Difficulty: Medium
Average Score: 87%
Simulated
A nurse is assessing a client and discovers the infusion pump with the client's total parenteral nutrition (TPN) solution is not infusing. The nurse should monitor the client for which of the following conditions?
Correct answer
D
Rationale
The correct answer is D, shakiness and diaphoresis. When a client's TPN solution stops infusing, it can lead to a sudden drop in blood glucose levels, causing symptoms like shakiness and diaphoresis, which are indicative of hypoglycemia. The nurse should monitor for these signs as they can progress to serious complications such as seizures or loss of consciousness.
A: Hypertension and crackles - These symptoms are not directly related to TPN infusion interruption.
B: Fever and chills - These symptoms are more indicative of an infection rather than TPN infusion interruption.
C: Excessive thirst and urination - These symptoms are more suggestive of diabetes or dehydration, not TPN infusion interruption.
D: Shakiness and diaphoresis - Correct, as these are classic signs of hypoglycemia due to TPN interruption.
A: Hypertension and crackles - These symptoms are not directly related to TPN infusion interruption.
B: Fever and chills - These symptoms are more indicative of an infection rather than TPN infusion interruption.
C: Excessive thirst and urination - These symptoms are more suggestive of diabetes or dehydration, not TPN infusion interruption.
D: Shakiness and diaphoresis - Correct, as these are classic signs of hypoglycemia due to TPN interruption.