A nurse is caring for a client with cirrhosis and portal hypertension. Which of the following complications should the nurse monitor for?

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.

Choice A reason: Collecting sputum specimens for acid-fast bacilli (AFB) testing over three consecutive mornings is critical for diagnosing active tuberculosis. AFB smear and culture detect Mycobacterium tuberculosis in sputum, confirming pulmonary TB. Morning samples yield higher bacterial loads, improving diagnostic sensitivity, as the bacteria accumulate overnight in the respiratory tract.

Choice B reason: Monitoring vital signs every shift is important for assessing patient stability but does not directly aid in diagnosing active tuberculosis. Fever or tachycardia may suggest infection, but these are non-specific and not confirmatory. Diagnostic tests like AFB, imaging, or serology are needed to identify Mycobacterium tuberculosis as the cause of symptoms.

Choice C reason: Ordering a complete blood count, basic metabolic panel, HIV viral load, and VDRL supports TB diagnosis. CBC may show anemia or leukocytosis, BMP assesses organ function, HIV testing identifies immunosuppression increasing TB risk, and VDRL rules out syphilis, which can mimic TB symptoms. These provide a comprehensive diagnostic workup.

Choice D reason: A chest X-ray is essential for diagnosing active pulmonary tuberculosis. It reveals characteristic findings like cavitary lesions, infiltrates, or hilar lymphadenopathy in the lungs. These radiographic signs, combined with clinical symptoms and AFB testing, confirm the presence of active TB, particularly in patients with cough and weight loss.

Choice E reason: Admitting the patient to a negative pressure room is crucial for diagnosing and managing suspected active TB. It prevents airborne transmission of Mycobacterium tuberculosis to others, ensuring safety while diagnostic tests like AFB and chest X-ray are conducted. This isolation is standard for suspected infectious TB cases.