A nurse is assessing a client with suspected bacterial meningitis. Which of the following findings should the nurse expect?

Choice A reason: Hyperglycemia is a priority complication of TPN due to high dextrose content, which can overwhelm glucose metabolism, especially in stressed or diabetic patients. Elevated blood glucose increases infection risk, impairs wound healing, and may lead to osmotic diuresis, causing dehydration. Monitoring and insulin administration are critical to manage this metabolic complication.

Choice B reason: Hypokalemia can occur with TPN if potassium is inadequately supplemented, but it is less common than hyperglycemia. TPN solutions are tailored to include electrolytes, and hypokalemia is typically prevented with monitoring. While significant, it is not the primary concern compared to hyperglycemia, which has broader systemic effects in TPN patients.

Choice C reason: Constipation is not a direct complication of TPN, as it bypasses the gastrointestinal tract. Lack of oral intake may reduce bowel motility, but this is secondary to metabolic complications like hyperglycemia. Managing blood glucose and electrolytes takes precedence, as constipation is less immediately life-threatening and can be addressed with other interventions.

Choice D reason: Weight loss is not a typical complication of TPN, which is designed to provide adequate calories and nutrients to prevent catabolism and promote weight gain in malnourished patients. Hyperglycemia or infection from TPN is a greater concern, as weight loss would indicate inadequate caloric delivery, not a primary complication.

Choice A reason: Bradypnea, or slow respiratory rate, is not typical in hypovolemic shock. The body compensates for reduced blood volume by increasing respiratory rate (tachypnea) to enhance oxygen delivery to tissues. This compensates for decreased oxygen-carrying capacity due to blood loss. Bradypnea would indicate a failure of compensatory mechanisms, which is not characteristic of hypovolemic shock’s early stages.

Choice B reason: Hypotension is an expected finding in hypovolemic shock due to decreased blood volume, reducing cardiac output and systemic perfusion pressure. The body activates the sympathetic nervous system, causing vasoconstriction and tachycardia to compensate, but blood pressure remains low. This reflects inadequate circulating volume, leading to impaired tissue perfusion and potential organ dysfunction if untreated.

Choice C reason: Bradycardia is not typical in hypovolemic shock. The body responds to low blood volume with tachycardia to maintain cardiac output and tissue perfusion. Bradycardia may occur in late, decompensated shock due to severe hypoxia or myocardial depression, but it is not an expected finding in earlier stages, where sympathetic activation predominates.

Choice D reason: Increased urine output is not expected in hypovolemic shock. The kidneys respond to reduced blood volume by decreasing urine production through activation of the renin-angiotensin-aldosterone system, which promotes sodium and water retention. Oliguria (low urine output) is typical, as the body conserves fluid to restore intravascular volume and maintain blood pressure.