TPN NCLEX-RN Practice Questions

TPN NCLEX-RN Practice Questions

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TPN NCLEX-RN Practice Questions

Total Parenteral Nutrition (TPN) is a high-alert therapy that demands precise clinical judgment, vigilant monitoring, and strict aseptic technique—key competencies assessed on the NCLEX-RN. This topic-wise question set focuses on pharmacological and parenteral therapy principles tied to TPN, including indications, central vs. peripheral administration, filter/tubing requirements, infusion safety, electrolyte management, and complication recognition. You will be tested on glucose management, refeeding syndrome, lipid safety, catheter care, compatibility, and evidence-based protocols for infusion changes and monitoring. Designed for advanced learners, these practice questions mirror real NCLEX-RN complexity and help refine your clinical reasoning, prioritization, and patient safety interventions specific to TPN. Use them to solidify your mastery and confidence.

Q1. A client requires TPN with dextrose 20% and amino acids 5%. Which is the most appropriate vascular access device for this infusion?

  • Peripheral IV catheter in a forearm vein
  • Midline catheter with electronic pump
  • Peripherally inserted central catheter (PICC)
  • Heparin lock in a hand vein

Correct Answer: Peripherally inserted central catheter (PICC)

Q2. A client’s next TPN bag is delayed from pharmacy. The current bag has finished. What is the nurse’s best immediate action?

  • Hang 0.9% normal saline at the same rate
  • Hang D10W at the same rate
  • Stop all IV fluids and wait for TPN
  • Increase the previous rate of TPN when it arrives to catch up

Correct Answer: Hang D10W at the same rate

Q3. A malnourished client newly started on TPN is at risk for refeeding syndrome. Which laboratory abnormality is most typical?

  • Hypercalcemia
  • Hypophosphatemia
  • Hypernatremia
  • Hypermagnesemia

Correct Answer: Hypophosphatemia

Q4. Which is the most appropriate in-line filter selection for a 3-in-1 TPN admixture (dextrose, amino acids, and lipids together)?

  • No filter is needed with lipid-containing solutions
  • 0.22-micron filter
  • 1.2-micron filter
  • 5-micron filter

Correct Answer: 1.2-micron filter

Q5. Which client condition is a contraindication to receiving IV lipid emulsion as part of TPN?

  • History of soy or egg allergy
  • Stable chronic kidney disease
  • Ulcerative colitis in remission
  • Iron deficiency anemia

Correct Answer: History of soy or egg allergy

Q6. The nurse is teaching about preventing calcium-phosphate precipitation in TPN. Which instruction is appropriate to verify with pharmacy?

  • Add calcium first, then phosphate to the TPN mixture
  • Add phosphate first, then calcium to the TPN mixture
  • Use calcium chloride instead of calcium gluconate for better solubility
  • Warm TPN to body temperature to dissolve precipitates

Correct Answer: Add phosphate first, then calcium to the TPN mixture

Q7. What is the recommended maximum hang time for a separate IV lipid emulsion infusion?

  • 4 hours
  • 8 hours
  • 12 hours
  • 24 hours

Correct Answer: 12 hours

Q8. A client on TPN develops tremors, diaphoresis, and confusion after the infusion was inadvertently stopped. What is the nurse’s priority action?

  • Restart TPN at double the previous rate
  • Hang D10W and notify the provider
  • Administer a bolus of D50 and discontinue all infusions
  • Begin normal saline at keep-vein-open (KVO) rate

Correct Answer: Hang D10W and notify the provider

Q9. A client with TPN via central line develops sudden shortness of breath during tubing change. The nurse suspects air embolism. What is the immediate action?

  • Place the client in high Fowler’s position and encourage deep breaths
  • Clamp the catheter, place in left lateral Trendelenburg, and administer 100% oxygen
  • Increase the TPN rate to stabilize blood pressure
  • Obtain a stat chest X-ray before intervening

Correct Answer: Clamp the catheter, place in left lateral Trendelenburg, and administer 100% oxygen

Q10. Which infection-prevention strategy is essential when caring for a central line used for TPN?

  • Change transparent dressings every 24 hours
  • Use sterile technique and chlorhexidine for dressing changes
  • Flush the line with heparin every shift instead of normal saline
  • Draw routine blood samples through the TPN line

Correct Answer: Use sterile technique and chlorhexidine for dressing changes

Q11. When TPN is infusing, which statement about medication administration is correct?

  • Compatible medications may be piggybacked into the TPN line
  • Heparin can be added at the bedside to prevent thrombosis
  • Run all medications through a dedicated, separate lumen
  • IV antibiotics are safest when mixed directly with TPN

Correct Answer: Run all medications through a dedicated, separate lumen

Q12. A patient newly started on TPN has glucose checks ordered. What frequency is most appropriate initially?

  • Once daily fasting glucose
  • Every 4–6 hours
  • Every 12 hours
  • Only when symptomatic

Correct Answer: Every 4–6 hours

Q13. Which assessment after subclavian central line insertion requires immediate action before starting TPN?

  • Localized tenderness at the insertion site
  • Diminished breath sounds on the right side
  • Heart rate 98 beats/min
  • Slight serosanguinous drainage under the dressing

Correct Answer: Diminished breath sounds on the right side

Q14. The nurse notes that a separate lipid emulsion bag appears to have an oily layer and fat globules at the top. What is the best action?

  • Warm the bag and gently shake before infusing
  • Infuse at a slower rate to reduce embolic risk
  • Return the bag to pharmacy and do not administer
  • Filter the emulsion through a 0.22-micron filter to remove droplets

Correct Answer: Return the bag to pharmacy and do not administer

Q15. A client on TPN has a blood glucose of 320 mg/dL. Which is the most appropriate nursing action?

  • Stop the TPN immediately
  • Check infusion rate, notify the provider, and anticipate insulin coverage
  • Increase TPN rate to meet metabolic demand
  • Bolus regular insulin IV through the TPN line

Correct Answer: Check infusion rate, notify the provider, and anticipate insulin coverage

Q16. Which guideline is correct for TPN tubing and bag changes (dextrose/amino acid solution without lipids)?

  • Change tubing and bag every 24 hours
  • Change tubing every 72 hours and bag every 48 hours
  • Change tubing and bag every 12 hours
  • Change tubing daily and bag every 72 hours

Correct Answer: Change tubing and bag every 24 hours

Q17. A client on TPN is ordered IV lipid emulsion. Which lab value warrants holding the lipid infusion and notifying the provider?

  • Albumin 3.2 g/dL
  • Triglycerides 650 mg/dL
  • ALT 48 U/L
  • Magnesium 1.9 mg/dL

Correct Answer: Triglycerides 650 mg/dL

Q18. A client with pancreatitis and severe malnutrition is starting TPN. To reduce refeeding risk, what is the best initial plan?

  • Start at full caloric goal and titrate down as tolerated
  • Start at 25–50% of goal calories and advance gradually
  • Start lipids only for the first 48 hours
  • Start with hypotonic IV fluids before TPN

Correct Answer: Start at 25–50% of goal calories and advance gradually

Q19. Which is the best action if the nurse suspects a thrombotic occlusion of the TPN central line?

  • Forcefully flush to dislodge the clot
  • Gently attempt to flush, check for kinks/clamps, reposition the client, and notify provider for possible alteplase
  • Remove the catheter immediately at the bedside
  • Hang TPN through a peripheral IV while assessing

Correct Answer: Gently attempt to flush, check for kinks/clamps, reposition the client, and notify provider for possible alteplase

Q20. Which statement about TPN infusion is correct?

  • TPN may be infused by gravity if carefully monitored
  • TPN must be administered using an infusion pump
  • TPN rates should be adjusted by the nurse based on hunger
  • TPN can be paused for 2–3 hours daily without consequence

Correct Answer: TPN must be administered using an infusion pump

Q21. The provider orders cyclic TPN over 14 hours nightly. To prevent hypoglycemia at the end of the cycle, what should the nurse ensure?

  • At end time, abruptly stop the infusion
  • Taper the infusion rate down for 1–2 hours before stopping
  • Switch to D5W for 30 minutes after stopping
  • Increase lipids for the last hour of infusion

Correct Answer: Taper the infusion rate down for 1–2 hours before stopping

Q22. A client with chronic CO2 retention (COPD) requires TPN. Which macronutrient adjustment is most appropriate?

  • Higher carbohydrate, lower fat to decrease CO2 production
  • Lower carbohydrate, higher fat to decrease CO2 production
  • High protein, high carbohydrate for nitrogen balance
  • Eliminate lipids to optimize respiratory drive

Correct Answer: Lower carbohydrate, higher fat to decrease CO2 production

Q23. Which outcome indicates possible fluid overload in a client receiving TPN?

  • Weight loss of 1 kg over 48 hours
  • Bilateral crackles and 2+ peripheral edema
  • Dry mucous membranes and tachycardia
  • Decreased central venous pressure

Correct Answer: Bilateral crackles and 2+ peripheral edema

Q24. A client on TPN via central line develops fever, chills, and erythema at the insertion site. What is the priority nursing action?

  • Stop TPN and remove the catheter without notifying the provider
  • Obtain blood cultures (peripheral and from the line), notify provider, and anticipate antibiotics
  • Increase the TPN rate to support immune function
  • Cover the site with additional gauze and continue therapy

Correct Answer: Obtain blood cultures (peripheral and from the line), notify provider, and anticipate antibiotics

Q25. Which instruction is correct for patient education regarding home TPN handling?

  • Warm the TPN bag in a microwave before hanging
  • Store TPN refrigerated; bring to room temperature for 30–60 minutes before infusion
  • Reuse tubing for up to 3 days if the line is clean
  • Adjust the infusion rate based on daily appetite

Correct Answer: Store TPN refrigerated; bring to room temperature for 30–60 minutes before infusion

Q26. Which insulin is commonly added to TPN solutions for glycemic control?

  • NPH insulin
  • Regular insulin
  • Insulin lispro
  • Insulin glargine

Correct Answer: Regular insulin

Q27. What is the best nursing action if a peripheral line infusing PPN shows redness, pain, and streaking along the vein?

  • Apply heat and continue the infusion
  • Stop the infusion, remove the catheter, elevate the limb, and notify the provider
  • Decrease the rate and reassess in one hour
  • Flush the catheter forcefully with saline

Correct Answer: Stop the infusion, remove the catheter, elevate the limb, and notify the provider

Q28. Which TPN composition requires a 0.22-micron in-line filter?

  • Dextrose and amino acids without lipids
  • 3-in-1 admixture (dextrose, amino acids, lipids)
  • Separate lipid emulsion infusion
  • Any solution with trace elements

Correct Answer: Dextrose and amino acids without lipids

Q29. A nutrition order specifies PPN for short-term support. Which solution composition is most appropriate for PPN via peripheral access?

  • Dextrose 5% and amino acids 3%
  • Dextrose 20% and amino acids 5%
  • Dextrose 25% and amino acids 5%
  • Dextrose 30% with added electrolytes

Correct Answer: Dextrose 5% and amino acids 3%

Q30. Before hanging a new TPN bag, which verification is most critical for the nurse?

  • Color of the tubing matches the previous bag
  • Bag label matches the provider’s order and patient identifiers; inspect for particulate matter/instability
  • Patient states they feel hungry
  • The TPN was mixed on the unit by the nurse

Correct Answer: Bag label matches the provider’s order and patient identifiers; inspect for particulate matter/instability

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