CRNI Parenteral Nutrition Administration 5 — Questions and Answers
Question 1: Which assessment finding in a patient receiving PN would indicate the EARLIEST sign of catheter-related bloodstream infection (CRBSI)?
- Unexplained fever and chills (Correct answer)
- Elevated blood glucose only
- Swelling at the catheter exit site
- Decreased urine output
Correct answer: Unexplained fever and chills
Unexplained fever and chills without another identifiable source is the earliest and most common sign of CRBSI in patients receiving PN.
Question 2: A provider orders PN to be started immediately, but the pharmacy-prepared bag is not yet available. The nurse should administer:
- Dextrose 10% in water (D10W) at the prescribed PN rate (Correct answer)
- Normal saline at the prescribed PN rate
- Lactated Ringer's at the prescribed PN rate
- Nothing until the PN bag arrives
Correct answer: Dextrose 10% in water (D10W) at the prescribed PN rate
D10W is the appropriate bridge solution when PN is unavailable because it prevents hypoglycemia in patients who have been on PN and maintains carbohydrate substrate.
Question 3: When weaning a patient off long-term PN, the nurse anticipates the rate should be:
- Tapered gradually over several hours to prevent hypoglycemia (Correct answer)
- Stopped abruptly once oral intake begins
- Reduced by 50% each hour until discontinued
- Maintained at full rate until oral intake meets 100% of needs
Correct answer: Tapered gradually over several hours to prevent hypoglycemia
PN should be tapered gradually (typically over 1-2 hours) rather than stopped abruptly to prevent rebound hypoglycemia from persistent insulin secretion.
Question 4: A patient on long-term home PN develops elevated AST, ALT, and alkaline phosphatase. The nurse recognizes this as:
- PN-associated liver disease (PNALD) (Correct answer)
- Acute pancreatitis
- Cholelithiasis from NPO status only
- Medication hepatotoxicity unrelated to PN
Correct answer: PN-associated liver disease (PNALD)
PN-associated liver disease (PNALD) is a well-recognized complication of long-term PN, presenting with elevated liver enzymes and potentially progressing to steatosis or cholestasis.
Question 5: Which nursing intervention BEST prevents catheter occlusion in a patient receiving PN via a central venous catheter?
- Flushing the catheter with preservative-free normal saline before and after PN infusion (Correct answer)
- Using heparinized saline at 100 units/mL routinely after each infusion
- Clamping the catheter between infusions without flushing
- Flushing only when resistance is felt during infusion
Correct answer: Flushing the catheter with preservative-free normal saline before and after PN infusion
Flushing with preservative-free normal saline before and after PN helps clear the catheter of residue and prevents fibrin and lipid buildup that can cause occlusion.
Question 6: A CRNI monitors blood glucose every 6 hours in a patient on PN. The glucose is consistently 220 mg/dL. The FIRST intervention should be:
- Notify the provider to adjust the insulin sliding scale or add insulin to the PN bag (Correct answer)
- Increase the PN infusion rate to dilute the glucose concentration
- Stop the PN infusion until glucose normalizes
- Administer oral hypoglycemic agents
Correct answer: Notify the provider to adjust the insulin sliding scale or add insulin to the PN bag
Persistent hyperglycemia during PN requires provider notification to adjust insulin coverage, either via sliding scale or by adding regular insulin directly to the PN formulation.
Question 7: Which documentation element is MOST critical when a nurse initiates a new PN infusion?
- Time infusion started, rate, lot number, and expiration date of the PN bag (Correct answer)
- Patient's weight from 1 week ago and dietary history
- Number of previous PN infusions administered
- Patient's preference for infusion timing
Correct answer: Time infusion started, rate, lot number, and expiration date of the PN bag
Documenting the start time, rate, lot number, and expiration date ensures traceability for quality control, medication safety, and infection investigation if needed.
CRNI Parenteral Nutrition Administration 5
Which assessment finding in a patient receiving PN would indicate the EARLIEST sign of catheter-related bloodstream infection (CRBSI)?