A nurse is performing medication reconciliation for a client newly admitted. Which of the following actions should the nurse take?

Choice A reason: Verifying TPN with another RN is a safety protocol for this high-risk, complex solution containing dextrose, amino acids, and lipids. Errors in formulation or additives can cause severe metabolic imbalances or infections. This double-check reduces risks, ensuring the prescribed nutrients match the bag’s contents. It’s a standard of care in TPN administration, protecting the client from potential harm due to preparation mistakes, especially given its central line delivery.

Choice B reason: TPN’s high dextrose content elevates blood glucose, risking hyperglycemia, especially in stressed or diabetic clients. Monitoring serum glucose during infusion allows timely insulin adjustments, preventing complications like osmotic diuresis or ketoacidosis. This action aligns with metabolic management, as TPN bypasses digestion, delivering glucose directly into the bloodstream. Regular checks ensure glycemic control, a critical aspect of safe parenteral nutrition therapy.

Choice C reason: Increasing the TPN infusion rate to catch up if delayed is dangerous, risking fluid overload, electrolyte shifts, and refeeding syndrome. TPN rates are calculated precisely based on caloric and fluid needs, administered via infusion pumps for consistency. Speeding it up disrupts this balance, potentially causing cardiac strain or metabolic chaos. This action violates administration guidelines, making it inappropriate and unsafe.

Choice D reason: Infusing 0.9% sodium chloride instead of TPN lacks calories, amino acids, and lipids, interrupting nutritional support and risking hypoglycemia from prior high-glucose TPN. Protocol recommends 10% dextrose if TPN is unavailable, maintaining some glucose input. Sodium chloride only provides hydration, not sustenance, undermining TPN’s purpose. This substitution fails to meet the client’s metabolic needs, rendering it an incorrect action.

Choice E reason: Daily weights assess fluid balance and nutritional efficacy in TPN clients, detecting overhydration (weight gain) or malnutrition (loss). TPN delivers precise fluid and calories, and weight changes signal adjustments needed in therapy. This non-invasive measure tracks trends, complementing lab data, and is a cornerstone of monitoring. It ensures the treatment meets goals without causing volume-related complications, making it essential.

Choice A reason: Thrombocytopenia from chemotherapy reduces platelets, impairing clotting and increasing bleeding risk. A soft-bristled toothbrush minimizes gum trauma, preventing hemorrhage in oral tissues, a common bleeding site. This instruction protects the client from excessive blood loss, aligns with bleeding precautions, and promotes safety during daily hygiene. It’s a practical, evidence-based measure to reduce mucosal injury, critical in managing low platelet counts effectively.

Choice B reason: Administering a rectal suppository risks rectal mucosal tearing in thrombocytopenia, where low platelets hinder clot formation, potentially causing significant bleeding. Chemotherapy-induced bone marrow suppression heightens this danger, making invasive procedures contraindicated. Safer alternatives, like oral medications, avoid this hazard. This action contradicts standard care, increasing harm in a client already prone to hemorrhage.

Choice C reason: A low-residue diet reduces bowel bulk, easing digestion, but doesn’t address thrombocytopenia’s bleeding risk, the primary concern here. It’s used in conditions like diverticulitis, not for platelet issues. Chemotherapy-related bleeding stems from vessel integrity, not diet, so this action lacks relevance. It fails to mitigate the client’s key vulnerability, making it inappropriate.

Choice D reason: Encouraging a safety razor in thrombocytopenia heightens bleeding risk, as even minor skin nicks won’t clot properly with low platelets from chemotherapy. Electric razors are recommended instead, minimizing cuts. This advice endangers the client, opposing bleeding precautions critical for safety. It ignores the condition’s pathophysiology, where external trauma must be avoided to prevent uncontrolled bleeding.