A nurse is planning care for a client who is to start receiving total parenteral nutrition (TPN). Which of the following interventions should the nurse include in the plan of care?

Correct Answer: D

Rationale: The correct answer is D: Change the TPN tubing every 48 hr. This is essential to prevent bacterial growth and infection, maintaining the integrity of the TPN solution. Regular tubing changes reduce the risk of contamination and ensure patient safety. A: Using a 1.2 micron filter is not directly related to tubing changes and is not a primary concern for TPN administration. B: Allowing 18 hr for lipids to infuse is not a standard practice and does not address the need for tubing changes. C: Changing the TPN solution after 36 hr is not a standard guideline and may not be necessary unless specific factors indicate a need for a change.

Correct Answer: D

Rationale: Stimulation of parasympathetic neurons in the GI tract from Auerbach's or myenteric plexus leads to the release of acetylcholine, which enhances GI motility and peristalsis. This is because acetylcholine acts on smooth muscle and stimulates contractions, promoting movement of food through the GI tract. Therefore, the correct answer is D. A: Inhibition of local secretions is incorrect as parasympathetic stimulation usually enhances glandular secretions in the GI tract. B: Inhibition of peristalsis is incorrect because parasympathetic stimulation typically increases peristalsis. C: Stimulation of local secretions is incorrect as parasympathetic stimulation usually promotes secretion but does not inhibit it.

Correct Answer: B

Rationale: The correct answer is B. The chewing reflex originates in the medulla oblongata, which controls basic life functions like breathing and swallowing. The ability to voluntarily initiate or stop chewing comes from the cerebrum, the part of the brain responsible for conscious thoughts and movements. The pons (choice A) is involved in regulating breathing, not chewing. The spinal cord (choice C) is responsible for reflex actions but not specifically chewing. The midbrain (choice D) is more related to sensory processing and motor function, not chewing reflex. Therefore, the correct answer is B based on the roles of the medulla oblongata and cerebrum in chewing.

Correct Answer: B

Rationale: The correct answer is B: rugae. Rugae are large folds in the tunica submucosa and mucosa of the stomach that allow for expansion when the stomach is full. Epiploic appendages (A) are fatty projections on the serosa of the large intestine. Plicae circulares (C) are circular folds in the small intestine for increasing surface area. Villi (D) are finger-like projections in the small intestine for absorption. Rugae specifically refer to the folds in the stomach lining, making them the correct answer.

Correct Answer: C

Rationale: Granular cells, also known as Paneth cells, produce antimicrobial peptides to protect the intestinal epithelium from bacteria. These peptides have antimicrobial properties that help prevent bacterial overgrowth and maintain intestinal homeostasis. Absorptive cells are primarily responsible for nutrient absorption, while goblet cells secrete mucus for lubrication. Endocrine cells produce hormones that regulate various physiological processes. Therefore, the correct answer is C, as granular cells play a direct role in protecting the intestinal epithelium from bacteria.