A nurse is monitoring a client receiving total parenteral nutrition (TPN). Which of the following complications should the nurse prioritize?

Hyperglycemia

Hypokalemia

Constipation

Weight loss

Answer and Explanation

The Correct Answer is A

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.

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Correct Answer is ["B","C","D"]

Explanation

Choice A reason: Frequent bowel movements are not typical in peritonitis. Inflammation of the peritoneal cavity causes ileus, reducing bowel motility and leading to constipation or obstipation. Peristalsis slows due to irritation, and the body diverts energy to combat infection, making diarrhea unlikely unless another condition, like gastroenteritis, is present, which is not indicated here.

Choice B reason: A rigid abdomen is a classic sign of peritonitis due to peritoneal inflammation causing muscle guarding and rigidity. The peritoneal irritation from infection or chemical irritants (e.g., bile, gastric contents) triggers involuntary abdominal wall contraction to protect inflamed tissues, resulting in a board-like abdomen, often with severe pain.

Choice C reason: Decreased urinary output occurs in peritonitis due to systemic inflammation and potential hypovolemia from fluid shifts into the peritoneal cavity (third-spacing). The kidneys receive reduced perfusion, activating the renin-angiotensin-aldosterone system, leading to oliguria. This reflects the body’s attempt to conserve fluid in response to systemic stress and inflammation.

Choice D reason: Inability to pass stools is expected in peritonitis due to paralytic ileus, where intestinal motility ceases from inflammation. Peritoneal irritation disrupts normal peristalsis, causing bowel obstruction symptoms like constipation or obstipation. This results from the body’s inflammatory response inhibiting gastrointestinal function, leading to stool retention.

Choice E reason: Hyperactive bowel sounds are not typical in peritonitis. The condition causes paralytic ileus, reducing or absent bowel sounds due to decreased peristalsis from peritoneal inflammation. Hyperactive sounds may occur in early mechanical obstruction but not in peritonitis, where inflammation halts bowel motility, leading to hypoactive or absent sounds.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A","dropdown-group-3":"C"}

Explanation

A. Pneumocystis pneumonia is a common opportunistic infection in HIV+ patients, particularly when CD4 counts fall below 200 cells/mm³, signaling severe immunosuppression. This aligns with the patient’s HIV+ status, as opportunistic infections exploit weakened immune systems. The DSM-5 does not directly address physical infections but notes that medical conditions like HIV can exacerbate mental health issues, which may be relevant in holistic care.

B. Tuberculosis is an opportunistic infection in HIV+ patients, often occurring at CD4 counts below 350 cells/mm³. However, it is less specific than Pneumocystis pneumonia as a hallmark of AIDS-defining illness in HIV+ patients, making it a less precise choice for this context.

C. Influenza is not typically an opportunistic infection in HIV+ patients. It affects immunocompetent individuals and does not specifically indicate HIV-related immunosuppression, making this choice incorrect.

D. Pneumocystis jirovecii is the causative organism of Pneumocystis pneumonia, directly linked to the opportunistic infection in HIV+ patients. This fungal pathogen thrives in immunocompromised hosts, aligning with the patient’s condition.

E. Mycobacterium tuberculosis causes tuberculosis, which is an opportunistic infection in HIV+ patients but less commonly the primary indicator compared to Pneumocystis jirovecii for Pneumocystis pneumonia, making it less accurate here.

F. Influenza virus causes influenza, which is not an opportunistic infection specific to HIV+ patients. This makes it an incorrect choice for the causative organism.

G. Trimethoprim-sulfamethoxazole is the first-line treatment for Pneumocystis pneumonia in HIV+ patients, effectively targeting Pneumocystis jirovecii. It is widely recommended in clinical guidelines for both treatment and prophylaxis, fitting the patient’s needs.

H. Isoniazid is used for tuberculosis treatment or prophylaxis, not Pneumocystis pneumonia. Since the correct infection is Pneumocystis pneumonia, this choice is inappropriate.

I. Oseltamivir treats influenza, which is not an opportunistic infection in HIV+ patients, making this an incorrect treatment option for the context of the question.

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A nurse is monitoring a client receiving total parenteral nutrition (TPN). Which of the following complications should the nurse prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing a patient with peritonitis. What findings should they expect? (Select all that apply)

Correct Answer is ["B","C","D"]

Explanation

Complete the sentence using the drop-down selections When caring for a HIV+ patient the nurse is aware that dropdown indicates an opportunistic infection. It is caused by dropdown and treated withdropdown

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A","dropdown-group-3":"C"}

Explanation

Identify which type of immunity each example represents.

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