A nurse is caring for a client who has hypertension and has a new prescription for lisinopril. The nurse should consult with the provider about a contraindication for which of the following medications in the client's medication administration record?

Total parenteral nutrition (TPN) is a hypertonic solutiondelivered intravenously to provide complete nutritional support when the enteral route is non-functional. It contains a balance of amino acids, dextrose, lipids, electrolytes, and vitamins tailored to the patient's metabolic needs. TPN bypasses the gastrointestinal tract, preventing the need for mechanical digestionand nutrient absorption through the intestinal mucosa.

Rationale:

A.TPN is specifically designed to provide all necessary calories and nutrients intravenously, which allows for complete bowel rest. This is essential for patients with severe inflammatory bowel disease, fistulas, or intestinal obstructions where oral intake is impossible. By bypassing the gut, the inflamed or injured tissues have the opportunity to heal without the stress of digestion.

B.TPN does not contain medications that specifically improve the absorption capabilities of the digestive tract itself. Its primary function is to deliver pre-digested nutrients directly into the bloodstream, making intestinal absorption unnecessary. The goal is to provide systemic nutrition while the gut is bypassed, not to pharmacologically alter the intestinal wall's function.

C.TPN does not typically stimulate a client's appetite; in fact, the administration of high-calorie intravenous nutrition often decreases the sensation of hunger. Because the body's nutritional requirements are being met systemically, the physiological triggers for appetite may be suppressed. The purpose of TPN is to replace oral eating, not to encourage increased food consumption.

D.The primary purpose of TPN is nutritional support, not bowel cleansing or preparation for surgical procedures. While the bowels may become relatively empty because the patient is not eating, TPN is not an osmotic laxative or a clearing agent. Bowel clearing for surgery usually requires specific oral preparations or enemas rather than intravenous nutrition.

Albuterol is a short-acting beta-2 agonist(SABA) that induces bronchodilationby relaxing smooth muscle in the airway. While it primarily targets pulmonary receptors, it can also stimulate beta-1 receptorsin the heart and beta-2 receptors in skeletal muscle. This systemic stimulation results in cardiovascular and neuromuscular side effects that clients must be able to identify.

Rationale:

A.Albuterol is more likely to cause an increase in blood pressure and heart rate rather than a decrease, due to its sympathomimetic properties. Stimulation of the adrenergic system increases cardiac output and peripheral resistance. Therefore, instructing the client to watch for hypotension would be clinically inaccurate and could lead to a failure to recognize relevant cardiovascular side effects.

B.Increased appetite is not a recognized adverse effect of albuterol nebulization. The medication acts as a stimulant, which typically has a neutral or mildly suppressive effect on appetite rather than an inductive one. The nurse should focus education on cardiovascular and neurological symptoms that are direct consequences of the medication’s action on the sympathetic nervous system.

C.Tremors are a classic adverse effect of albuterol because the drug stimulates beta-2 receptors in the skeletal muscles, causing fine muscle contractions. This is particularly common after nebulized treatments where a higher systemic dose may be absorbed. The nurse should reassure the client that this effect is common but should be reported if it becomes severe or interferes with daily activities.

D.Muscle weakness is not an expected side effect of albuterol; instead, muscle excitability or cramping is more common. While albuterol can cause a temporary shift of potassium into cells (hypokalemia), which can lead to weakness, it is not the primary side effect clients should observe for. Tremors are a far more frequent and immediate neuromuscular response to beta-agonist therapy.