Author Question: The nurse receives a bag of total parenteral nutrition (TPN) for the client. Prior to hanging the ... (Read 87 times)

segrsyd · **on:** Jun 25, 2018

The nurse receives a bag of total parenteral nutrition (TPN) for the client. Prior to hanging the solution, which nursing actions are priorities?

Select all that apply.
1. Checking the expiration date
2. Creating a sterile field
3. Checking the nutrients in the bag against the order written by the primary care provider with another licensed nurse
4. Adding additional medications to the fluid
5. Applying a timing tape to the solution container

Question 2

The nurse is checking the client's nasogastric tube for placement prior to administering the client's first tube feeding. Which is the most accurate means of assessing placement?

1. Checking the pH of stomach contents aspirated from the tube
2. Infusing air into the tube and auscultating for the sound of the air over the stomach
3. Obtaining an x-ray
4. Checking for residual

izzat · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

Correct Answer: 1,3,5

The nurse should check the expiration date because the solution is high in sugar, providing an ideal location for pathogen growth. Outdated solutions should never be administered. The primary care provider's order should be checked against the contents of the solution with another nurse to ensure the proper mixture is prepared and administered. A timing tape should be applied to the solution to ensure that the fluid is infused at the proper rate, because it is high in glucose and could induce hyperglycemia if infused too quickly. There is no need to create a sterile field until the fluid is checked for accuracy and the bag prepared. Nurses do not add medications or anything to the prepared TPN, because it must be mixed under sterile technique with a laminar air flow device to prevent introduction of pathogens.

Answer to Question 2

Correct Answer: 3

The most accurate means of assessing placement prior to the first tube feeding is obtaining an x-ray, because this ensures exact location of the tube. Checking pH of stomach contents is the most cost-effective means of assessing placement, and minimizes the client's exposure to radiation. Infusing air and auscultating are not an accurate means of checking placement, because a tube that is high in the esophagus will still sound as though it is properly placed. Checking for residual is also a useful means of assessing placement, but not as accurate as an x-ray.