A nurse is assessing a male client who began receiving total parenteral nutrition 24 hr ago. Which of the following findings should indicate to the nurse the client is experiencing a complication?

Elevated erythrocyte sedimentation rate (ESR)

Increased bilirubin levels

Guaiac fecal occult blood test positive

Weight gain 1.6 kg (3.5 lb)

Answer and Explanation

The Correct Answer is D

A. Elevated erythrocyte sedimentation rate (ESR): An elevated ESR is a nonspecific marker of inflammation. It can be elevated due to a variety of conditions, including infection, autoimmune disease, or chronic illness. In TPN, this finding would require further evaluation but is not a definitive or immediate indicator of a TPN-related complication.
B. Increased bilirubin levels: While increased bilirubin levels may suggest liver dysfunction, they are not uncommon in clients receiving TPN over an extended period due to hepatobiliary complications like cholestasis. However, after just 24 hours of TPN, a rise in bilirubin is unlikely to occur this quickly as a result of TPN alone.
C. Guaiac fecal occult blood test positive: A positive fecal occult blood test indicates the presence of gastrointestinal bleeding, which is not a typical complication associated with TPN initiation. While it is a concerning clinical finding, it is not directly linked to the use of TPN and may be related to other underlying gastrointestinal issues that need separate investigation.
D. Weight gain 1.6 kg (3.5 lb): A rapid weight gain of this magnitude within 24 hours of starting TPN suggests fluid overload, which is a potential complication of TPN therapy especially in clients with compromised cardiac or renal function. This finding indicates the need for immediate intervention to prevent further complications such as pulmonary edema or hypertension.

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Correct Answer is A

Explanation

A. Feedings should begin within 1 hr after birth. Initiating feeding within the first hour of life supports early bonding and helps stabilize the newborn’s blood glucose. This applies to both breastfed and bottle-fed infants and is considered a key component of newborn care.
B. Feedings can be controlled by gravity. Bottle feedings should not rely solely on gravity, as this can increase the risk of overfeeding and aspiration. Instead, caregivers should hold the bottle at an angle and watch for feeding cues, allowing the infant to suck and swallow at their own pace.
C. Feedings should be on demand. While on-demand feeding is typically encouraged with breastfeeding, bottle feeding is generally guided by scheduled intervals (e.g., every 3–4 hours) early on. Over time, bottle-fed infants may show hunger cues, but structured timing helps regulate intake initially.
D. Feedings may occur in clusters. Cluster feeding is common with breastfeeding due to variable milk flow and infant comfort needs. Bottle-fed infants usually have more consistent feeding patterns and are less likely to feed in unpredictable clusters.

A. Elevated vitamin K levels B. Zinc deficiency C. Constipation D. Acid reflux

Correct Answer is B

Explanation

A. Elevated vitamin K levels: While excessive levels of Vitamin K can sometimes increase the risk of bleeding, it does not directly hinder the body’s ability to heal pressure injuries. Healing of wounds is more dependent on factors like protein and collagen synthesis, which are affected by zinc levels rather than vitamin K.
B. Zinc deficiency: Zinc plays a crucial role in wound healing by supporting cell growth, collagen formation, and immune function. A deficiency in zinc impairs the synthesis of collagen, which is necessary for the healing of pressure injuries. It also weakens the immune system, increasing the risk of infection and delaying the healing process.
C. Constipation: While constipation can cause discomfort and lead to additional complications, such as straining or increased intra-abdominal pressure, it does not directly affect the healing process of the skin or tissue at the site of a pressure injury.
D. Acid reflux: Acid reflux, or gastroesophageal reflux disease (GERD), primarily affects the digestive system and is not directly related to wound healing. While chronic acid reflux can cause discomfort and complications like esophageal damage, it does not impact the body’s ability to heal a pressure injury.

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A nurse is assessing a male client who began receiving total parenteral nutrition 24 hr ago. Which of the following findings should indicate to the nurse the client is experiencing a complication?

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