# A nurse is caring for an adult client receiving central venous total parenteral nutrition (TPN) at 75 mL/h. Which actions reflect safe TPN management? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=366131&lang=en  
> language: en  
> subject: Nutrition and Oral Hydration  
> category: BCC

## Question

A nurse is caring for an adult client receiving central venous total parenteral nutrition (TPN) at 75 mL/h. Which actions reflect safe TPN management? Select all that apply.

1

Verify the TPN bag against the order with a second RN before hanging

2

If the bag is unavailable when the current bag finishes, hang 10 percent dextrose at the same rate to prevent rebound hypoglycemia

3

Use a dedicated central venous lumen for TPN; do not infuse other medications through it

4

Monitor blood glucose every 4 to 6 hours and treat per sliding scale

5

Continue infusing the TPN bag for up to 48 hours because the lipid emulsion is stable for extended periods

## Explanation

TPN is a high-alert hyperosmolar formulation. Standard safety: independent two-RN verification, glycemic monitoring (q4-6 h initially), dedicated central lumen, and replace with 10 percent dextrose at the same rate if TPN is not immediately available to prevent rebound hypoglycemia. Each TPN bag is changed every 24 hours, NOT 48, due to bacterial growth risk in lipid emulsion.

## In-depth explanation

Clinical Judgment
TPN safety: two-RN verification, dedicated central line lumen, 24-hour bag change, glucose q4-6 h, do not abruptly stop. Hyperglycemia risk early; rebound hypoglycemia if abruptly stopped (taper or hang 10 percent dextrose). Daily weight, electrolytes, BUN/creatinine, LFTs, triglycerides.

Memory Tip
TPN: 2-RN check + Dedicated lumen + 24-h bag + Glucose q4-6h + Taper or D10W

KR vs U
ASPEN and Korean Society for Parenteral and Enteral Nutrition (KSPEN) follow the same safety principles. Both endorse refeeding syndrome screening (electrolytes baseline) and gradual rate increase over 24-48 hours.

## Clinical scenario

Clinical Practice Guide
ASPEN TPN safety bundle:
- Two-RN check at every new bag and rate change
- Dedicated central line lumen; no piggyback or simultaneous medications
- 24-hour bag change regardless of remaining volume
- Glucose q4-6 h initially, then per stability
- Daily monitoring: weight, intake/output, BMP, LFTs, triglycerides, fluid balance
- Refeeding syndrome screen: phosphorus, potassium, magnesium baseline and trended
- Taper when discontinuing; if interrupted, infuse 10 percent dextrose at same rate to avoid rebound hypoglycemia
- Filter change with bag change

Caution
CLABSI risk is high in TPN clients. Strict aseptic technique for line care and tubing change. Notify provider for fever, chills, hyperglycemia trending up, or LFT abnormalities.

## Key concepts

- **TPN (total parenteral nutrition)** — Hyperosmolar nutrition delivered via central venous catheter when enteral feeding is not possible. Composition: dextrose, amino acids, lipids, electrolytes, vitamins, minerals. Requires dedicated lumen, glycemic monitoring, and refeeding-syndrome surveillance.
- **Refeeding syndrome** — Severe electrolyte and fluid shifts when nutrition restarts after prolonged starvation. Hallmarks: hypophosphatemia, hypokalemia, hypomagnesemia, fluid overload. Risk highest in first 24-72 hours. Start TPN slowly, replete electrolytes before and during, monitor labs every 12-24 hours initially.
- **Rebound hypoglycemia** — Sudden hypoglycemia after abrupt cessation of TPN due to continued endogenous insulin response to recent high-dextrose infusion. Prevent by tapering TPN and, if interrupted, infusing 10 percent dextrose at the same rate while a new bag is prepared.

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