Parenteral Medications

EXPLANATION

✔Correct answer:

Air embolism from the PN line.  The symptoms of sudden shortness of breath, shoulder pain, and an increased pulse rate are classic signs of an air embolism. This complication can occur if air enters the venous system through the PN line, particularly during tubing changes or if there is a disconnection in the line. The air embolism can travel to the heart and lungs, causing an obstruction in blood flow and leading to the symptoms observed.

An air embolism happens when a bubble of air enters the vascular system, usually through the central venous catheter. As the air travels through the bloodstream, it can block blood flow in the pulmonary arteries or the heart, leading to a sudden decrease in oxygenation and blood flow to vital organs. This causes shortness of breath, an increase in heart rate as the body tries to compensate, and shoulder pain due to irritation of the phrenic nerve or pressure changes within the thorax.

Imagine a bubble of air getting stuck in a water pipe (your blood vessels). This bubble blocks the water (blood) from flowing smoothly, creating pressure and causing issues in the system, such as shortness of breath and increased pulse rate, as the body tries to push blood around the blockage.

Nurse Lee should immediately take action to prevent the air embolism from causing further harm. The client should be placed in the left lateral Trendelenburg position to trap the air in the right atrium and prevent it from entering the pulmonary circulation. Administering 100% oxygen is also critical to reduce the size of the air embolism and improve oxygenation. The healthcare provider should be notified immediately for further intervention.

• Place the client in the left lateral Trendelenburg position to trap the air embolism.
• Administer 100% oxygen to reduce the size of the air bubble and improve oxygenation.
• Notify the healthcare provider immediately for further evaluation and intervention.
• Monitor the client’s vital signs, including oxygen saturation and heart rate.
• Ensure proper education on air embolism prevention, especially during line manipulation.

✘Incorrect answer options:

Catheter-related bloodstream infection. While an infection can cause an increased pulse rate and respiratory distress, it would typically present with symptoms like fever, chills, or hypotension rather than sudden shortness of breath and shoulder pain. These specific symptoms are more indicative of an air embolism.

Hyperglycemia due to high glucose content in the PN solution. Hyperglycemia usually presents with symptoms like increased thirst, frequent urination, blurred vision, and fatigue. It does not typically cause sudden shortness of breath or shoulder pain, making it an unlikely explanation for these symptoms.

Fluid overload from excessive infusion rate. Fluid overload can lead to symptoms like shortness of breath, edema, and possibly increased pulse rate, but it typically presents with signs such as jugular vein distension or crackles in the lungs, not shoulder pain. The sudden onset of symptoms suggests an air embolism rather than fluid overload.

EXPLANATION

✔Correct answer:

Crackles when listening to the lungs.  A sudden weight gain of 5 pounds within a week in a client receiving parenteral nutrition (PN) can indicate fluid retention, which might lead to fluid overload. One of the most significant signs of fluid overload is the presence of crackles or rales upon auscultation of the lungs. These crackles are caused by fluid accumulation in the alveoli, suggesting pulmonary edema, which is a serious complication of fluid overload. Early detection of crackles can help prevent further progression to respiratory distress or heart failure.

In fluid overload, the body retains more fluid than it can effectively manage, which can lead to increased hydrostatic pressure in the pulmonary circulation. This pressure forces fluid out of the pulmonary capillaries into the alveoli, causing pulmonary edema. Crackles heard on lung auscultation are due to the presence of this fluid, indicating that the alveoli are "popping" open during inhalation, a classic sign of fluid overload.

Think of your lungs like sponges. If you pour too much water into the sponge too quickly (fluid overload), it can't hold it all, and the excess water leaks out (fluid in the alveoli), making a squishing sound when squeezed (crackles in the lungs).

Nurse Carter should carefully monitor the client’s respiratory status, including regular lung auscultation, to detect any worsening signs of fluid overload. It is also essential to review the client's fluid intake and output, adjust the PN infusion rate if necessary, and notify the healthcare provider if fluid overload is suspected. Managing fluid overload may involve diuretic therapy and fluid restriction.

• Monitor the client’s lung sounds regularly for any crackles or other abnormal sounds.
• Review the client’s fluid balance, including intake and output.
• Adjust the rate of PN infusion if fluid overload is confirmed.
• Notify the healthcare provider for potential adjustments to the client’s care plan, including diuretic therapy.
• Educate the client and family about the signs of fluid overload and when to seek immediate help.

✘Incorrect answer options:

Low blood pressure. Low blood pressure is not typically associated with fluid overload; rather, it is more likely associated with dehydration or blood loss. In fluid overload, the blood pressure might actually be elevated due to increased fluid volume.

Increased thirst. Increased thirst is a symptom of dehydration or hyperglycemia, not fluid overload. It suggests that the body is trying to signal a need for more fluid intake, which is the opposite of what happens in fluid overload.

Excessive urination. Excessive urination could indicate hyperglycemia or diabetes insipidus, but it is not a typical sign of fluid overload. In fluid overload, the body may struggle to excrete excess fluid, leading to retention rather than increased urination.

EXPLANATION

✔Correct answer:

PEG tube.  The PEG tube (Percutaneous Endoscopic Gastrostomy tube) is not used for administering parenteral nutrition. A PEG tube is a type of feeding tube that is inserted directly into the stomach through the abdominal wall and is used for enteral nutrition, which involves delivering nutrients directly into the gastrointestinal (GI) tract. Parenteral nutrition, on the other hand, involves delivering nutrients directly into the bloodstream, bypassing the GI tract, which requires intravenous (IV) access.

Parenteral nutrition is used when the GI tract cannot be used for nutrition, such as in cases of severe GI disorders, bowel obstructions, or when the patient cannot digest or absorb nutrients adequately. It is administered through a central venous access device, such as a central venous catheter (CVC), subclavian line, or a peripherally inserted central catheter (PICC line). These routes allow the hypertonic solution containing glucose, amino acids, lipids, vitamins, and minerals to be delivered directly into the bloodstream.

Think of parenteral nutrition as an "IV meal" that goes directly into your blood, bypassing your stomach. A PEG tube, on the other hand, is like a direct "meal pipeline" to your stomach, so it’s not used for parenteral (IV) feeding.

When administering parenteral nutrition, it’s important for nurses to ensure that the correct route is used and to monitor the patient for potential complications, such as infections, metabolic imbalances, or issues related to the central line.

• Verify the correct placement and function of the central venous access device before initiating parenteral nutrition.
• Monitor for signs of infection at the insertion site and systemic signs of sepsis, given the risk of bloodstream infections associated with central lines.
• Regularly assess the patient’s electrolyte levels, blood glucose, and liver and kidney function to detect and manage potential complications of parenteral nutrition.
• Ensure strict aseptic technique during the preparation and administration of parenteral nutrition to minimize the risk of contamination and infection.
• Educate the patient and family about the purpose of parenteral nutrition, the importance of central line care, and the signs and symptoms of potential complications.

✘Incorrect answer options:

Subclavian line. The subclavian line is a type of central venous catheter inserted into the subclavian vein. It is commonly used for administering parenteral nutrition because it provides access to a large central vein, which can handle the hypertonic solutions used in parenteral nutrition.

Central Venous Catheter. A central venous catheter (CVC) is the standard route for administering parenteral nutrition. It is placed into a large central vein, such as the subclavian, internal jugular, or femoral vein, and is ideal for the infusion of the concentrated nutrients that bypass the GI tract.

PICC line (Peripherally inserted central catheter). A PICC line is another common route for administering parenteral nutrition. It is a type of central line that is inserted into a peripheral vein in the arm and advanced toward a central vein near the heart. PICC lines are less invasive than other central venous catheters and can be used for long-term parenteral nutrition.

EXPLANATION

✔Correct answer:

Temperature and weight.  During a follow-up home visit for a client receiving parenteral nutrition (PN), Nurse Allen should most carefully monitor the client’s temperature and weight. Monitoring temperature is critical because an elevated temperature could indicate a potential infection, particularly a central line-associated bloodstream infection (CLABSI), which is a serious complication in clients receiving PN. Monitoring weight is equally important because it helps assess the client’s nutritional status and fluid balance. Significant changes in weight can indicate either overnutrition, undernutrition, or fluid imbalance, which are crucial to manage in a client receiving PN.

Clients on PN are at an increased risk for infections due to the invasive nature of central lines and the nutrient-rich solution, which can be an ideal medium for bacterial growth. Weight is a vital indicator of how well the client is responding to the PN therapy—whether they are gaining, losing, or maintaining appropriate weight—and can also help identify issues like fluid retention or dehydration.

Think of temperature as an alarm system alerting you to an infection, and weight as a gauge showing whether the client is receiving the right amount of nutrients and fluids.

Nurse Allen should educate the client and family about the importance of monitoring temperature and weight daily and reporting any significant changes immediately. Additionally, reviewing the client’s nutritional intake, fluid balance, and overall tolerance to PN is crucial during each visit.

• Regularly check the client’s temperature and report any fever or signs of infection immediately.
• Monitor and document the client’s weight at each visit, looking for trends that may indicate issues with the PN regimen.
• Assess the central line insertion site for any signs of infection, such as redness, swelling, or discharge.
• Evaluate the client’s overall nutritional status, including energy levels and any symptoms of malnutrition or overnutrition.
• Ensure the client and family understand how to manage the PN at home, including maintaining aseptic technique and recognizing signs of complications.

✘Incorrect answer options:

Blood pressure and temperature. While blood pressure is important for overall cardiovascular health, it is not the most critical parameter in the context of PN management. Temperature is essential for detecting infections, but weight monitoring is more directly related to assessing nutritional and fluid status.

Blood pressure and pulse rate. Like the previous option, while these vital signs are important, they are not as directly related to the specific risks associated with PN, such as infection and nutritional status. Pulse rate can be an indicator of dehydration or fluid overload, but it does not provide the same level of detail as weight monitoring.

Height and weight. While weight is crucial to monitor, height does not change and is not useful in the context of a follow-up visit for PN management. Height is typically used in the initial assessment to calculate nutritional needs but does not require regular monitoring in follow-up visits.

EXPLANATION

✔Correct answer:

Verify the TPN order, check the solution for clarity, prime the tubing, and start the infusion.  When preparing to administer total parenteral nutrition (TPN) via a central line, it is essential to follow a precise and systematic sequence to ensure the safe administration of the solution. First, verifying the TPN order is crucial to ensure that the correct solution and rate of infusion are being administered as prescribed by the healthcare provider. Next, checking the solution for clarity ensures that there are no particles, cloudiness, or discoloration, which could indicate contamination or an improper mixture. After confirming the solution is safe, priming the tubing is necessary to remove any air that could enter the central line and cause an air embolism. Finally, starting the infusion can be done safely once all these steps have been completed.

TPN solutions are nutrient-dense and delivered directly into the bloodstream, bypassing the gastrointestinal tract. This method of delivery requires meticulous attention to detail to prevent complications such as infection, air embolism, or incorrect administration of nutrients. The order of steps ensures that the TPN solution is correctly prepared and that the risk of introducing air or contaminants into the central venous system is minimized.

Think of preparing to water a garden using a hose. First, you check the instructions (verify the TPN order) to ensure you’re using the right nozzle and setting. Then, you check the water (solution) to make sure it's clear and free of dirt (particles). Next, you fill the hose with water (prime the tubing) to avoid air bubbles. Finally, you start watering (begin the infusion) to ensure everything is running smoothly.

Nurse Payton should be vigilant in each step of the TPN administration process to prevent potential complications. Proper verification, solution inspection, and tubing priming are all critical steps to ensure that the TPN is delivered safely and effectively. After starting the infusion, Nurse Payton should monitor the client’s response, including blood glucose levels, to detect any adverse reactions or imbalances.

• Verify the TPN order with the healthcare provider's prescription.
• Inspect the TPN solution for clarity, ensuring there are no particles or discoloration.
• Prime the tubing carefully to remove any air before connecting it to the central line.
• Start the infusion at the prescribed rate, monitoring the client closely.
• Regularly check blood glucose levels and other relevant parameters during the infusion.

✘Incorrect answer options:

Verify the TPN order, check the solution for clarity, attach the tubing, and start the infusion. Attaching the tubing directly without priming it first can introduce air into the central line, leading to an air embolism, which is a serious complication. Priming the tubing is essential before starting the infusion.

Check the patient's blood glucose, attach the tubing, verify the TPN order, and start the infusion. While monitoring blood glucose is important, it is not the first step in the sequence of preparing the TPN solution. Also, attaching the tubing before verifying the order and inspecting the solution is incorrect and unsafe.

Prime the tubing, verify the TPN order, check the solution for clarity, and start the infusion. Priming the tubing before verifying the order and checking the solution's clarity is out of sequence. The solution should be verified and inspected before priming to ensure that it is safe for use.

EXPLANATION

✔Correct answer:

Allergy to eggs.  Fat emulsions, which are a component of parenteral nutrition, often contain egg phospholipids as an emulsifying agent. Clients with an allergy to eggs are at risk of an allergic reaction when receiving fat emulsions. Hives are a common manifestation of an allergic reaction, which could indicate that the client is reacting to the egg-derived components in the fat emulsion.

Allergic reactions occur when the immune system mistakenly identifies a harmless substance, such as proteins found in eggs, as a threat. In the case of fat emulsions, egg phospholipids are used to stabilize the mixture of fats and water. For clients with an egg allergy, exposure to these egg components can trigger an immune response, leading to symptoms like hives, itching, and potentially more severe reactions such as anaphylaxis.

Imagine your body is like a security system that mistakenly flags a friendly visitor (egg protein) as an intruder. The alarm goes off (immune reaction), causing the body to react with hives and other symptoms as it tries to "defend" itself against what it wrongly believes is a threat.

Nurse Johnson should immediately stop the infusion of fat emulsions and assess the client for other signs of an allergic reaction, such as difficulty breathing or swelling. The healthcare provider should be notified promptly, and antihistamines or other emergency medications may need to be administered. It is also important to document the reaction and update the client’s allergy information to prevent future exposure.

• Stop the infusion of fat emulsions immediately.
• Assess the client for additional signs of an allergic reaction, including respiratory distress.
• Notify the healthcare provider and be prepared to administer emergency medications.
• Document the reaction and update the client’s allergy information in their medical record.
• Educate the client about the allergy and the importance of avoiding egg-containing products in the future.

✘Incorrect answer options:

Allergy to peanuts. While peanut allergies are serious and can cause severe reactions, peanuts are not a typical component of fat emulsions. Therefore, this is less likely to be the cause of the hives in this scenario.

Allergy to shellfish. Shellfish allergies are also common and can cause allergic reactions, but shellfish proteins are not used in the preparation of fat emulsions, making this an unlikely cause of the client’s hives.

Allergy to corn. Corn allergies are relatively rare, and while some medications and food products contain corn derivatives, corn is not typically involved in the formulation of fat emulsions used in parenteral nutrition.

EXPLANATION

✔Correct answer:

Secure all connections in the parenteral system.  In a combative client receiving parenteral nutrition (PN), it is essential to secure all connections in the parenteral system to prevent accidental disconnection or damage to the central venous catheter. A combative client may inadvertently pull at or dislodge the tubing or connections, which can lead to complications such as infection, air embolism, or the disruption of the nutrient supply. Securing the connections ensures that the PN system remains intact, reducing the risk of injury or complications.

The central venous catheter used for PN provides a direct route into the bloodstream, which can be a critical access point for delivering nutrients but also a potential source of serious complications if mishandled. A dislodged or disconnected central line can lead to life-threatening issues such as air embolism or infection. In combative clients, the risk of accidental dislodgment is higher, making it imperative to take precautions by securing the tubing and connections effectively.

Imagine a garden hose connected to a water source. If the hose is not securely attached and someone pulls on it, the connection can come apart, spilling water everywhere. Similarly, in a medical context, if the PN tubing isn't secure and a client pulls at it, it could disconnect and cause harm, like spilling the essential nutrients or allowing air to enter the bloodstream.

Nurse Kim should regularly check the integrity of the PN system, ensuring that all connections are secure and that the catheter is well-protected. If the client’s behavior poses a significant risk to their safety or the integrity of the catheter, Nurse Kim should collaborate with the healthcare team to develop a plan that might include protective restraints, if appropriate, or increased supervision. Additionally, providing a calm environment and addressing any underlying causes of agitation, such as pain or anxiety, can help reduce combative behavior.

• Secure all connections in the PN system to prevent dislodgement or disconnection.
• Regularly check the integrity of the central line and connections.
• Collaborate with the healthcare team to develop a safety plan for the combative client.
• Provide a calm environment and address underlying causes of agitation, such as pain or anxiety.
• Educate the client and their family on the importance of maintaining the integrity of the PN system.

✘Incorrect answer options:

Monitor blood glucose twice a day. While monitoring blood glucose is important in clients receiving PN due to the risk of hyperglycemia, this action does not address the immediate concern of preventing injury in a combative client.

Instruct a relative to stay with the client. Having a relative stay with the client may provide comfort, but it does not specifically address the risk of the client disrupting the PN system. Additionally, relying on a relative may not be appropriate or sufficient for managing a combative client.

Measure the 24-hour intake and output. Measuring intake and output is a routine aspect of managing a client on PN, but it does not directly prevent injury in a combative client. The priority is to secure the PN system to prevent any potential dislodgement or disconnection that could lead to serious complications.

EXPLANATION

✔Correct answer:

Obtain a new bottle of the solution.  Nurse Rivera should obtain a new bottle of the lipid emulsion because the presence of visible fat globules indicates that the solution is not properly emulsified. This separation can occur due to improper storage, contamination, or expiration, and it can increase the risk of fat embolism if infused. Administering a solution with visible fat globules can be dangerous as it might lead to the formation of emboli, potentially causing severe complications such as pulmonary embolism or fat embolism syndrome.

Fat emulsions are designed to deliver essential fatty acids and calories intravenously, typically in patients who cannot meet their nutritional needs orally or enterally. These emulsions are stabilized with emulsifying agents to keep the fat droplets evenly dispersed in the solution. If the emulsion breaks down, leading to visible fat globules, there is a risk of these larger fat droplets aggregating in the bloodstream, which can obstruct blood vessels and cause fat emboli. Fat emboli can travel to the lungs, brain, or other vital organs, leading to life-threatening complications such as respiratory distress or ischemic injury.

Think of the fat emulsion like a well-mixed salad dressing. If the oil separates and floats to the top, it means the dressing isn't mixed properly, and using it could result in an unpleasant or even harmful experience. Similarly, if a lipid emulsion isn't properly mixed, it could cause harm if administered to a patient.

When preparing to administer a fat emulsion, it is crucial to inspect the solution carefully before hanging it. If any irregularities, such as visible fat globules, are noticed, the solution should not be used.

• Always check the expiration date and ensure proper storage of lipid emulsions according to the manufacturer's guidelines.
• Inspect the solution for any signs of separation, contamination, or other irregularities before administration.
• Educate the patient on the purpose and potential side effects of the lipid infusion.
• Monitor the patient closely during the infusion for any signs of adverse reactions, such as fever, chills, or shortness of breath.

✘Incorrect answer options:

Warm the bottle by running it under warm water. Warming the bottle is not an appropriate action in this scenario. While some medications or solutions might require warming to dissolve precipitates, this is not the case with lipid emulsions. Warming could potentially worsen the separation of the fat and water phases.

Gently roll the bottle to mix the solution. Gently rolling the bottle might seem like a logical step to remix the solution, but it is not recommended for lipid emulsions with visible fat globules. Once the emulsion has separated, it cannot be reliably remixed, and using it could result in harm to the patient.

Shake the bottle vigorously to disperse the fat globules. Shaking the bottle vigorously is contraindicated for lipid emulsions. Shaking can cause the fat to coalesce into larger globules, increasing the risk of embolism when infused. Lipid emulsions are delicate and must be handled gently to maintain their stability.

EXPLANATION

✔Correct answer:

Blood glucose of 210 mg/dL.  A blood glucose level of 210 mg/dL in a client receiving total parenteral nutrition (TPN) for the first time requires the most immediate attention. TPN solutions are high in glucose, and clients who are new to TPN may experience hyperglycemia as their bodies adjust to the sudden increase in glucose intake. Hyperglycemia can lead to serious complications if not managed promptly, including osmotic diuresis, dehydration, electrolyte imbalances, and even diabetic ketoacidosis in clients with diabetes. Early identification and management of elevated blood glucose levels are crucial to prevent these complications.

When a client begins TPN, the body may struggle to regulate the sudden influx of glucose, particularly in individuals who have been malnourished or have anorexia. The pancreas may not secrete enough insulin to keep up with the high glucose load, leading to hyperglycemia. Sustained high blood glucose levels can have harmful effects, including damage to blood vessels and nerves, and can disrupt fluid and electrolyte balance. Immediate action is necessary to manage the hyperglycemia and adjust the TPN regimen if needed.

Think of your bloodstream like a traffic system. If you suddenly flood the roads with too many cars (glucose), traffic jams (hyperglycemia) occur, slowing everything down and causing problems. Just like how you’d need to quickly manage the flow of cars to avoid a gridlock, the body needs immediate intervention to manage the high glucose levels and keep things moving smoothly.

Nurse Taylor should immediately notify the healthcare provider of the elevated blood glucose level. The healthcare provider may order insulin coverage or adjust the TPN formula to manage the glucose level. Regular monitoring of blood glucose levels should be performed to ensure that they remain within a safe range. Nurse Taylor should also educate the client about the symptoms of hyperglycemia and the importance of reporting them immediately.

• Notify the healthcare provider about the elevated blood glucose level.
• Administer insulin or adjust the TPN formula as prescribed to manage hyperglycemia.
• Monitor the client’s blood glucose levels regularly, especially during the initial days of TPN therapy.
• Educate the client on the signs and symptoms of hyperglycemia, such as increased thirst, frequent urination, and fatigue.
• Document the findings and the interventions taken to manage hyperglycemia.

✘Incorrect answer options:

Dry, sticky mouth. While a dry, sticky mouth could indicate dehydration or electrolyte imbalance, it is not as immediately critical as a blood glucose level of 210 mg/dL. This symptom should be monitored, but it does not require the same urgent intervention as hyperglycemia.

Temperature of 100°F. A mild fever of 100°F may indicate a low-grade infection or an inflammatory response, but it is not an immediate emergency. The fever should be monitored, and the healthcare provider should be informed, but it does not require as urgent attention as hyperglycemia.

Fasting blood sugar of 98 mg/dL. A fasting blood sugar of 98 mg/dL is within the normal range and does not require any immediate intervention. It suggests that the client’s glucose levels were well-controlled prior to the initiation of TPN, but the elevated glucose level of 210 mg/dL now indicates a more urgent concern.

EXPLANATION

✔Correct answer:

On the left side, with the head lowered below the feet.  This position is known as the left lateral Trendelenburg position. It is the recommended position for a client suspected of having an air embolism. Placing the client on the left side helps to trap any air that may have entered the venous system in the right atrium or right ventricle of the heart, preventing it from moving into the pulmonary circulation. Lowering the head below the feet (Trendelenburg position) further helps in keeping the air in the right side of the heart, where it can be absorbed gradually without causing a pulmonary embolism.

An air embolism occurs when air enters the venous system and travels to the right side of the heart. If the air is not quickly managed, it can enter the pulmonary arteries, causing a pulmonary air embolism, which can obstruct blood flow to the lungs, leading to hypoxia, respiratory distress, or even death. The left lateral Trendelenburg position uses gravity to keep the air in the right atrium or ventricle, minimizing the risk of air entering the pulmonary circulation.

Imagine a bubble in a water pipe. If the pipe is tilted so the bubble stays in one part of the pipe (the right side of the heart), it’s easier to control and prevent it from traveling to other areas (like the lungs), where it could cause serious problems.

If an air embolism is suspected, the immediate nursing action is to place the client in the left lateral Trendelenburg position and to clamp the catheter to prevent further air entry. The nurse should then call for emergency assistance and prepare for potential interventions such as administering 100% oxygen to help reduce the size of the air embolism through nitrogen absorption.

• Place the client in the left lateral Trendelenburg position.
• Clamp the catheter to prevent further air entry.
• Administer 100% oxygen as prescribed.
• Call for emergency assistance immediately.
• Monitor the client for signs of respiratory distress or cardiovascular compromise.

✘Incorrect answer options:

On the right side, with the head elevated above the feet. This position is incorrect because placing the client on the right side would allow the air embolism to travel more easily into the pulmonary circulation, potentially causing a pulmonary embolism. Elevating the head above the feet would also increase the risk of air traveling into the lungs.

On the right side, with the head lowered below the feet. Although lowering the head below the feet (Trendelenburg) is appropriate, placing the client on the right side could cause the air to move more freely into the pulmonary arteries, increasing the risk of a life-threatening pulmonary embolism.

On the left side, with the head elevated above the feet. Placing the client on the left side is correct for trapping the air in the right side of the heart, but elevating the head above the feet would not use gravity to assist in trapping the air, making this position less effective.

EXPLANATION

✔Correct answer:

The client’s temperature. Redness and drainage at the central line insertion site are potential signs of infection. The next step Nurse Davis should take is to assess the client's temperature, as an elevated temperature could indicate a systemic infection or sepsis, which can result from a localized infection at the central line site. Monitoring the client’s temperature helps to determine if the infection has spread and to assess the severity of the condition. Early detection of a systemic infection is critical for prompt treatment and to prevent complications.

Central line-associated bloodstream infections (CLABSIs) are serious infections that occur when bacteria or other pathogens enter the bloodstream through a central venous catheter. The redness and drainage at the insertion site suggest local infection, which can quickly progress to a systemic infection if not addressed promptly. Fever (elevated temperature) is a key indicator of systemic infection or sepsis, which occurs when the body’s immune response to infection leads to widespread inflammation, potentially causing organ dysfunction and requiring immediate medical intervention.

Think of an infection like a fire that starts in one room of a house (local infection at the central line site). Checking the temperature is like checking the smoke alarm to see if the fire has spread to the rest of the house (systemic infection). The sooner you catch it, the better you can prevent serious damage.

After assessing the client’s temperature, Nurse Davis should document the findings and notify the healthcare provider. The healthcare provider may order blood cultures, wound cultures, or other diagnostic tests to confirm the infection and determine the appropriate treatment. It’s also important to assess for other signs of systemic infection, such as chills, increased heart rate, or hypotension, and to ensure that the central line site is properly cleaned and the dressing is changed using sterile technique.

• Assess and document the client’s temperature.
• Notify the healthcare provider of the findings.
• Prepare for possible blood cultures and other diagnostic tests.
• Monitor the client for additional signs of systemic infection, such as chills or hypotension.
• Ensure strict aseptic technique when cleaning the central line site and changing the dressing.

✘Incorrect answer options:

The time of the last dressing change. While it is important to know when the last dressing change occurred to determine if the dressing change schedule is being followed, this is not the most immediate concern when signs of infection are present. The priority is to assess for systemic infection by checking the client's temperature.

Any known allergies. Although allergies are important to consider, they are not directly relevant to the immediate assessment of a potential infection at the central line site. The focus should be on signs of infection, such as fever.

The expiration date of the PN solution. The expiration date of the PN solution is critical to ensure the safety and sterility of the nutrition being administered, but it is not directly related to the signs of infection observed at the central line site. Assessing the client’s temperature takes precedence in this situation.

EXPLANATION

✔Correct answer:

A 59-year-old client recovering from an appendectomy.  Parenteral nutrition (PN) is typically reserved for clients who are unable to meet their nutritional needs through enteral (oral or tube feeding) methods due to severe gastrointestinal dysfunction or other significant barriers to nutrient absorption. A 59-year-old client recovering from an appendectomy is the least likely to require PN because, in most cases, clients recovering from an appendectomy can resume oral intake relatively soon after surgery. Even if there are temporary dietary restrictions immediately post-surgery, these can usually be managed with oral fluids and a gradual return to a regular diet.

An appendectomy is a surgical procedure to remove the appendix, usually following appendicitis. Post-surgical recovery generally involves a brief period of fasting, followed by the reintroduction of clear fluids and gradually advancing to a regular diet as bowel function returns. The gastrointestinal tract is typically intact and functional after an appendectomy, allowing for adequate nutrient absorption without the need for parenteral nutrition.

Imagine the GI tract like a road system. After a small repair on a side street (appendectomy), traffic (food/nutrients) can resume normally without needing a detour (PN). There's no need for a major alternative route unless the entire road system is blocked or severely damaged (as in severe GI conditions).

For a client recovering from an appendectomy, Nurse Bennett should focus on monitoring the return of bowel function, managing pain, and gradually reintroducing oral intake. Ensuring adequate hydration and preventing postoperative complications are key nursing priorities. PN is not typically indicated unless complications arise that prevent normal gastrointestinal function.

• Monitor for the return of bowel sounds and passage of flatus, indicating the return of GI function.
• Manage pain effectively to facilitate mobility and recovery.
• Gradually advance the client’s diet from clear fluids to regular food as tolerated.
• Ensure the client is well-hydrated, especially if oral intake is initially limited.
• Educate the client about postoperative care, including dietary progression and signs of complications.

✘Incorrect answer options:

A 55-year-old client with ongoing nausea and vomiting due to chemotherapy. This client may require PN if their nausea and vomiting are severe enough to prevent adequate oral intake over an extended period, leading to significant nutritional deficiencies.

A 44-year-old client diagnosed with ulcerative colitis. Ulcerative colitis can lead to severe inflammation of the colon, resulting in malabsorption and poor nutritional status. In severe cases, PN may be needed to meet the client’s nutritional needs if the gastrointestinal tract cannot adequately absorb nutrients.

A 25-year-old client with Hirschsprung's disease. Hirschsprung's disease is a condition affecting the colon, leading to severe constipation or intestinal obstruction. If the disease results in a significant portion of the bowel being non-functional, PN might be necessary to maintain nutrition, especially if surgical intervention is required.

EXPLANATION

✔Correct answer:

Infusion pump.  The most essential piece of equipment Nurse Jackson should ensure is available before starting parenteral nutrition (PN) is an infusion pump. Parenteral nutrition is a hypertonic solution that contains a precise mixture of glucose, amino acids, lipids, vitamins, and minerals. This solution needs to be administered at a carefully controlled rate to avoid complications such as fluid overload, hyperglycemia, and electrolyte imbalances. An infusion pump is crucial because it allows for precise control over the rate of infusion, ensuring that the PN is delivered safely and effectively.

Parenteral nutrition is administered via a central line due to its high osmolarity. The central line allows the solution to be delivered into a large vein where it can be diluted quickly in the bloodstream. The infusion pump ensures that the PN is administered at the correct rate, preventing potential complications such as rapid blood sugar changes, shifts in fluid and electrolyte balance, or overloading the circulatory system.

Think of the infusion pump like the cruise control on a car. It maintains a steady speed (or in this case, infusion rate) to ensure the journey (or infusion) is smooth and safe. Without it, the car might go too fast or too slow, leading to problems.

Nurse Jackson should confirm the availability and proper functioning of the infusion pump before starting the PN. Additionally, monitoring the patient’s response to the PN, including regular glucose checks and electrolyte monitoring, is crucial.

• Ensure the infusion pump is calibrated and functioning correctly before connecting the PN bag to the central line.
• Monitor the patient’s blood glucose levels regularly, especially when initiating PN, as hyperglycemia is a common complication.
• Regularly assess the patient’s electrolyte levels, fluid balance, and overall tolerance to the PN.
• Check the central line site for signs of infection or complications, such as redness, swelling, or leakage.
• Document the rate of infusion, any adjustments made, and the patient’s response to the therapy.

✘Incorrect answer options:

Glucometer. While a glucometer is important for monitoring blood glucose levels in patients receiving PN, it is not the essential piece of equipment needed before starting the infusion. It is used after the PN is started to monitor for hyperglycemia, but the infusion pump is needed to begin the PN safely.

Dressing tray. A dressing tray may be needed for central line care, such as changing the dressing or managing the line site. However, it is not the essential equipment required specifically to start PN. The infusion pump is directly related to the safe administration of the PN solution.

Nebulizer. A nebulizer is used for administering aerosolized medications to the respiratory tract and is unrelated to the administration of parenteral nutrition. It is not relevant in this context.

EXPLANATION

✔Correct answer:

Hypervolemia.  The signs and symptoms described—headache, bounding pulse, jugular vein distension, and significant weight gain—are indicative of hypervolemia, or fluid overload. Hypervolemia occurs when there is an excessive amount of fluid in the bloodstream, which can result from too rapid administration of parenteral nutrition (PN) or an imbalance between fluid intake and output. The observed symptoms suggest increased venous pressure and fluid accumulation, which are hallmark signs of hypervolemia.

Hypervolemia occurs when the body retains more fluid than it can effectively manage. This can lead to an increase in blood volume, causing the heart to pump harder, resulting in a bounding pulse. The excess fluid may back up into the veins, leading to jugular vein distension, and can also cause fluid to accumulate in tissues, leading to weight gain and possibly edema. The increased fluid volume can cause a headache due to elevated intracranial pressure or hypertension. Left untreated, hypervolemia can lead to complications such as pulmonary edema, heart failure, or hypertension.

Imagine a water balloon that is being filled too quickly (fluid overload). As more water (fluid) is added, the balloon (body) starts to stretch and bulge, creating pressure (bounding pulse, headache) and eventually causing it to overflow or leak (symptoms like jugular vein distension).

Nurse Thompson should immediately assess the client’s fluid status by checking intake and output, and consider slowing down or adjusting the PN infusion rate if hypervolemia is suspected. The nurse should also monitor vital signs, including blood pressure and respiratory status, to assess the severity of the fluid overload. Administering diuretics may be necessary to remove excess fluid from the body. It's also important to notify the healthcare provider about the client’s symptoms for further evaluation and intervention.

• Monitor the client’s intake and output to assess fluid balance.
• Consider adjusting the rate of PN infusion if hypervolemia is confirmed.
• Assess the client’s vital signs, including blood pressure and respiratory status, to monitor for complications.
• Administer diuretics as prescribed to reduce fluid overload.
• Notify the healthcare provider immediately to discuss further interventions.

✘Incorrect answer options:

Air embolism. An air embolism may cause symptoms such as chest pain, difficulty breathing, and a sudden drop in blood pressure, but it is not associated with symptoms like weight gain, a bounding pulse, or jugular vein distension.

Hyperglycemia. Hyperglycemia typically presents with symptoms such as increased thirst, frequent urination, blurred vision, and fatigue. It does not typically cause a bounding pulse, jugular vein distension, or significant weight gain.

Sepsis. Sepsis may present with symptoms like fever, chills, hypotension, and a rapid heart rate, but it is not characterized by a bounding pulse, jugular vein distension, or significant weight gain. The symptoms described are more closely aligned with hypervolemia.

EXPLANATION

✔Correct answer:

10% dextrose in water.  When a parenteral nutrition (PN) bag is empty and a new PN solution is not immediately available, the priority is to prevent hypoglycemia in the client, as they have been receiving a continuous source of glucose from the PN solution. Hanging 10% dextrose in water (D10W) is the correct choice because it provides a higher concentration of glucose, similar to that provided by the PN, helping to maintain the client's blood glucose levels until the new PN solution arrives. This is particularly important because sudden discontinuation of PN without an adequate glucose substitute can lead to dangerous drops in blood glucose.

Parenteral nutrition solutions typically contain a significant amount of glucose to meet the client’s caloric needs. If PN is abruptly stopped without replacing it with a glucose-containing solution, the client is at risk of hypoglycemia, as their body is accustomed to the continuous glucose supply. Administering 10% dextrose in water ensures that the client continues to receive glucose, preventing a sudden decrease in blood sugar levels, which could lead to symptoms such as shakiness, sweating, confusion, or even loss of consciousness.

Think of the body as a car that has been running on high-octane fuel (PN solution). If you suddenly switch off the fuel supply, the car (body) might stall (experience hypoglycemia). To keep it running smoothly until you refill the tank, you provide an alternative fuel (10% dextrose in water) that closely matches what the car has been using.

Nurse Adams should monitor the client's blood glucose levels closely during this period to ensure they remain stable. Once the new PN solution is ready, it should be administered as soon as possible to resume the client’s full nutritional support. Additionally, it's crucial to document the temporary use of 10% dextrose and notify the healthcare provider of the situation.

• Monitor the client's blood glucose levels frequently during the temporary administration of D10W.
• Administer the new PN solution as soon as it becomes available.
• Document the use of 10% dextrose and communicate with the healthcare provider.
• Educate the client on the importance of maintaining continuous glucose intake during PN therapy.

✘Incorrect answer options:

5% dextrose in water. While this solution does provide some glucose, the concentration is lower than what is typically found in PN solutions. Using 5% dextrose in water (D5W) may not adequately prevent hypoglycemia, especially in clients who have been receiving a higher glucose concentration from their PN.

5% dextrose in normal saline. This solution also contains 5% dextrose, but like D5W, it may not provide sufficient glucose to prevent hypoglycemia. Additionally, the normal saline component can contribute to unnecessary sodium and fluid load, which may not be appropriate for all clients.

5% dextrose in lactated Ringer's solution. Although this solution provides some glucose, it contains electrolytes that may not be necessary or appropriate for the client, depending on their clinical condition. The 5% glucose concentration is also lower than what is needed to prevent hypoglycemia in clients previously receiving PN.

EXPLANATION

✔Correct answer:

Send them to the laboratory for culture.  When a client receiving parenteral nutrition (PN) develops a sudden fever, one of the potential concerns is an infection related to the PN solution or the tubing. The physician's instruction to change the PN solution and tubing suggests a suspicion of contamination. Nurse Roberts should send the discontinued PN solution and tubing to the laboratory for culture to determine if there is any bacterial, fungal, or other microbial growth that could have caused the fever. Identifying the specific pathogen can guide appropriate treatment and prevent further complications.

Parenteral nutrition is administered directly into the bloodstream, bypassing the body's usual barriers to infection. This makes it critical to ensure the sterility of the PN solution, the tubing, and the central line through which it is administered. Any contamination can lead to bloodstream infections (BSIs), which may manifest as fever and other signs of sepsis. Culturing the PN solution and tubing helps in identifying the pathogen responsible for the infection, which is essential for targeted antibiotic therapy and infection control.

Imagine you find spoiled milk in your fridge (the PN solution and tubing), and it made you sick (the fever). Instead of just throwing it away, you would test it (send it to the lab for culture) to find out what caused it to spoil, so you can avoid it happening again and treat any illness properly.

After sending the discontinued PN materials to the lab, Nurse Roberts should monitor the client's vital signs and watch for any further signs of infection or sepsis. Blood cultures may also be ordered to identify the presence of systemic infection. Proper documentation of the event, including the time of fever onset and the actions taken, is crucial. Additionally, ensuring that the replacement PN solution and tubing are handled with strict aseptic technique is essential to prevent further contamination.

• Send the discontinued PN solution and tubing to the laboratory for culture.
• Monitor the client for further signs of infection or sepsis.
• Obtain blood cultures if ordered by the physician.
• Document the onset of fever, actions taken, and any subsequent findings.
• Ensure strict aseptic technique when handling the new PN solution and tubing.

✘Incorrect answer options:

Save them for return to the manufacturer. There is no need to return the PN solution or tubing to the manufacturer. The primary concern in this scenario is identifying any potential pathogens, which is why sending them to the laboratory for culture is the correct action.

Return them to the hospital pharmacy. Returning the materials to the hospital pharmacy is not appropriate in this context. The pharmacy is responsible for preparing and dispensing PN solutions, but the investigation of potential contamination or infection is a clinical matter that requires laboratory analysis.

Discard them in the unit trash. Discarding the materials in the trash would eliminate the opportunity to identify the cause of the client's fever and could delay appropriate treatment. Proper investigation through laboratory culture is necessary to guide clinical decisions and prevent further complications.

EXPLANATION

✔Correct answer:

Decrease the PN rate to 60 ml/hr.  When a client is being weaned off parenteral nutrition (PN) and transitioning to a regular diet, the PN infusion rate is typically decreased gradually rather than stopped abruptly. This gradual reduction allows the client’s gastrointestinal (GI) system to adjust to enteral nutrition and ensures that their blood glucose levels remain stable. Decreasing the PN rate to 60 ml/hr provides a balance between maintaining adequate nutritional support and encouraging the GI tract to take over the full role of nutrient absorption.

Parenteral nutrition provides a constant source of glucose and other nutrients directly into the bloodstream. A sudden discontinuation of PN can lead to hypoglycemia, as the body may not have adjusted to the new source of glucose from oral intake. Gradual tapering of the PN rate allows the body to begin relying on dietary intake for nutrients, while the reduced PN infusion continues to support metabolic needs and prevent a sudden drop in blood glucose levels.

Imagine you're driving a car that's been running on autopilot (PN) for a long journey. As you approach your destination (starting a regular diet), you don't just abruptly turn off the autopilot (PN) and take full control (regular diet) instantly. Instead, you gradually take over the steering while the autopilot slowly disengages, ensuring a smooth transition without any sudden jolts (hypoglycemia or metabolic imbalance).

Nurse Garcia should monitor the client's blood glucose levels frequently during this transition period to detect any signs of hypoglycemia or hyperglycemia. The nurse should also assess the client's tolerance to the oral diet, including monitoring for any GI symptoms like nausea or diarrhea. Adjustments to the PN rate should be done as per the healthcare provider's prescription, with close monitoring to ensure the client’s nutritional needs are met as they transition off PN.

• Monitor blood glucose levels regularly during the transition.
• Assess the client’s tolerance to oral intake and watch for GI symptoms.
• Gradually decrease the PN rate as prescribed to prevent hypoglycemia.
• Educate the client about the importance of maintaining adequate oral intake during the transition.

✘Incorrect answer options:

Initiate 0.9% normal saline at 30 ml/hr. While this option might be used in cases where PN is discontinued entirely, it is not appropriate in this context where the goal is to gradually reduce the PN rate rather than replace it with saline. Normal saline does not provide the nutrients and glucose that PN supplies.

Keep the current infusion rate as it is. Keeping the infusion rate at 120 ml/hr would continue full nutritional support from PN, which is not necessary as the client is starting a regular diet. This would also risk overfeeding and hyperglycemia.

Discontinue the PN completely. Abruptly stopping PN can lead to hypoglycemia, especially if the client has not yet fully transitioned to adequate oral intake. Gradual reduction is preferred to ensure a smooth transition and to avoid metabolic complications.

EXPLANATION

✔Correct answer:

Thirst, blurred vision, and frequent urination.  These symptoms are classic signs of hyperglycemia. Hyperglycemia occurs when there is too much glucose in the blood, often due to insufficient insulin or insulin resistance. In the context of parenteral nutrition (PN), hyperglycemia can occur because PN solutions contain glucose as a key component for energy. The body may not adequately regulate this glucose, leading to elevated blood sugar levels. The high glucose levels cause osmotic diuresis, leading to increased urination (polyuria), and the loss of fluids can cause dehydration, leading to increased thirst (polydipsia). Additionally, high blood glucose can cause osmotic changes in the lens of the eye, resulting in blurred vision.

In hyperglycemia, the elevated glucose levels in the blood exceed the renal threshold, leading to glucose spilling into the urine (glycosuria). The presence of glucose in the urine pulls water with it due to osmosis, causing polyuria. This excessive urination then leads to dehydration, which triggers the sensation of thirst (polydipsia). The high levels of glucose in the blood also create osmotic imbalances in the lens of the eye, leading to blurred vision. If hyperglycemia persists, it can result in more severe complications, including diabetic ketoacidosis (DKA) in patients with diabetes.

Think of your bloodstream like a river carrying sugar (glucose). If too much sugar is dumped into the river and the system that regulates it (like insulin) isn't working properly, the river becomes too "sticky" (thick with sugar). To try and dilute this stickiness, the body draws in more water (causing thirst) and then tries to flush it out (leading to frequent urination), but this can make vision blurry due to the high concentration of sugar.

Nurses monitoring clients receiving PN should regularly check blood glucose levels, especially in clients with risk factors for hyperglycemia, such as those with diabetes or those receiving large volumes of PN. Adjusting the rate of infusion or adding insulin to the PN may be necessary to control blood glucose levels. Nurses should also assess for signs of dehydration and visual disturbances and educate clients on recognizing symptoms of hyperglycemia.

• Regular monitoring of blood glucose levels.
• Adjust the rate of PN infusion or insulin administration as prescribed.
• Assess for signs of dehydration and provide hydration as necessary.
• Educate the client on recognizing hyperglycemia symptoms.
• Provide visual assessments if the client reports blurred vision.

✘Incorrect answer options:

High-grade fever, chills, and reduced urination. These symptoms are more indicative of an infection or sepsis rather than hyperglycemia. While fever and chills could be related to a systemic infection, which is a different complication of PN, they are not typical of hyperglycemia.

Fatigue, increased sweating, and sensitivity to heat. These symptoms may suggest hyperthyroidism, where the body’s metabolism is increased, leading to heat intolerance and sweating. However, they are not directly associated with hyperglycemia.

Coarse, dry hair, weakness, and fatigue. These symptoms are more characteristic of hypothyroidism, a condition of decreased thyroid hormone production. Hypothyroidism can lead to a slowed metabolism, causing these symptoms, but it is unrelated to hyperglycemia.

EXPLANATION

✔Correct answer:

Confirm that the infusion is running at the prescribed rate.  The safest and most appropriate action is for Nurse Kelly to confirm that the infusion is running at the prescribed rate. If the fat emulsion (lipid) infusion is behind schedule, it is important not to increase the infusion rate to "catch up." Fat emulsions should be infused at a controlled, steady rate to prevent complications such as fat overload syndrome, hyperlipidemia, or other metabolic disturbances. Increasing the rate to catch up could overload the client’s system, leading to adverse reactions.

Fat emulsions are used in parenteral nutrition to provide essential fatty acids and calories. These emulsions must be administered at a controlled rate because they are emulsified fats that can cause complications if infused too rapidly. Rapid infusion can lead to fat embolism, pulmonary issues, or a sudden increase in blood lipids, which can be dangerous for the patient.

Imagine watering a plant. If you’ve missed some watering times, dumping all the water at once can overwhelm the plant and cause damage, rather than allowing it to absorb water slowly over time.

Nurse Kelly should assess the current rate of the infusion, verify it matches the physician’s orders, and document any discrepancies. If the infusion is behind schedule due to a rate discrepancy, this should be reported, and the physician or pharmacist should be consulted before making any adjustments.

• Verify the infusion rate with the order sheet to ensure the prescribed rate is correct and consistent.
• Check the infusion equipment for proper functioning, including the IV pump settings, and inspect for potential blockages or issues with the IV line.
• Document the discrepancy in the infusion timeline, including any observations or actions taken.
• Contact the healthcare provider for guidance if there is significant delay and discuss whether the current rate should be adjusted or if other interventions are needed.
• Monitor the patient closely for signs of complications related to fat emulsion infusion, such as fever, chills, headache, or signs of lipid overload, and report any abnormalities immediately.

✘Incorrect answer options:

Adjust the infusion rate to catch up within the next hour. This option is incorrect because rapidly increasing the rate can cause serious complications, such as hyperlipidemia or fat overload syndrome. The infusion should be maintained at the prescribed rate, even if it is behind schedule.

Increase the infusion rate gradually to catch up over the next few hours. Even gradually increasing the rate can be unsafe, as it may still lead to the same complications as rapidly increasing the rate. Fat emulsions should not be infused at a higher rate than prescribed without specific orders from a healthcare provider.

Set the infusion rate to the maximum until the solution is back on schedule. This option is the most dangerous because it involves significantly increasing the infusion rate, which can lead to severe complications such as fat overload, hyperlipidemia, or other metabolic disturbances. Administering lipids too quickly can be harmful and is contraindicated in clinical practice.

EXPLANATION

✔Correct answer:

Inhale deeply, hold it, and bear down.  The correct action for the client to take during a tubing change for a central venous line is to perform the Valsalva maneuver, which involves inhaling deeply, holding the breath, and bearing down. This action increases intrathoracic pressure, which helps to prevent air from being sucked into the central venous line during the tubing change, thereby reducing the risk of air embolism. The central venous line is directly connected to the venous system, and any sudden drop in intrathoracic pressure could create a vacuum effect, potentially drawing air into the bloodstream. The Valsalva maneuver counteracts this by increasing pressure within the chest cavity.

When changing the tubing on a central venous line, there is a risk that air could enter the line and subsequently the venous system, leading to an air embolism. The Valsalva maneuver temporarily increases intrathoracic pressure, collapsing the veins slightly and preventing air from entering the bloodstream. This is especially important when the central venous line is in a location like the subclavian vein, where the risk of air embolism is higher due to the proximity to the thoracic cavity and the negative pressure generated during normal breathing.

Think of the bloodstream like a garden hose full of water. If you open a valve on the hose while the water is still flowing (like disconnecting the central line tubing during normal breathing), air can get sucked in. But if you squeeze the hose tightly at one end (like performing the Valsalva maneuver), you create pressure that prevents any air from entering the system, keeping the water (blood) flow steady and safe.

Nurse Garcia should instruct the client to perform the Valsalva maneuver at the precise moment of tubing disconnection and reconnection to minimize the risk of air embolism. The nurse should also ensure that the central line is clamped when not in use and before disconnecting or connecting any tubing. After completing the tubing change, the nurse should monitor the client for any signs of air embolism, such as sudden chest pain, shortness of breath, or changes in vital signs.

• Instruct the client to perform the Valsalva maneuver during the tubing change.
• Clamp the central line before disconnecting or connecting tubing.
• Monitor the client for signs of air embolism after the procedure.
• Document the procedure and the client's response.
• Educate the client about the importance of the Valsalva maneuver during tubing changes.

✘Incorrect answer options:

Turn the head to the right. Turning the head to the right does not prevent air embolism during a central line tubing change. It is not necessary unless it provides better access to the central line site, but it does not address the primary concern of preventing air entry.

Breathe normally. Normal breathing does not increase intrathoracic pressure, and therefore, it does not prevent air from entering the central line during the tubing change. This could increase the risk of an air embolism.

Exhale slowly and evenly. Exhaling slowly and evenly decreases intrathoracic pressure, which could actually increase the risk of air being drawn into the central line during a tubing change. This action is not recommended in this context.