A nurse is preparing to screen a newborn for phenylketonuria. The nurse should inform the parents that this screening allows for early detection and intervention to prevent the development of which of the following conditions?

A. Offer the client thickened liquids to drink: Offering thickened liquids can help reduce the risk of aspiration in clients with dysphagia, which is common after a stroke. However, this should be done after confirming that the client has a safe swallowing mechanism, such as an intact gag reflex. Administering liquids before assessing swallowing safety can increase the risk of aspiration pneumonia.
B. Monitor the client for indications of fatigue during meals: Fatigue can compromise the client’s ability to chew and swallow effectively, increasing the risk of aspiration. Monitoring for this is important but is not the immediate priority when the client is already drooling, a sign that they may be unable to manage their oral secretions. Ensuring safe swallowing should be addressed before monitoring meal-time fatigue.
C. Check the client's gag reflex: Checking the gag reflex is the most important initial action because it directly assesses the client’s ability to swallow safely. Drooling after a stroke often indicates impaired neuromuscular control, which puts the client at high risk for aspiration. The gag reflex gives immediate information on whether oral intake is safe.
D. Monitor the client's ability to speak consistently: Monitoring speech consistency can provide insights into neurological recovery and motor control, but it is not the first concern in a drooling stroke patient. The primary danger is aspiration due to impaired swallowing. Speaking ability does not directly reflect swallowing safety.

A. Elevated erythrocyte sedimentation rate (ESR): An elevated ESR is a nonspecific marker of inflammation. It can be elevated due to a variety of conditions, including infection, autoimmune disease, or chronic illness. In TPN, this finding would require further evaluation but is not a definitive or immediate indicator of a TPN-related complication.
B. Increased bilirubin levels: While increased bilirubin levels may suggest liver dysfunction, they are not uncommon in clients receiving TPN over an extended period due to hepatobiliary complications like cholestasis. However, after just 24 hours of TPN, a rise in bilirubin is unlikely to occur this quickly as a result of TPN alone.
C. Guaiac fecal occult blood test positive: A positive fecal occult blood test indicates the presence of gastrointestinal bleeding, which is not a typical complication associated with TPN initiation. While it is a concerning clinical finding, it is not directly linked to the use of TPN and may be related to other underlying gastrointestinal issues that need separate investigation.
D. Weight gain 1.6 kg (3.5 lb): A rapid weight gain of this magnitude within 24 hours of starting TPN suggests fluid overload, which is a potential complication of TPN therapy especially in clients with compromised cardiac or renal function. This finding indicates the need for immediate intervention to prevent further complications such as pulmonary edema or hypertension.