Karen, a 54-year-old female, is in the hospital for treatment of complications associated with Crohn's disease. She was diagnosed with Crohn's disease 10 years ago and has suffered from intermittent abdominal pain and diarrhea ever since. Last year, Karen underwent surgical resection of part of her bowel to alleviate some of her symptoms. Upon hospital admission, Karen states that she has lost almost 10 percent of her body weight; she complains of fatigue and increased abdominal pain and has been suffering from steatorrhea. Her laboratory testing shows that she is deficient in vitamins A and D and she has iron deficiency anemia. Based on her symptoms and laboratory results, the physician has diagnosed Karen with short bowel syndrome. Because of her malnutrition and her gastrointestinal symptoms, the healthcare provider determines that Karen would benefit from parenteral nutrition.

1. Karen's physician is deciding whether peripheral parenteral nutrition (PPN) or total parenteral nutrition (TPN) would be more appropriate for her condition. What situation would most likely warrant the need for TPN?

a. The patient requires a solution with low osmolarity.

b. The patient needs nutrition support for less than two weeks.

c. The patient has various access sites available in the arms and legs.

d. The patient has low nutrient needs.

e. The patient is on fluid restriction.

2. The physician orders TPN with 20% lipid emulsion for Karen. The lipids are prepared in a 500 mL bag to run concurrently with the TPN solution. Based on the information provided, calculate the total amount of kcalories in the lipid emulsion.

a. 150 kcal

b. 500 kcal

c. 1000 kcal

d. 1500 kcal

e. 2000 kcal

3. Karen's TPN contains prescribed amounts of such nutrients as sodium, potassium, magnesium, and phosphate. What information should the clinician include in teaching Karen about this solution?

a. The amounts of nutrients are the same as an oral supplement.

b. The amounts of nutrients differ from DRI values.

c. The nutrients must be combined with an oral supplement to achieve the full effects.

d. The nutrients are broken down in the solution so that they will be absorbed quickly.

e. The amounts of nutrients are the same as DRI values.

4. The nurse is preparing to administer the first solution of TPN for Karen. What steps can the nurse take that would best prevent infection when administering TPN?

a. Monitor the infusion rate of the solution at each shift change.

b. Increase the rate of the infusion to prevent clotting.

c. Flush the tubing before starting the infusion.

d. Use aseptic technique when changing the catheter dressing.

e. Notify the physician if the dressing becomes wet or soiled.

5. The clinician checks Karen's blood glucose levels after starting TPN and notes that they are 198 mg/dL. What is the most appropriate response to this laboratory result?

a. Turn down the rate of the TPN infusion.

b. Decrease the amount of dextrose in the solution.

c. Encourage Karen to increase oral intake of fluids.

d. Decrease the rate of the insulin infusion.

e. Include lipid emulsions with the TPN administration.

6. Because Karen will most likely need long-term nutrition therapy, the physician changes her order so that she receives cyclic parenteral nutrition. What best describes this concept?

a. The solution is infused over a period of 24 hours.

b. The TPN solution is alternated with the lipid emulsion.

c. Insulin is administered with heparin solution.

d. The site of administration is rotated between two different locations.

e. The solution is infused over a period of 10 to 14 hours.