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 {"dropdown-group-1":"C","dropdown-group-2":"E"}

Explanation

Anemia: The client's hemoglobin level is 10.1 g/dL, which is below the normal reference range of 12 to 16 g/dL for females. This, along with the hematocrit being slightly low at 36%, indicates anemia, which can contribute to symptoms like fatigue.
Hypertension: The client's blood pressure is 136/85 mm Hg, which falls into the elevated to stage 1 hypertension range. Combined with a BMI of 38.8, which classifies the client as obese, she is at increased risk of developing hypertension over time.
Hyperthyroidism is unlikely given her normal TSH level and the symptom of fatigue, which is more consistent with hypothyroidism or anemia.
Malnutrition is not indicated, as the client is overweight and has no signs of nutrient deficiencies aside from anemia.
Leukemia is unlikely given her normal WBC and platelet counts, and there are no associated symptoms like bruising, frequent infections, or severe fatigue beyond what's explained by anemia.

A. Remove the solution from the refrigerator 1 hr before infusing. B. Increase the rate of the infusion as needed to keep it on schedule. C. Weigh the client every other day. D. Change the client's TPN catheter tubing every 72 hr. E. Infuse TPN through a central venous line.

Correct Answer is ["A","E"]

Explanation

A. Remove the solution from the refrigerator 1 hr before infusing: Allowing the TPN solution to warm to room temperature helps reduce the risk of vein irritation and discomfort. Cold solutions can cause venospasm or systemic reactions when infused into the bloodstream.
B. Increase the rate of the infusion as needed to keep it on schedule: TPN must be administered at a consistent prescribed rate. Increasing the rate without orders can lead to hyperglycemia, fluid overload, or metabolic complications. Any delays should be reported to the healthcare provider.
C. Weigh the client every other day: Daily weight monitoring is essential in TPN therapy to assess fluid balance and nutritional status. Weighing the client only every other day may delay the recognition of fluid overload or dehydration.
D. Change the client's TPN catheter tubing every 72 hr: TPN tubing should be changed every 24 hours to reduce the risk of catheter-related bloodstream infections. Extending beyond this time frame increases the likelihood of microbial contamination.
E. Infuse TPN through a central venous line: Due to its high glucose and osmolarity content, TPN must be administered via a central line to prevent phlebitis and allow for rapid, well-tolerated infusion. Peripheral administration is not suitable for long-term TPN.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a provider's office is caring for a client. Exhibits The client is at greatest risk for developing dropdownanddropdown

Correct Answer is {"dropdown-group-1":"C","dropdown-group-2":"E"}

Explanation

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Correct Answer is ["A","E"]

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