Fever, chills, or redness at the insertion site may indicate catheter-related bloodstream infection and must be reported.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is prescribed parenteral iron dextran by the intramuscular route. Which technique should the nurse use to prevent skin staining?
Answer: A. Iron given IM stains and irritates subcutaneous tissue and skin, so the Z-track method is used to seal the medication in the muscle, along with a separate needle for drawing up and not massaging the site. A test dose is given first to monitor for anaphylaxis.
Question 2 of 5
A child weighs 22 lb. The safe dose of a medication is 5 mg/kg/day. What is the maximum safe total daily dose the nurse should expect?
Answer: B. First convert pounds to kilograms: 22 lb / 2.2 = 10 kg. Then 10 kg x 5 mg = 50 mg per day. Always convert weight to kilograms before applying a weight-based dose.
Question 3 of 5
An order reads amoxicillin 40 mg/kg/day divided into two doses for a 20 kg child. How many milligrams should the nurse give per dose?
Answer: B. First find the daily dose: 20 kg times 40 mg/kg equals 800 mg/day. Divided into two doses gives 400 mg per dose. Failing to divide the daily total is a common error.
Question 4 of 5
A client is to receive iron dextran by the intramuscular route. Which technique should the nurse use to administer this medication?
Answer: A. Parenteral iron (iron dextran) stains the skin and must be given by deep intramuscular injection using the Z-track technique into the ventrogluteal site, with a separate needle for drawing up and injecting. This prevents the dark iron solution from tracking back through the needle path and staining or irritating subcutaneous tissue. Massaging the site would increase leakage and staining.
Question 5 of 5
When pharmacologic therapy is required for gestational diabetes, which medication is considered the preferred agent during pregnancy?
Answer: A. Insulin is the preferred pharmacologic agent for gestational diabetes because it does not cross the placenta in clinically significant amounts and provides reliable glycemic control. It is used when nutrition and exercise alone fail to meet glucose targets.
Keep the streak going with more questions like these, each with a full rationale.
What is total parenteral nutrition?
It is used when the gastrointestinal tract cannot be used, such as in bowel obstruction, severe malabsorption, or prolonged NPO status. Because it is highly concentrated and bypasses the gut, it carries significant infection and metabolic risks.
Key points to remember
- TPN is hypertonic and high in dextrose, so it must run through a central line, not a peripheral IV.
- Strict aseptic technique is essential because the high glucose and central line are major infection risks.
- Abrupt discontinuation can cause rebound hypoglycemia, so the rate is tapered.
- If a bag is unavailable, hang 10 percent dextrose to prevent hypoglycemia rather than stopping abruptly.
- Tubing and the bag are changed every 24 hours, and the bag is never sped up to catch up if behind.
Nursing priorities
- Check blood glucose every 4 to 6 hours and treat hyperglycemia per protocol.
- Use strict aseptic technique for line care and tubing changes.
- Confirm central line placement by x-ray before initiating TPN.
- Run TPN on an infusion pump and never abruptly stop or speed up the rate.
- Monitor daily weights, intake and output, and electrolytes.
Labs & values
Patient teaching
- Report any fever, chills, or redness, swelling, or drainage at the catheter site.
- Do not adjust the pump rate yourself.
- Keep the dressing clean, dry, and intact to prevent infection.
- Blood sugar checks are routine while you are on this nutrition.
Red flags: report now
- Fever, chills, or redness at the insertion site may indicate catheter-related bloodstream infection and must be reported.
- Never abruptly stop TPN, as it causes rebound hypoglycemia; hang dextrose if the next bag is delayed.
- Sudden dyspnea, chest pain, or tachycardia may signal air embolism or refeeding complications and is an emergency.
- Never speed up or slow down to catch up an off-schedule TPN infusion.
References
Clinical references for this topic
