The client is scheduled to receive 30 grams of lactulose orally every 12 hours. An oral solution containing 5 g/10 mL is available. How many mL should be poured into the medication cup to administer the required dose?

Choice A: Fever and chills Fever and chills are not typically associated with the abrupt cessation of TPN. These symptoms are more commonly related to infections or inflammatory processes in the body. While infections can be a complication of TPN due to the invasive nature of the therapy, they are not a direct result of the discontinuation of the infusion. Total Parenteral Nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs. The sudden stop in the infusion of TPN can lead to a rapid drop in blood sugar levels, known as hypoglycemia, because the body has become accustomed to the continuous influx of glucose from the TPN solution.

Choice B: Hypertension and crackles Hypertension (high blood pressure) and crackles (sounds heard on lung auscultation indicative of fluid in the air spaces) are not expected clinical manifestations due to the stopping of TPN. These symptoms are more commonly associated with cardiovascular and pulmonary conditions, respectively.

Choice C: Excessive thirst and urination Excessive thirst and urination could be symptoms of hyperglycemia (high blood sugar), which might occur if TPN is infused too quickly or if the patient has an increased insulin requirement. However, these are not the immediate concerns when TPN is abruptly stopped.

Choice D: Shakiness and diaphoresis Shakiness and diaphoresis (sweating) are common signs of hypoglycemia, which can occur if TPN is stopped suddenly. The body may have been receiving a steady supply of glucose from the TPN, and a sudden halt can cause blood sugar levels to drop quickly. This can lead to symptoms such as weakness, shakiness, sweating, and even confusion or loss of consciousness if not addressed promptly. When TPN is abruptly discontinued, the nurse should monitor the client for signs of hypoglycemia, including shakiness and diaphoresis. It is important to restart the TPN infusion as soon as possible or provide an alternative source of glucose to prevent hypoglycemia and its potential complications.

Choice A: Administer antiemetics as needed Reason: Acute pancreatitis often causes severe nausea and vomiting. Antiemetics are administered to control these symptoms and prevent further complications such as dehydration and electrolyte imbalance.

Choice B: Administer analgesics as needed Reason: Pain management is a crucial part of the treatment for acute pancreatitis. The condition can cause severe abdominal pain, and analgesics are administered to provide relief.

Choice C: NPO (nothing by mouth) until pain-free Reason: The goal in treating acute pancreatitis is to allow the pancreas to rest and recover from the inflammation3. Keeping the patient NPO (nothing by mouth) helps achieve this by reducing the stimulation and workload of the pancreas.

Choice D: Monitor blood glucose and provide insulin as needed Reason: Acute pancreatitis can affect the pancreas’ ability to produce insulin, leading to elevated blood glucose levels. Therefore, monitoring blood glucose levels and administering insulin as needed is an important part of the management plan.

Choice E: Side-lying or fetal position Reason: While the side-lying or fetal position might help some patients with abdominal pain, it is not a standard intervention for acute pancreatitis. Therefore, this option is not correct.

Choice F: Monitor hydration status Reason: Patients with acute pancreatitis are at risk of dehydration due to symptoms like vomiting and decreased oral intake. Monitoring hydration status is crucial to ensure appropriate fluid replacement.