Which assessment should the nurse prioritize for a client receiving total parenteral nutrition (TPN)?

Correct Answer: A

Rationale: When a client receives total parenteral nutrition (TPN), monitoring blood glucose levels is critical due to the high glucose content in TPN solutions, which can lead to hyperglycemia. This condition arises because TPN delivers concentrated nutrients directly into the bloodstream, bypassing the digestive system, and the body may struggle to regulate sugar levels effectively without proper insulin response. Potassium levels, while important in overall electrolyte balance, are less immediately impacted by TPN compared to glucose, as potassium imbalances typically develop over time rather than acutely from TPN initiation. Mental status assessments are valuable for neurological conditions but lack direct relevance to TPN's metabolic effects. Similarly, blood pressure monitoring is essential for cardiovascular health but isn't the primary concern with TPN, as it doesn't directly influence hypertension or hypotension in the same way glucose dysregulation does. The focus on glucose stems from its rapid impact on the client's metabolic state, making it the priority assessment to prevent complications like hyperglycemia, which can escalate to severe outcomes if unaddressed. Regular monitoring ensures timely intervention, aligning with TPN's nutritional goals.

Correct Answer: B

Rationale: The therapeutic levels for digoxin are typically considered to be between 0.5 % 2 ng/mL. This range is associated with optimal therapeutic effects of digoxin in managing heart conditions such as heart failure and atrial fibrillation. Levels below 0.5 ng/mL may be subtherapeutic while levels above 2 ng/mL can lead to toxicity symptoms like nausea, vomiting, visual disturbances, and cardiac arrhythmias. Monitoring digoxin levels within the therapeutic range ensures the medication is effective and safe for the patient.

Correct Answer: B

Rationale: Digitalis is a medication commonly used to treat heart failure and certain cardiac arrhythmias. It works by increasing the force of heart contractions and slowing down the heart rate. Digitalis has a negative chronotropic effect, which means it decreases the heart rate by affecting the electrical conduction system of the heart. When a patient is receiving intravenous digitalis, a decreased heart rate would be evident as a result of this pharmacological action. Therefore, the correct answer is B. Decreased heart rate.

Correct Answer: A

Rationale: Methotrexate targets rapidly dividing cells. Buccal mucosa , with high turnover, is most vulnerable, causing mucositis. Bones (B, D) and skin are less affected. Teeth (E) aren't primary. This toxicity reflects methotrexate's antimetabolite action in ALL.

Correct Answer: C

Rationale: Glyceryl trinitrate, also known as nitroglycerin, is a medication commonly used for the management of angina (chest pain). When administered sublingually (under the tongue), glyceryl trinitrate is rapidly absorbed through the highly vascular sublingual mucosa, leading to a quick onset of action. The sublingual route allows for the drug to enter the bloodstream directly without being metabolized by the liver first, resulting in faster relief of angina symptoms. This makes sublingual administration the most effective route for managing acute episodes of angina. Other routes of administration, such as oral, subcutaneous, intravenous, or intramuscular, would not provide the same rapid and reliable relief for angina.