A nurse is reviewing the medical record of a client who has hyperthyroidism (Graves disease). Which of the following serum laboratory findings should the nurse expect to be below the expected reference range?

Choice A: Weigh the client weekly. This is incorrect because the client receiving PN should be weighed daily, not weekly, to monitor fluid balance and nutritional status. The nurse should also measure the client’s intake and output, blood glucose, electrolytes, and other laboratory values daily.

Choice B: Reduce the rate of the solution gradually to discontinue. This is correct because the nurse should taper off the PN solution slowly to prevent rebound hypoglycemia, which can occur when the high concentration of glucose in the PN solution is abruptly stopped. The nurse should follow the provider’s orders or the facility’s protocol for reducing and discontinuing PN.

Choice C: Remove solution from refrigerator 2 hr before infusion. This is incorrect because the nurse should remove the PN solution from the refrigerator 30 to 60 minutes before infusion, not 2 hr, to allow it to reach room temperature. Infusing a cold solution can cause discomfort, vasoconstriction, and impaired absorption of nutrients.

Choice D: Shake the solution before hanging if there is a layer of fat present on the top. This is incorrect because the nurse should not shake the PN solution at all, as this can cause fat emulsion droplets to coalesce and form large particles that can clog the filter or cause embolism. The nurse should gently invert or roll the PN solution container to mix it if there is any separation of components.

Choice A reason: Roast chicken with white rice is a low-fiber, easy-to-digest meal that is suitable for a client who has recovered from the acute phase of diverticulitis. A low-fiber diet can help reduce the stress on the colon and allow it to heal. White rice is a refined grain that has less fiber than whole grains, such as brown rice or quinoa12.

Choice B reason: A poached egg with sliced tomatoes is not a good choice for a client who has recovered from the acute phase of diverticulitis. Although eggs are a good source of protein and do not contain fiber, tomatoes are high in fiber and may irritate the colon. Tomatoes also have seeds, which were previously thought to cause problems for people with diverticular disease, but there is no evidence to support this. However, some people may still find them uncomfortable to eat13.

Choice C reason: Bean soup with steamed broccoli is not a good choice for a client who has recovered from the acute phase of diverticulitis. Beans and broccoli are both high in fiber and may cause gas, bloating, and cramping in the colon. A high-fiber diet is recommended for people with diverticulosis (the presence of pouches without inflammation) to prevent constipation and diverticulitis, but it should be avoided during or shortly after an episode of diverticulitis12.

Choice D reason: Ham sandwich on white bread is not a good choice for a client who has recovered from the acute phase of diverticulitis. Although white bread is low in fiber, ham is a processed meat that may increase the risk of developing diverticular disease. Research suggests that a diet high in red meat and processed meat may contribute to inflammation and infection of the pouches in the colon.