CRNI Parenteral Nutrition Administration 4 — Questions and Answers
Question 1: A patient receiving PN develops sudden onset chest pain, hypotension, and cyanosis shortly after the infusion begins. The nurse should first suspect:
- Air embolism (Correct answer)
- Hyperglycemia
- Catheter occlusion
- Fluid overload
Correct answer: Air embolism
Air embolism is a life-threatening complication of PN that presents with sudden chest pain, hypotension, and cyanosis, requiring immediate intervention including placing the patient in left lateral Trendelenburg position.
Question 2: Which electrolyte abnormality is MOST associated with refeeding syndrome in a severely malnourished patient starting PN?
- Hypophosphatemia (Correct answer)
- Hypernatremia
- Hypercalcemia
- Hyperkalemia
Correct answer: Hypophosphatemia
Hypophosphatemia is the hallmark of refeeding syndrome, occurring as insulin shifts phosphate intracellularly when carbohydrate metabolism resumes after prolonged starvation.
Question 3: When using a 1.2-micron in-line filter for PN administration, the nurse understands this filter is appropriate for:
- Total nutrient admixtures (3-in-1) (Correct answer)
- Dextrose/amino acid solutions only
- Lipid emulsions administered separately
- Electrolyte additives only
Correct answer: Total nutrient admixtures (3-in-1)
A 1.2-micron filter is used for total nutrient admixtures (3-in-1) because it allows lipid particles to pass through while filtering particulates and some microorganisms.
Question 4: A CRNI is calculating the osmolarity of a peripheral PN solution. Which finding would indicate it is safe for peripheral administration?
- 900 mOsm/L (Correct answer)
- 1200 mOsm/L
- 1500 mOsm/L
- 1800 mOsm/L
Correct answer: 900 mOsm/L
Peripheral PN should not exceed 900 mOsm/L to minimize the risk of phlebitis and vein damage.
Question 5: Which action is correct when a PN bag must be changed before it is completely infused?
- Discard the remaining solution and hang the new bag (Correct answer)
- Store the partially used bag for up to 24 hours and reuse
- Add the remaining solution to the new bag
- Continue running the old bag until it empties, then hang the new one
Correct answer: Discard the remaining solution and hang the new bag
Partially infused PN bags should be discarded because PN is an ideal growth medium for microorganisms and must not be stored after being spiked.
Question 6: A patient's PN infusion is 4 hours behind schedule. The nurse should:
- Continue the infusion at the prescribed rate and notify the provider (Correct answer)
- Increase the rate to make up for the lost volume
- Discontinue the current bag and start a new one
- Double the rate for 2 hours to catch up
Correct answer: Continue the infusion at the prescribed rate and notify the provider
PN should never be infused faster than prescribed to avoid hyperglycemia and metabolic complications; the nurse should continue at the ordered rate and notify the provider.
Question 7: During PN administration via a PICC, the nurse notes the patient's arm is swollen and the infusion rate has slowed. The MOST appropriate action is:
- Stop the infusion and assess for PICC tip migration or extravasation (Correct answer)
- Increase the infusion pump pressure to overcome resistance
- Reposition the patient's arm and resume infusion
- Flush the line with normal saline and continue
Correct answer: Stop the infusion and assess for PICC tip migration or extravasation
Swelling and decreased flow rate suggest possible PICC migration or extravasation, and infusing PN into tissue can cause serious necrosis.
CRNI Parenteral Nutrition Administration 4
A patient receiving PN develops sudden onset chest pain, hypotension, and cyanosis shortly after the infusion begins.
The nurse should first suspect: