TPN Care And Metabolic Monitoring - NCLEX Rn

Which filter is used for standard dextrose–amino acid TPN solutions (no lipids)?

In-line $0.22\ \mu\text{m}$ filter. This filter size effectively removes bacteria, fungi, and particulates from non-lipid TPN formulations.
Which finding most strongly suggests catheter-related bloodstream infection in a patient receiving TPN?

Fever or chills during infusion. These symptoms reflect systemic inflammatory response to catheter-introduced pathogens.
What is the correct action if particulate matter or a crack is noted in the TPN bag before hanging it?

Do not infuse; discard and obtain a new bag from pharmacy. Defects compromise integrity, risking contamination or embolism upon infusion.
Which blood glucose monitoring frequency is most appropriate when initiating or adjusting TPN?

Check capillary glucose every $4$ – $6$ hours (or per protocol). Frequent checks detect glucose fluctuations early during TPN initiation or rate changes.
What is the most common early metabolic complication of TPN therapy?

Hyperglycemia. High dextrose content overwhelms glucose regulation, especially in stressed or diabetic patients.
Which metabolic complication is most associated with abrupt discontinuation of TPN?

Hypoglycemia. Abrupt stop leads to rebound effect from sustained insulin secretion without glucose input.
What is the primary reason TPN requires strict aseptic technique during tubing and dressing care?

High risk of catheter-related bloodstream infection. Nutrient-rich TPN solutions promote bacterial proliferation, heightening sepsis risk if asepsis is not maintained.
Which laboratory marker is most appropriate to monitor for hypertriglyceridemia during lipid infusion?

Serum triglycerides. Elevated levels indicate lipid intolerance, risking pancreatitis or other complications.
Which assessment finding most suggests dehydration in a patient receiving TPN and needs prompt evaluation?

Decreased urine output. Oliguria signals fluid deficit, potentially from TPN's osmotic diuresis or inadequate intake.
Which liver-related complication is associated with prolonged TPN and requires monitoring of liver enzymes?

Cholestasis (TPN-associated liver dysfunction). Prolonged TPN impairs bile flow and causes fatty liver, necessitating enzyme surveillance.
What is the correct nursing action if TPN is infusing and the patient must leave the unit for imaging?

Continue via pump on transport; do not stop unless ordered. Continuous infusion via portable pump maintains metabolic stability during transport.
Which daily bedside assessment best supports metabolic monitoring for fluid overload during TPN?

Daily weight. Weight gain indicates fluid retention from TPN's osmotic effects or overload.
What is the priority nursing action when a malnourished patient on new TPN develops hypophosphatemia?

Notify provider and anticipate phosphate replacement and slower advancement. Early intervention corrects deficits and prevents cardiac or respiratory complications of refeeding.
Which patient symptom during lipid infusion should prompt stopping the infusion and notifying the provider?

Dyspnea or signs of hypersensitivity reaction. Symptoms may signal allergic response or fat embolism, requiring immediate cessation.
Identify the best temporary intervention if a new TPN bag is delayed and the current bag is empty.

Hang $10\%$ dextrose (D $10$ W) at the same rate until TPN arrives. D10W provides interim glucose to stabilize blood sugar and prevent hypoglycemic crisis.
What is the correct action if a TPN bag is found disconnected or the sterility of the system is compromised?

Stop infusion and replace with new sterile tubing and solution per policy. Immediate replacement prevents infusion of contaminated solution and potential systemic infection.
Which electrolyte is most directly linked to dysrhythmia risk and should be monitored closely with TPN?

Potassium. Imbalances in potassium disrupt cardiac conduction, increasing arrhythmia likelihood in TPN patients.
Which triad of electrolyte abnormalities is classic for refeeding syndrome after nutrition initiation?

Hypophosphatemia, hypokalemia, and hypomagnesemia. Anabolic shift in refeeding causes intracellular electrolyte depletion, leading to this classic imbalance.
Which laboratory value is most important to monitor for refeeding syndrome risk when starting TPN?

Serum phosphate. Low phosphate signals refeeding risk in malnourished patients as cells uptake it rapidly.
Which filter is used for IV lipid emulsion or 3-in-1 (TPN with lipids) admixtures?

In-line $1.2\ \mu\text{m}$ filter. Larger pore size accommodates lipid globules while filtering out larger contaminants and air.
Which dedicated IV line requirement is correct for administering TPN?

Use a dedicated lumen/line; do not piggyback other IV meds or fluids. A dedicated line minimizes incompatibility issues with other medications and reduces infection risk from repeated access.
Which infusion device is required to administer TPN safely?

An electronic infusion pump. Precise rate control is essential to avoid rapid glucose shifts leading to metabolic instability.
What is the immediate nursing action if a patient becomes diaphoretic and confused during TPN infusion?

Check blood glucose immediately. Symptoms suggest hypoglycemia from excessive insulin response to TPN's high glucose content.
What is the preferred vascular access for long-term total parenteral nutrition (TPN) infusion?

Central venous access (PICC or tunneled CVC) into the superior vena cava. TPN's high osmolarity requires dilution in a large central vein to prevent phlebitis and thrombosis in peripheral vessels.
Which statement best describes why TPN solutions are changed on a scheduled basis (often every $24$ hours)?

To reduce microbial growth risk and maintain solution stability. Scheduled changes limit bacterial colonization and prevent chemical degradation of nutrients.

Study these flashcards