# A nurse discovers the TPN bag is empty 1 hour before the next bag is due. Which action is most appropriate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391891&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A nurse discovers the TPN bag is empty 1 hour before the next bag is due. Which action is most appropriate?

## Option

1. Switch immediately to enteral feeds
2. Push concentrated dextrose IV
3. Hang D10W (or D5W if D10 unavailable) at the same rate to prevent rebound hypoglycemia, monitor blood glucose, and notify pharmacy for the next bag **✔ Correct answer**
4. Disconnect the IV and wait

**Correct answer: 3**

## Explanation

Correct (2): TPN has high glucose load; abrupt discontinuation → rebound hypoglycemia from endogenous insulin still circulating. Hang D10W (preferred) or D5W at the same rate until new TPN available; monitor glucose. Also taper TPN gradually when planned discontinuation (over 1-2 hours). (1,3,4) Wrong.

## In-depth explanation

Memory Tip TPN abrupt stop = "Rebound HYPOglycemia." Hang D10 bridge. Plan taper for elective discontinuation. Same line — do NOT piggyback other meds with TPN.

## Clinical scenario

Scenario Adult on continuous central TPN; bag empty 1 hour early. Next TPN bag not yet available from pharmacy.

## Key concepts

- **TPN abrupt discontinuation** — Risk of rebound hypoglycemia; bridge with D10W and monitor glucose.
- **TPN taper** — Gradual reduction over 1-2 hours when discontinuing electively.
- **TPN dedicated line** — TPN requires dedicated line; do not piggyback medications or draw blood.

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