client does not have a prior history of hemolysis in the past C. Febrile reactions: Insuring that the client does not have a prior history of hemolysis in the past D. Febrile reactions: Typing and cross matching the blood and checking for ABO compatibility prior to administration Correct Response: A Hemolysis can be prevented by typing and cross matching the blood and checking for ABO compatibility prior to administration. This incompatibility can occur as the result of a laboratory error in terms of typing and cross matching and a practitioner error in terms of checking the blood and matching it to the client’s blood type. Febrile reactions are the most commonly occurring reaction to blood and blood products administration. Although a febrile reaction can occur with all blood transfusions, it is most frequently associated with packed red blood cells and this reaction is not accompanied with hemolysis nor is it associated with its occurrence. 7. You will be administering packed red blood cells to your client. Which of the following principles should you apply to this blood administration? A. You must insure that the client has a patent intravenous catheter that is at least 20 gauge. B. You will need the help of another nurse prior to the administration of these packed red blood cells. C. The unit of packed red blood cells should start no more than 1 hour after it is picked up. D. You must remain with and monitor the client for at least 30 minutes after the transfusion begins. Correct Response: B You will need the help of another nurse prior to the administration of these packed red blood cells. Two nurses must check the blood, the doctor’s order, the ABO compatibility and the client’s identity using at least two unique identifiers prior to the administration of this blood. You must insure that the client has a patent intravenous catheter that is at least 18 gauge and not 20 gauge; you will be using normal saline and a Y infusion set for the administration of the blood because Ringer’s lactate and other intravenous solutions are not compatible with blood; blood should not remain in the client care area for more than 30 minutes so it is important that the nurse is prepared to begin the transfusion shortly after the blood is delivered to the patient care area; and, lastly, the nurse should remain with and monitor the client for at least 15 minutes after the transfusion begins at a slow rate since most serious blood reactions and complications occur shortly after the transfusion begins. 8. You are caring for a multiple trauma client who has just arrived at the emergency room with a number of other external disaster victims. This client has multiple blast injuries and hypovolemic shock; it is anticipated that this unstable critically injured and unconscious client will have long term intravenous therapy, blood products and possibly hyperalimentation as well. Which type of venous access would you most likely anticipate for this client? A. A percutaneous, non tunneled subclavian catheter B. A peripheral intravenous catheter that is 20 gauge C. A multi lumen implanted tunneled and cuffed central venous catheter D. A peripherally inserted central venous catheter Correct Response: C You would most likely anticipate that this client will be given a multi lumen implanted tunneled and cuffed central venous catheter because this multi trauma client is in need of multiple intravenous therapies such as blood, medications and total parenteral nutrition over an extended period of time. A percutaneous, non tunneled subclavian catheter would not be the device of preference because percutaneous, non tunneled subclavian catheters are used when short term treatments are anticipated; a peripheral intravenous catheter that is at least 18 gauge is necessary for the administration of blood; and a peripherally inserted central venous catheter would also not be the venous access device of choice for this seriously ill client who will require long term treatments and care. 9. How many tablets should be administered daily using the below information? Doctor’s order: 200 mg of medication once a day Medication label: 1 tablet = 150 mg A. 1.5 tablets B. 1.25 tablets C. 1.33 tablets D. 1 tablet Correct Response: C You have to determine how many tablets the patient will take if the doctor has ordered 200 mg a day and the tablets are manufactured as 150 mg per tablet. The mathematical rule for this type of calculation is: Have = Desired Quantity X This problem is calculated as shown below. 200 mg: X tablets = 150 mg: 1 tablet Or as 200 mg = 150 mg X tablets 1 tab You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 200 x 1 = 150 X 200/150 = 1.33 tabs rounded off to 1 1/3 tabs 10. How many mL of a liquid medication would you administer intramuscularly using the below information? Doctor’s order: 10 mg of medication BID Medication label: 1 mL = 12 mg A. 0.8 mL B. 0.9 mL C. 0.75 mL D. 0.125 mL Correct Response: A You have to determine how many mLs the patient will take if the doctor has ordered 10 mg twice a day and there are 12 mg in each mL. The mathematical rule for this type of calculation is: Have = Desired Quantity X This problem is calculated as shown below. 10 mg: X mL = 12 mg: 1 mL Or as 10 mg = 12 mg X mL 1 mL You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 10 x 1 = 10 X 10/12 = 0.833 mL rounded off to 0.8 mL 11. How many units of heparin would you administer subcutaneously using the below information? Doctor’s order: 6,500 units of heparin subcutaneously Medication label: 4,500 units in one mL A. 1.4 mL B. 1.5 mL C. 1.475 mL D. 1.425 mL E. 1.375 mL Correct Response: A You have to determine how many mLs the patient will take if the doctor has ordered 6,500 units of heparin subcutaneously and there are 4,500 units in one mL. The mathematical rule for this type of calculation is: Have = Desired Quantity X This problem is calculated as shown below. 6,500 units: X mL = 4,500 units: 1 mL Or as 6,500 units = 4,500 units X mL 1 mL You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 6,500 x 1 = 6,500 6,500/4,500 = 1.44 mL which is rounded off to 1.4 mL 12. Your pediatric client weighs 48 pounds. How many mg of a medication would you administer to this client with each dose when the doctor has ordered 5 mg/kg/day in two equally divided doses? A. 45 mg B. 60 mg C. 52 mg D. 55 mg Correct Response: D To calculate the number of mg that this pediatric client will receive in each dose, you will have to calculate the client’s weight in kg and then determine the total mg for the day after which you will divide the daily dosage by 2 because the order is for two equally divided doses each day. The steps for this calculation are shown below: This is how to determine the client’s weight in terms of kg: 48 pounds: x kg = 2.2 pounds: 1 kg Or as 48 pounds = 2.2 pounds x kg 1 kg You will criss cross multiply the known numbers and then divide this product by the remaining number to solve for X, as below. 48 x 1 = 48 48/2.2 = 21.81 or 21.81 kg This is how to determine the client’s total daily dosage when the doctor has ordered has ordered 5 mg/kg/day: 21.81 kg x 5 = 109.05 mg per day This is how to determine the client’s dose for each of the two divided doses: 109.05/2 = 54.53 mg which is rounded off to 55 mg for each of two divided doses. 13. How many drops per minute would you administer when the doctor’s order states that the client should receive 1 liter of fluid over 8 hours and the intravenous set delivers 20 gtts per cc? A. 31 gtts B. 42 gtts C. 48 gtts D. 51 gtts Correct Response: B The first step of this calculation is to calculate the number of mLs, or cc s, per hour and then determine the number of drops per minute. This calculation is done as follows: 1000 ml = 125 mL per hour 8 hrs The next step is done using this rule that reflects the fact that there are 60 minutes per hour in order to determine the number of mLs per minute . 1 hour = The ordered mL per hour 125 mLs X min 60 min 1 hour = 125 mL X min 60 min 60 x 1 = 60 88/60 = 2.08 mL per minute Finally, the number of drops per minute is calculated by using the intravenous infusion set’s drop factor by using this rule. Volume per minute x Drop factor 2.08 x 20 = 41.6 gtts per minute which is rounded off to 42 gtts per minute 14. How many mLs will you administer to the client after you use 3.3 mL of normal saline to reconstitute a medication that will yield 12 mg per mL and the doctor’s order is as follows. Doctor’s order: 25 mg of medication BID A. 1.9 mL B. 2.0 mL C. 2.5 mL D. 2.1 mL Correct Response: D With this type of calculation, the amount of normal saline that will be added to a powder in a vial to reconstitute the medication is important, instead, it is the amount of medication that results after the addition of the normal saline. For example, this reconstituted medication yields it is the yield of 12 mg in an mL that is relevant. It is this that will be used in the calculation. This calculation is done as shown below: 12 mg = 25 mg 1 mL X mL 25 x 1 = 25 25/12 = 2.08 mL which is 2.1 mL rounded off 15. You are caring for a client who has a doctor’s order for 1200 mLs of intravenous fluid every 8 hours. Your shift began at 8 am and there were 600 mLs remaining in the intravenous fluid bag. How many mLs would you expect to see at 12 noon? A. 0 mL B. 5 mL C. 10 mL D. 7.5 mL Correct Response: A When the doctor has ordered 1200 mLs of intravenous fluid every 8 hours, you would calculate the number of mLs per hour, as below. 1200/8 = 150 mLs per hour From 8 am to 12 noon there are 4 hours so: 150 mLs x 4 = 600 mLs Because you had 600 mLs at 8 am, you should be prepared to hand another intravenous bag because this 600 mLs should all be infused at 12 noon. 16. Your client has a doctor’s order for the antihistamine medication diphenhydramine for sleep. What should you do? A. Question the order because Benadryl is an antihistamine and not a sleeping medication. B. Refuse to give the Benadryl because this medication is a stimulant. C. Question the order because Benadryl is contraindicated when the client has a sleep inducement disorder. D. Give the Benadryl because sleep inducement is an accepted off label use of this medication. Correct Response: D You would administer this Benadryl because sleep inducement is an accepted off label use of this medication. When a medication is used for any other than these established and approved uses, this usage is referred to as an “off label use”. 17. Which of the following is not considered one of the “Ten Rights of Medication Administration”? A. The “right” verification B. The “right” to refuse C. The “right” documentation D. The “right” client education Correct Response: A The “right verification” is not one of the “Ten Rights of Medication Administration”. The verification of the doctor’s order for a medication is to confirm the right paint, medication, dose, route and time or frequency, it, in itself, is not one of the “10 Rights”. The “Ten Rights of Medication Administration” are the right, or correct: 1. Medication 2. Dose 3. Time or frequency 4. Patient 5. Route 6. Client education 7. Documentation 8. Right to refuse 9. Assessment and 10. Evaluation 18. The administration of an intramuscular injection to a neonate should be given in the: A. Gluteus maximus muscle. B. Vastus lateralis muscle. C. Deltoid muscle. D. The sternocledomastoid muscle. Correct Response: B The administration of an intramuscular injection to a neonate should be given in the vastus lateralis, rectus femoris and ventrogluteal muscle sites and not the deltoid or the gluteus maximus muscles because these muscles have not yet developed. The sternocledomastoid muscle is not an intramuscular injection site. 19. Which site or technique would you expect to use to administer ferrous sulfate? A. A subcutaneous injection site B. The PQRST technique C. The Z track technique D. The sublingual site Correct Response: C You would expect to use to use the Z track technique to administer ferrous sulfate. Ferrous sulfate IM is given using the Z Track technique to avoid the leakage and dark staining of the injection site with this medication. Ferrous sulfate is not administered with a subcutaneous injection or using the sublingual route. Lastly, the PQRST method is used to assess pain and not used as a guideline for medication administration. 20. Place the following steps for mixing NPH and regular insulin in the proper sequential order from # 1 to # 6 below. #1 - Prep the top of the shorter acting insulin with an alcohol swab #2 - Inject air that is equal to the ordered dosage of the shorter acting insulin using the same insulin syringe. #3 - Withdraw the ordered dosage of the shorter acting insulin using the same insulin syringe. #4 - Prep the top of the longer acting insulin vial with an alcohol swab. #5 - Inject air that is equal to the ordered dosage of the longer acting insulin using the insulin syringe. #6 - Withdraw the ordered dosage of the longer acting insulin using the same insulin syringe. A. 1,5,4,2,3,6 B. 4,3,2,6,1,5 C. 4,2,5,3,1,6 D. 1,5,3,6,4,2 Correct Response: A The steps for mixing NPH, the long acting insulin, with regular insulin, the short acting insulin in the correct sequential order are: 1. Prep the top of the longer acting insulin vial with an alcohol swab. 2. Inject air that is equal to the ordered dosage of the longer acting insulin using the insulin syringe. Do NOT withdraw the longer acting insulin yet. 3. Prep the top of the shorter acting insulin with an alcohol swab 4. Inject air that is equal to the ordered dosage of the shorter acting insulin using the same insulin syringe. 5. Withdraw the ordered dosage of the shorter acting insulin using the same insulin syringe. 6. And, then lastly, withdraw the ordered dosage of the longer acting insulin using the same insulin syringe. 21. You are precepting a new graduate nurse who will be administering an intramuscular injection to an adult client. The new graduate nurse identifies the gluteus maximum muscle by palpating it. What would you do? A. Allow the nurse to administer the injection. B. Ask the nurse to use the vastus lateralis muscle instead. C. Ask the nurse to verify the doctor’s order again. D. Stop the nurse from administering the injection. Correct Response: D You would stop the nurse from administering the injection when you observe that the nurse has palpated the gluteus maximum muscle to determine the correct site. Intramuscular injection sites are determined by using boney landmarks and not by palpating the muscle. You would not allow the nurse to administer the injection and you would not ask the nurse to use the vastus lateralis muscle instead because nothing indicates the need to do so. Lastly, you would verify the doctor’s order prior to entering the room and preparing to administer the injection and not during the time that the intramuscular site is being identified. 22. You are preparing to administer a PRN medication for pain. After your assessment of the client for pain you open the narcotics cabinet with the special key. Your calculations indicate that the client will be getting 0.8 mLs of the medication and the unit dose vial is 1 mL. You discard the excess of 0.2 mLs into the sink drain and enter the client’s room. After you identify the client using two unique identifiers, the client refuses the medication. You then discard the 0.8 mLs into the sink and document the client’s refusal on the narcotics count record. What have you failed to do during this process? A. You have failed to have another nurse witness the 0.8 mLs and the 0.2 mLs of waste. B. You have failed to have another nurse witness the 0.8 mLs of waste. C. You have failed to have another nurse witness the 0.2 mLs of waste. D. You have failed ask another nurse to verify the calculation of the dosage. Correct Response: A You have failed to have another nurse witness the 0.8 mLs and the 0.2 mLs. All controlled substances are documented on the narcotics record as soon as they are removed, and all controlled substances that are wasted for any reason, either in its entirety or only partially, must be witnessed or documented by the wasting nurse and another nurse. Both nurses document this wasting. It should not be necessary for you to ask another nurse to verify this calculation; the nurse is accountable and responsible for accurate dosage calculations. 23. Place these steps of the medication reconciliation process in the correct sequential order from # 1 to # 5. Do NOT include steps that are not part of the medication reconciliation process. 1: Compile a list of newly prescribed medications and other preparations 2: Compile a list of current medications and other preparations 3: Compile a list of only current vitamins, over the counter medications, herbal remedies, nutritional and dietary supplements 4: Compare the two lists and make note of any discrepancies and inconsistencies 5: Employ critical thinking and professional judgments during the comparisons of the two lists 6: Communicate and document the new list of medications to the appropriate healthcare providers A. 3,2,1,4,6 B. 2,1,4,5,6 C. 1,2,3,5,4 D. 4,1,3,2,6 Correct Response: B The procedure for this medication reconciliation process is: 2. Compile a list of current medications and other preparations 1. Compile a list of newly prescribed medications 4. Compare the two lists and make note of any discrepancies and inconsistencies 5. Employ critical thinking and professional judgments during the comparisons of the two lists 6. Communicate and document the new list of medications to the appropriate healthcare providers 24. Which of the following clients is at greatest risk for extravasation? A. The client with heart failure who is receiving Ringer’s lactate B. The client with cancer who is receiving bendamustine C. The client who is receiving potassium supplementation intravenously D. The client who is receiving total parenteral nutrition Correct Response: B The client with cancer who is receiving bendamustine is at greatest risk for extravasation. Extravasation occurs when vesicant and other vein irritating drugs infiltrate into the tissue. In severe cases, extravasation can lead to necrosis and the loss of an affected limb. Bendamustine is a vesicant chemotherapy drug. Extravasation is not associated with the intravenous administration of Ringers lactate or potassium supplementation intravenously because this solution and medication are not vesicants. These intravenous preparations can lead to infiltration but not extravasation. Lastly, the client who is receiving total parenteral nutrition is at risk for other complications such as infection, but not extravasation. 25. Select the complication of intravenous therapy that is accurately paired with one of its interventions. A. Infection: Lowering the limb to promote circulation B. Infiltration: The application of cold to the site C. Extravasation: The aspiration of contents including blood from the IV cannula D. Hematoma: The administration of dexrazonxane Correct Response: C In addition to other interventions, intravenous fluid contents including blood are aspirated from the IV cannula. Other interventions include immediate cessation of the infusion, elevating the limb, applying warm compresses initially to rid the area of any remaining drug that is in the tissues which is then followed by cool compresses to reduce any swelling, and the administration of an ordered substance specific medication such as dexrazoxane. One of the interventions for infection include the elevation, not lowering, of the affected limb; infiltration is treated with the application of warm, not cold, compresses and one of the interventions for hematoma is the application of pressure and heat and not the administration of dexrazonxane. 26. The CRIES scale is used to: A. Assess motor functioning. B. Assess sensory functioning. C. Evaluate responses to a tactile stimulation. D. Evaluate responses to a pain analgesic. Correct Response: D The CRIES scale is used to evaluate the neonate’s response to a pain analgesic; this pain scale is also used to assess pain among neonates. Observational behavioral pain assessment scales for the pediatric population are used among children less than three years of age. Some of these standardized pediatric pain scales, in addition to the CRIES scale, include the FACES Pain Scale, the Toddler Preschooler Postoperative Pain Scale (TPPPS), the Neonatal Infant Pain Scale (NIPS), the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Faces Legs Activity Cry Consolability Pain Scale (FLACC), the Visual Analog Scale (VASobs) the Observation Scale of Behavioral Distress (OSBD), the COMFORT Pain Scale and the Pre-Verbal Early Verbal Pediatric Pain Scale (PEPPS) that is used with toddlers. 27. Select the opioid classification that is accurately coupled with an example of it AND a side effect or adverse reaction to it. A. Opioid Agonist: Dilaudid: Constipation B. Opioid Agonist: Naloxone: Constipation C. Opioid Antagonist: Dilaudid: Anaphylaxis D. Opioid Antagonist: OxyContin: Anaphylaxis Correct Response: A Dilaudid is an opioid agonist that can cause constipation. Other opioid agonists are codeine, OxyContin, Darvon, Dilaudid, Demerol and Percocet. The side effects and adverse reactions to this classification of drugs include constipation, sedation, nausea, dizziness, pruritus, and sedation, respiratory depression and arrest, hepatic damage, an anaphylactic reaction, circulatory collapse and cardiac arrest. Opioid antagonists also referred to as opioid receptor antagonists, such as naloxone and naltrexone, can have side effects such as hepatic damage, joint pain, insomnia, vomiting, anxiety, headaches and nervousness. 28. Your client has been getting total parenteral nutrition for bowel rest for the last four days. During your assessment of the client today, your client tells you that their “chest hurts”. You assess that the client is also experiencing dyspnea. What is most likely occurring with this client? A. Your client may be experiencing a fluid overload. B. Your client may be experiencing an embolus. C. Your client may be hyperglycemic. D. Your client may have an inadvertent pneumothorax. Correct Response: B The client may be experiencing an embolus, which is a complication of total parenteral nutrition. Some of the signs and symptoms of an embolus are chest pain, dyspnea, shortness of breath, coughing, and respiratory distress. Emboli, secondary to total parenteral nutrition occur when air is permitted to enter this closed system during tubing changes and when a new bottle or bag of hyperalimentation is hung. This complication can be prevented by instructing the client to perform the Valsalva maneuver and the nurse’s rapid changing of tubings and solutions when the closed system is opened to the air. An inadvertent pneumothorax can occur and become symptomatic during the insertion of the TPN catheter and not four days later. Other side effects of TPN and their signs and symptoms are listed below.  Infection: The classical signs of infection including a fever, malaise, swelling and redness at the insertion site, diaphoresis, chilling and pain in the area of the TPN catheter insertion site.  Fluid overload: Hypertension, edema, adventitious breath sounds like crackles and rales, shortness of breath, and bulging neck veins.  Hyperglycemia: High blood glucose levels, thirst, excessive urinary output, headache, nausea and fatigue.  Hypoglycemia: Low blood glucose levels, shakiness, clammy and cool skin, blurry vision, diaphoresis and unconsciousness and seizures. 29. Which statement about total parenteral nutrition is true? A. Clients are at high risk for infection when they are getting TPN because they are immunocompromised. B. Clients are at high risk for hyperglycemia when they are getting TPN because they are diabetic. C. The client should perform the Valsalva maneuver when the nurse changes the TPN tubing. D. The client should perform the Valsalva maneuver when the nurse changes the TPN dressing. Correct Response: C The client should perform the Valsalva maneuver when the nurse changes the TPN tubing to prevent an embolus which can occur when the tubing is opened to the air while it is being changed. A mask, not the Valsalva maneuver, is indicated for TPN dressing changes. Lastly, clients are at risk for infection secondary to TPN because these solutions are high in dextrose and because TPN is an invasive sterile procedure; and clients are at high risk for hyperglycemia when they are getting TPN because these solutions are high in dextrose and not because the client is already a diabetic client.