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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Blood pressure of 104/72 mm Hg, pulse of 80, and respiratory rate of 16 are within normal ranges for a postoperative patient. These vital signs indicate stable hemodynamic status and adequate oxygenation. Opioids may slightly lower blood pressure or respiratory rate, but these values do not suggest distress or complications requiring immediate provider notification. The patient’s condition appears stable, with no critical abnormalities warranting urgent intervention.
Choice B reason: Blood pressure of 110/60 mm Hg, pulse of 70, and respiratory rate of 14 are normal for a postoperative patient. These parameters reflect stable cardiovascular and respiratory function. Opioids can cause mild respiratory depression, but a rate of 14 is acceptable. No signs of opioid overdose, hypotension, or tachycardia are present, indicating no need for immediate provider contact or intervention.
Choice C reason: Blood pressure of 90/50 mm Hg, pulse of 120, and respiratory rate of 18 indicate potential opioid-related complications or postoperative issues like hypovolemia or shock. Hypotension and tachycardia suggest inadequate perfusion, possibly due to bleeding or opioid-induced vasodilation. These signs require immediate provider notification to assess for overdose, hemorrhage, or other serious conditions affecting systemic circulation and tissue oxygenation.
Choice D reason: Blood pressure of 120/80 mm Hg, pulse of 100, and respiratory rate of 20 are within acceptable ranges, though the pulse is slightly elevated. This could reflect pain or mild stress but does not indicate critical instability. Opioids may cause mild tachycardia, but these vital signs do not necessitate immediate provider contact as they suggest stable physiological function without severe complications.
Correct Answer is A
Explanation
Choice A reason: Elevated troponin is a strong indicator of myocardial infarction, reflecting massive cardiac cell destruction. Troponins are proteins released from damaged cardiomyocytes during ischemia. Their high specificity for cardiac muscle makes them a key biomarker for diagnosing acute myocardial infarction, as levels rise within hours of cell death.
Choice B reason: Decreased hemoglobin indicates anemia or blood loss but is not specific to massive cell destruction in myocardial infarction. It may occur secondary to chronic conditions or bleeding but does not directly reflect acute cardiac tissue damage, unlike troponin, which is a precise marker of cardiomyocyte necrosis.
Choice C reason: Elevated creatinine reflects renal dysfunction, not massive cell destruction in myocardial infarction. It indicates impaired kidney filtration, often due to hypoperfusion or chronic disease. While shock from infarction may cause secondary renal injury, creatinine is not a direct marker of cardiac cell death, unlike troponin.
Choice D reason: Decreased sodium (hyponatremia) may occur in heart failure or fluid overload but is not a marker of massive cell destruction. It reflects electrolyte imbalance, not tissue necrosis. In myocardial infarction, sodium levels are typically unaffected unless complicated by other conditions, making it irrelevant to acute cardiac damage.
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