Test your knowledge with this NCLEX Question of the Day: Delayed TPN dose? Discover why evaluating glucose levels first is essential to prevent hypoglycemia and complications.
The nurse notes the pharmacy is late sending up a dose of total parenteral nutrition (TPN) for a client who has been receiving it for several months. Which action should the nurse take first?
A. Assess the client for symptoms of jaundice
B. Evaluate the client’s glucose level
C. Assess the client’s temperature
D. Prepare to administer a potassium supplementScroll down for the correct answer!
The correct answer to today’s NCLEX-RN® Question is…
B. Evaluate the client’s glucose level
Rationale: Any abrupt discontinuation or delay in administering parenteral nutrition can increase the risk of rapid onset of hypoglycemia. Therefore, the nurse should check the client’s glucose level first since hypoglycemia can lead to altered mental status, coma, seizures, and death.
Major Takeaway
Parenteral nutrition is considered a high-risk medication because the consequences of improper delivery can lead to serious complications like hyperglycemia or fluid and electrolyte imbalances. Clients receiving parenteral nutrition often have a prescription for electrolyte testing at least daily and glucose testing every 4 hours. The nurse should also verify the infusion rate to avoid overfeeding, which occurs when nutrients are delivered faster than the body can handle. Any abrupt discontinuation or delay in administering parenteral nutrition should be avoided because this increases the risk of a rapid onset of hypoglycemia. Clients who receive parenteral nutrition are also at an increased risk of infection, so be sure to monitor for redness, pain, and warmth at the intravenous (IV) insertion site or systemic indications of infection like fever, chills, or altered mental status. Clients who receive parenteral nutrition for long periods are at a higher risk for conditions like cholestasis, gallbladder inflammation, and liver disease, so the nurse should monitor them for symptoms of these conditions, such as right upper quadrant pain, pruritus or itching, and jaundice which is a yellowish discoloration of the skin and mucous membranes.

Incorrect answer explanations
A. Assess the client for symptoms of jaundice
Rationale: Clients who receive parenteral nutrition for long periods are at a higher risk for liver disease which is associated with the development of jaundice; however, there is another action that takes priority.
C. Assess the client’s temperature
Rationale: Clients receiving parenteral nutrition are at risk for infection; however, assessing the client’s temperature is not the highest nursing priority.
C. Prepare to administer a potassium supplement
Rationale: Parenteral nutrition is considered a high-risk medication because the consequences of improper delivery can lead to serious complications like electrolyte imbalances. However, the nurse should check the client’s electrolyte levels prior to administering supplements. Therefore, another action should be performed instead.
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