A client receiving parenteral nutrition (PN) in home setting has a weight gain of 5 lb in 1 week. The nurse next assesses client to identify presence of which of following?

Correct Answer: B. Crackles upon auscultation of the lungs.

Normally, the weight gain of a client receiving PN is about 1-2 pounds a week. A weight gain of five (5) pounds over a week indicates a client is experiencing fluid retention that can result in hypervolemia. Signs of hypervolemia include weight gain more than desired, headache, jugular vein distention, bounding pulse, and crackles on lung auscultation.

• Option A: Hypertension, not hypotension is expected. Fluid overload can occur for the same reasons that fluid overload can occur with a regular peripheral intravenous flow. The rate is too fast and rapid for the client. The signs and symptoms of fluid overload include hypertension, edema, adventitious breath sounds like crackles and rales, shortness of breath, and bulging neck veins.
• Option C: Thirst is associated with hyperglycemia. Hyperglycemia can occur as the result of the high dextrose content of the total parenteral nutrition solution as well as the lack of a sufficient amount of administered. This total parenteral nutrition complication can be prevented with the continuous monitoring of the client’s blood glucose levels and the titration of insulin administration based on these levels of insulin.
• Option D: Polyuria is associated with hyperglycemia. The signs and symptoms of hyperglycemia secondary to total parenteral nutrition are the same as those associated with poorly managed diabetes and they include a high blood glucose level, thirst, excessive urinary output, headache, nausea, and fatigue.