A client receiving parenteral nutrition (PN) complains of a headache. The nurse notes that the client has an increased blood pressure, bounding pulse, jugular vein destention and crackles bilaterally, the nurse determines that the client is experiencing which complication of PN therapy?

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

The client's symptoms are hallmark signs of hypervolemia (fluid overload), a potential complication of PN therapy.
Increased blood pressure, a bounding pulse, and jugular vein distention are caused by the expanded fluid volume in the vascular space.
Bilateral crackles indicate pulmonary edema, which occurs when fluid accumulates in the lungs due to the circulatory system being overwhelmed.
These signs collectively point to an excessive rate or volume of PN infusion.
Headache can also result from the increased intravascular pressure.

Option A: Sepsis, or bloodstream infection, would typically present with fever, chills, tachycardia, and hypotension (low blood pressure), not hypertension.
Option B: An air embolism is characterized by a sudden onset of dyspnea (difficulty breathing), chest pain, cyanosis, anxiety, and hypotension. The client's symptoms do not match this acute event.
Option D: Hyperglycemia (high blood sugar) presents with symptoms like excessive thirst (polydipsia), increased urination (polyuria), fatigue, and blurred vision. While headache can occur, it does not cause JVD, a bounding pulse, or lung crackles.

Clinical Relevance

Nursing practice connection: Knowing Complications of Parenteral Nutrition (PN) Therapy helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses must meticulously monitor clients on PN for complications. Using an infusion pump is critical to ensure the prescribed rate is maintained and prevent accidental rapid infusion.
A key nursing responsibility is to perform regular cardiovascular and respiratory assessments, including checking for JVD and auscultating breath sounds, to detect fluid overload early.
What if? If the client had the same symptoms but was also hypotensive and had a fever, the priority would shift to suspecting septic shock, another serious complication of central lines and PN.

How to Approach the Question

First, identify the key signs and symptoms presented in the clinical scenario: headache, increased BP, bounding pulse, JVD, and bilateral crackles.
Group the symptoms into categories: cardiovascular (increased BP, bounding pulse, JVD) and respiratory (crackles).
Recognize that this specific cluster of symptoms points towards an excess of fluid in the body's circulatory and pulmonary systems.
Evaluate each option against this clinical picture.
Hypervolemia directly explains all the presented signs.
Rule out the other options by recalling their distinct hallmark symptoms (e.g., Sepsis involves fever and hypotension; Air Embolism is sudden with chest pain; Hyperglycemia involves thirst and polyuria).

Concept Tested & Keywords

Concept Tested: Complications of Parenteral Nutrition (PN) Therapy
Stem keywords: parenteral nutrition (PN), headache, increased blood pressure, bounding pulse, jugular vein distention, crackles
Lead-in keywords: which complication
Clinical cues: The combination of cardiovascular signs (hypertension, bounding pulse, JVD) and respiratory signs (crackles) is a classic presentation of fluid overload.
Clinical cues: The complaint of a headache can also be associated with the increased circulatory pressure.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 106-108

E6 Nursing Fundamentals Potter Perry 12e Part 5 p. 207-209

Practise the full NORCET 3 - 2022 (Shift-1)

Attempt every question from this paper in a timed mock, then review the full solution for each one.