NCLEX-PN® ExaminationPharmacological TherapiesHard
A client is receiving total parenteral nutrition (TPN) via a central venous catheter. The LPN notes that the TPN solution bag is almost empty, and the new bag from the pharmacy is not yet available. The client's next scheduled TPN infusion is due in 15 minutes. What is the most appropriate action by the LPN?
- AIncrease the rate of the current TPN infusion to finish it quickly.
- BClamp the central venous catheter until the new TPN bag arrives.
- CAdminister a bolus of 0.9% sodium chloride through the central line.
- DInitiate an infusion of Dextrose 10% in water (D10W) at the ordered TPN rate.
Show answer & explanationAnswer & explanation
Correct answer: D. Initiate an infusion of Dextrose 10% in water (D10W) at the ordered TPN rate.
TPN contains high concentrations of dextrose. Abruptly stopping TPN or running out without a replacement can lead to rebound hypoglycemia. Infusing Dextrose 10% in water (D10W) at the TPN rate helps prevent this by providing a glucose source until the new TPN bag is available.
Why the other options are wrong
- A. Increasing the TPN rate can lead to hyperglycemia, fluid overload, and electrolyte imbalances, and does not address the pending gap.
- B. Clamping the line would stop glucose delivery entirely and lead to rebound hypoglycemia, which is dangerous for the client.
- C. 0.9% sodium chloride does not contain glucose and would not prevent rebound hypoglycemia.
TPN Interruption Management
When TPN infusion is interrupted or runs out, Dextrose 10% in water (D10W) should be administered at the TPN's previous rate to prevent rebound hypoglycemia.
- TPN is high in dextrose.
- Abrupt cessation causes rebound hypoglycemia.
- D10W provides temporary glucose.
- Administer D10W at the TPN's ordered rate.
Memory trick: TPN OUT: Temp D10W, Prevent Hypo