The nurse is caring for a patient who is receiving total parenteral nutrition (TPN) and notes that the patient becomes dyspneic when transferring from the bed to a chair. The nurse auscultates rales in both lungs. Which action will the nurse take next?
a. Ask the patient to perform the Valsalva maneuver.
b. Decrease the TPN rate and request an order for a diuretic medication.
c. Obtain an order for a chest radiograph and an antibiotic.
d. Stop the TPN and request an order for intravenous isotonic dextrose.
ANS: B
The patient who is being treated with TPN and has dyspnea and rales is experiencing fluid overload. The nurse should slow the rate of the TPN and request an order for a diuretic. Patients perform the Valsalva maneuver during bag changes to help prevent pulmonary emboli. Patients receiving TPN are not necessarily at risk for aspiration pneumonia. Intravenous isotonic dextrose is given after sudden interruption of TPN to prevent hypoglycemia.
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