the client is npo and is receiving total parenteral nutrition tpn via a subclavian line which precautions should the nurse implement select one that d

HESI RN

HESI Leadership and Management

1. The client is NPO and is receiving total parenteral nutrition (TPN) via a subclavian line. Which precautions should the nurse implement? Select one that does not apply.

A. Place the solution on an IV pump at the prescribed rate.
B. Monitor blood glucose every twelve (12) hours.
C. Weigh the client weekly, first thing in the morning.
D. Change the IV tubing every three (3) days.

Correct answer: D

Rationale: Precautions for clients receiving TPN include placing the solution on an IV pump to control the rate, monitoring blood glucose levels to detect hyperglycemia, and monitoring intake and output to assess fluid balance. Changing the IV tubing every three days is not a standard precaution for clients receiving TPN via a subclavian line.

2. Which of the following describes the role of the nurse in advocating for a patient?

A. The nurse ensures that the patient has all the information needed to make an informed decision about their care.
B. The nurse advocates for the patient by communicating their needs and preferences to the healthcare team.
C. The nurse advocates for the patient by ensuring that they receive the care they need and by protecting their rights.
D. The nurse advocates for the patient by helping them navigate the healthcare system and access necessary resources.

Correct answer: C

Rationale: The correct answer is C. Nurses advocate for patients by ensuring that they receive the necessary care and by protecting their rights. This involves speaking up for patients, ensuring they are treated with respect, and helping them access appropriate healthcare services. Option A, providing information for informed decision-making, is an important aspect of nursing care but not the central role of advocacy. Option B, communicating patients' needs to the healthcare team, is essential but more focused on teamwork and collaboration. Option D, helping patients navigate the healthcare system and access resources, is valuable but not the primary definition of advocacy in nursing.

3. A client with DM visits the health care clinic. The client's diabetes has been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

A. Atenolol (Tenormin)
B. Prednisone (Deltasone)
C. Phenelzine (Nardil)
D. Allopurinol (Zyloprim)

Correct answer: B

Rationale: The correct answer is B. Prednisone is a corticosteroid that can cause hyperglycemia by increasing glucose production in the liver. Atenolol (Choice A) is a beta-blocker that typically does not affect blood glucose levels significantly. Phenelzine (Choice C) is a monoamine oxidase inhibitor used for depression and does not directly impact blood glucose levels. Allopurinol (Choice D) is a xanthine oxidase inhibitor used to manage gout and does not contribute to hyperglycemia.

4. A patient with acute congestive heart failure is receiving high doses of a diuretic. On assessment, the nurse notes flat neck veins, generalized muscle weakness, and diminished deep tendon reflexes. Suspecting hyponatremia, what additional signs would the nurse expect to note in this patient if hyponatremia were present?

A. Dry skin
B. Decreased urinary output
C. Hyperactive bowel sounds
D. Increased specific gravity of the urine

Correct answer: C

Rationale: In a patient with hyponatremia, hyperactive bowel sounds are expected due to increased gastrointestinal motility. Dry skin (Choice A) is not a typical sign of hyponatremia. Decreased urinary output (Choice B) is more commonly associated with conditions like dehydration or renal issues, not specifically hyponatremia. Increased specific gravity of the urine (Choice D) is a sign of concentrated urine, which is not a characteristic finding in hyponatremia.

5. When implementing a new policy on the unit, what process should a nurse manager follow?

A. The nurse manager should involve staff members in the decision-making process, gather input, and communicate the reasons for the policy change to ensure buy-in from the team.
B. The nurse manager should implement the policy change immediately and monitor staff compliance to ensure that the new policy is being followed.
C. The nurse manager should delegate the implementation of the policy change to a staff member and provide support as needed to ensure that the change is successful.
D. The nurse manager should communicate the policy change to staff members, provide training as needed, and monitor the implementation process to ensure that the change is effective.

Correct answer: A

Rationale: When introducing a new policy on the unit, it is essential for the nurse manager to involve staff members in the decision-making process. This approach helps in gathering input and insights from the team, fostering a sense of ownership and commitment. By communicating the reasons behind the policy change, the nurse manager ensures transparency and promotes understanding among the staff, leading to buy-in and acceptance of the new policy. Choice B is incorrect because implementing a policy change without involving staff and explaining the rationale may lead to resistance or lack of understanding. Choice C is not ideal as delegation without active involvement and communication with the team may result in misunderstandings or incomplete implementation. Choice D lacks the crucial step of involving staff in the decision-making process, which is important for successful policy implementation and team engagement.