# The charge nurse reviews central parenteral nutrition administration. Which observations require immediate follow-up? Highlight the observations that make administration unsafe.

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> language: en  
> subject: Medication Administration  
> category: PPT

## Question

The charge nurse reviews central parenteral nutrition administration. Which observations require immediate follow-up? Highlight the observations that make administration unsafe.

| Record section | Observed administration practice |
| --- | --- |
| Verification | Two qualified clinicians compare the label, client, route, and rate |
| Final label | Bag potassium concentration differs from the active pharmacy-verified order |
| Asepsis | Nurse disinfects the needleless connector before attaching sterile tubing |
| Admixture | Nurse injects an additional medication into the compounded bag at bedside |
| Pump | Electronic pump is programmed at the prescribed hourly infusion rate |
| Monitoring | Bedside glucose checks occur at the times listed in the care plan |
| Access | Intermittent antibiotics share the same central lumen during nutrition infusion |
| Delay response | Infusion rate is increased to catch up after the bag arrives late |
| Tubing | Ordered filter remains intact and the connection is secured without leakage |

## 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.

## In-depth explanation

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

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