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

Choice A reason: Impaired gas exchange is the highest priority in Pneumocystis carinii pneumonia (now Pneumocystis jirovecii pneumonia). This opportunistic infection causes alveolar inflammation, reducing oxygen diffusion across the alveolar-capillary membrane. Hypoxemia results, impairing tissue oxygenation. Prioritizing gas exchange ensures adequate oxygen delivery to vital organs, addressing the life-threatening nature of this respiratory infection.

Choice B reason: Activity intolerance occurs in Pneumocystis pneumonia due to hypoxemia and fatigue from infection. While significant, it is secondary to impaired gas exchange, as oxygen delivery is critical for survival. Addressing hypoxemia through oxygen therapy or ventilation support takes precedence, as it directly impacts the patient’s ability to sustain physical activity.

Choice C reason: Imbalanced nutrition: less than body requirements may occur due to increased metabolic demands or poor appetite in Pneumocystis pneumonia. However, it is not the highest priority, as nutritional deficits are less immediately life-threatening than hypoxemia. Correcting gas exchange ensures oxygenation, which supports metabolic processes before addressing long-term nutritional needs.

Choice D reason: Impaired oral mucous membranes may result from opportunistic infections or treatment side effects in Pneumocystis pneumonia. While uncomfortable, it is not life-threatening compared to impaired gas exchange, which causes hypoxemia and risks organ failure. Addressing respiratory function is critical before managing secondary issues like oral health in this acute infection.

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.