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 B

Explanation

A. "Provide a small feeding just before bedtime." Feeding just before bedtime can increase the risk of reflux during sleep due to a full stomach and recumbent positioning. It is better to allow time for digestion before lying down to reduce reflux episodes.
B. "Position the newborn at a 20-degree angle after feeding." Keeping the newborn in an upright or slightly elevated position (typically 20 to 30 degrees) after feeding helps reduce gastroesophageal reflux by using gravity to prevent stomach contents from flowing back into the esophagus.
C. "Place the newborn in a side-lying position if vomiting." Side-lying is not the recommended sleeping or resting position due to the risk of sudden infant death syndrome (SIDS). The safest position for infants is on the back, even if they have reflux.
D. "Dilute formula with 1 tablespoon of water." Diluting formula can lead to electrolyte imbalances and inadequate caloric intake. Formula should be prepared according to manufacturer or provider instructions to ensure nutritional needs are met.

A. Record between-meal snacks on the calorie count form. B. Begin the calorie count with the client's next evening meal. C. Exclude liquids in the total calorie count. D. Complete the calorie count for a 5-day period.

Correct Answer is A

Explanation

A. Record between-meal snacks on the calorie count form: Between-meal snacks contribute significantly to a client's total daily caloric intake and must be included to obtain an accurate calorie count. Omitting these snacks can result in an incomplete dietary assessment, potentially leading to inaccurate evaluations of the client's nutritional status.
B. Begin the calorie count with the client's next evening meal: Calorie counts should begin as soon as the prescription is initiated, not delayed until a specific mealtime. Waiting to begin with the evening meal may result in missed intake data and reduce the accuracy of the assessment. Timely initiation ensures the healthcare team captures a complete and accurate picture of the client’s intake patterns.
C. Exclude liquids in the total calorie count: Liquids, especially those containing calories such as juice, milk, nutritional supplements, or sweetened beverages, must be included in a calorie count. Excluding these items can underestimate the client’s actual caloric intake and interfere with proper evaluation and planning of their nutritional needs.
D. Complete the calorie count for a 5-day period: A standard calorie count is typically conducted over a 72-hour (3-day) period, which is sufficient to identify trends and provide nutritional insights. Extending the count unnecessarily to 5 days may not yield additional useful data and can burden both clients and staff. The focus should be on consistency and completeness within the accepted timeframe.

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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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