The nurse is expected to monitor blood glucose every 6 hours in a patient who is receiving Total Parenteral Nutrition to detect which of the following complication?

1. A

   Hyponatremia

2. B

   Hyperkalemia

3. C

   Hypocalcemia

4. D

   Hyperglycemia

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• Total Parenteral Nutrition (TPN) solutions are highly concentrated with dextrose to provide adequate calories.
• This high glucose load places the patient at a significant risk for developing hyperglycemia (high blood sugar) because the pancreas may not be able to produce enough insulin to manage the influx.
• Regular monitoring of blood glucose levels, typically every 6 hours, is the standard of care to detect and manage hyperglycemia promptly.
• Signs of hyperglycemia include thirst, headache, lethargy, and increased urination.

Why Other Options Were Wrong

• Option A: Hyponatremia is a low sodium level in the blood. While it can be a complication of TPN due to fluid shifts or incorrect formulation, it is detected by monitoring serum electrolyte levels, not blood glucose.
• Option B: Hyperkalemia is a high potassium level in the blood. This is a serious electrolyte imbalance but is monitored via a serum potassium test from a blood panel, not a blood glucose test.
• Option C: Hypocalcemia is a low calcium level in the blood. It is another potential electrolyte disturbance with TPN but is assessed by measuring serum calcium levels, not blood glucose.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Complications of Total Parenteral Nutrition (TPN) to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a vital role in managing patients on TPN, which includes meticulous monitoring for complications. Hyperglycemia is one of the most frequent metabolic complications.
• Early detection of hyperglycemia allows for timely intervention, such as adjusting the TPN infusion rate or administering insulin, to prevent more severe complications like hyperglycemic hyperosmolar nonketotic syndrome (HHNS).
• What if the patient's blood glucose was low (hypoglycemia)? This could indicate the TPN infusion was stopped too abruptly. The nurse's priority would be to administer a source of dextrose (e.g., D10W infusion) as per protocol to prevent a dangerous drop in blood sugar.

How to Approach the Question

• First, identify the core subject of the question: Total Parenteral Nutrition (TPN).
• Recall the primary components of TPN. The key component related to blood sugar is dextrose, which is a concentrated sugar solution.
• Connect the intervention mentioned (monitoring blood glucose) to the components of TPN.
• Since TPN is high in glucose, the most direct and logical complication to monitor for with a glucometer is an excess of glucose in the blood.
• Evaluate the options. Hyperglycemia is a direct result of high glucose infusion. The other options (Hyponatremia, Hyperkalemia, Hypocalcemia) are electrolyte imbalances and would be checked with a serum electrolyte panel, not a blood glucose meter.

Concept Tested & Keywords

• Concept Tested: Complications of Total Parenteral Nutrition (TPN)
• Stem keywords: Total Parenteral Nutrition, monitor blood glucose, complication
• Lead-in keywords: which of the following
• Negative lead-in flag: false

Question ID

QuIXSW84gGlSWLuwDEncc1

Copy ID

Reference Book

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

E6 Pharmacology Nursing Lilley 11e Part 3 p. 234-236

E6 Medicine Harrison 22e Part 2 p. 529-531