Examkin

Question

Difficulty: MediumPharmacological and Parenteral Therapies

Upon evaluating a client recovering from an extensive small bowel resection, the assigned nurse notes a scheduled order for intravenous pantoprazole. The client's only vascular access is a single-lumen peripherally inserted central catheter (PICC) that is currently delivering total parenteral nutrition (TPN) at 90 mL/hr. How should the nurse proceed with administering the prescribed gastrointestinal protectant?

  1. Establish a new peripheral intravenous access site specifically for the medication administration.Answer
  2. B
    Discontinue the nutritional infusion for ten minutes, irrigate the catheter with sodium chloride, and then infuse the medication.
  3. C
    Utilize a Y-site port on the existing central line tubing to deliver the medication concurrently with the nutritional formula.
  4. D
    Direct the unlicensed assistive personnel to secure a peripheral catheter immediately to prevent delayed administration.

Answer

The nurse must establish a new peripheral intravenous access site specifically for the medication administration.
Total parenteral nutrition (TPN) is a complex, hypertonic solution that carries an exceptionally high risk for microbial growth and chemical incompatibility when mixed with other pharmacological substances. Evidence-based nursing practice dictates that TPN must be administered through a strictly dedicated intravenous line. Because the client only has a single-lumen PICC currently infusing TPN, the nurse must establish a new, separate peripheral IV line to safely administer the prescribed medication without interrupting the continuous nutritional support or risking precipitation within the central line.

Step-by-Step Solution

1
Analyze the client's current vascular access and active infusions.
The client possesses a single-lumen PICC that is entirely dedicated to a continuous TPN infusion.
Identifying existing access determines whether a new medication can be administered safely through the current line or if alternative access is necessary.
2
Evaluate the safety principles and protocols regarding total parenteral nutrition (TPN).
TPN requires a strictly dedicated line; it cannot be paused for other medications, nor can medications be piggybacked into its tubing.
TPN solutions are complex, highly concentrated mixtures that are prone to chemical incompatibilities. Furthermore, frequently accessing the line significantly increases the risk of dangerous bloodstream infections.
3
Determine the most appropriate and safe nursing intervention for the scheduled medication.
A new peripheral IV catheter must be inserted by a qualified healthcare professional (the RN) to administer the pantoprazole.
This action ensures the scheduled medication is delivered on time while simultaneously preserving the integrity, safety, and continuous flow of the TPN line.

Key Concept

Total parenteral nutrition (TPN) must always be administered through a strictly dedicated intravenous line to prevent severe chemical incompatibilities, catheter occlusion, and life-threatening bloodstream infections.
Rate this question

Topics

Pharmacological and Parenteral Therapies

More questions from this topic