The charge nurse reviews central parenteral nutrition administration. Which observations require immediate follow-up? Highlight the observations that make administration unsafe.
Highlight in Table
Choose your responses, then check the answer.
Explanation
A label-order electrolyte mismatch, bedside additive injection, sharing the nutrition lumen with antibiotics, and increasing the rate to catch up require follow-up. Verification, asepsis, a dedicated lumen, and the prescribed pump rate reduce harm.
Quick answer Highlight the potassium mismatch, medication added to the compounded bag at bedside, intermittent antibiotics connected to the nutrition lumen, and a catch-up rate increase. Each action bypasses a key parenteral-nutrition safety control.
Why this is correct Parenteral nutrition is a high-alert therapy with many components and direct vascular delivery. Safe administration depends on matching the final label to the order, protecting the compounded product, using compatible dedicated access, and controlling the rate rather than improvising after an interruption.[2]
Easy analogy or mental picture Picture parenteral nutrition as a sealed, precisely addressed package entering an express vascular lane. Changing the contents, address, lane, or speed after verification defeats the safeguards; the picture does not replace pharmacy compatibility review.
Memory hook Match, keep sealed, dedicate, control the rate.
NCLEX decision rule For parenteral nutrition, stop when the final label, bag integrity, vascular route, lumen use, or pump rate conflicts with the verified order and facility protocol.
Why the other choices are wrong Independent verification, hand hygiene and hub disinfection, a correctly programmed pump, scheduled glucose monitoring, and intact filtered tubing are expected controls. Those actions detect or prevent harm without altering the compounded prescription.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
ISMP-ASPEN: Parenteral Nutrition Safety RecommendationsInstitute for Safe Medication Practices and American Society for Parenteral and Enteral Nutrition