Which assessment should the nurse prioritize for a client receiving total parenteral nutrition (TPN)?

Correct Answer: A

Rationale: When a client receives total parenteral nutrition (TPN), monitoring blood glucose levels is critical due to the high glucose content in TPN solutions, which can lead to hyperglycemia. This condition arises because TPN delivers concentrated nutrients directly into the bloodstream, bypassing the digestive system, and the body may struggle to regulate sugar levels effectively without proper insulin response. Potassium levels, while important in overall electrolyte balance, are less immediately impacted by TPN compared to glucose, as potassium imbalances typically develop over time rather than acutely from TPN initiation. Mental status assessments are valuable for neurological conditions but lack direct relevance to TPN's metabolic effects. Similarly, blood pressure monitoring is essential for cardiovascular health but isn't the primary concern with TPN, as it doesn't directly influence hypertension or hypotension in the same way glucose dysregulation does. The focus on glucose stems from its rapid impact on the client's metabolic state, making it the priority assessment to prevent complications like hyperglycemia, which can escalate to severe outcomes if unaddressed. Regular monitoring ensures timely intervention, aligning with TPN's nutritional goals.

Correct Answer: B

Rationale: Myopathy, characterized by muscle pain or weakness, is a potential side effect associated with the use of HMG-CoA reductase inhibitors, also known as statins. Common examples of statins include atorvastatin, simvastatin, and rosuvastatin. Patients taking statins should be monitored for any signs or symptoms of myopathy, as it can progress to a more serious condition called rhabdomyolysis, where muscle breakdown products can lead to kidney damage. Monitoring for muscle pain, weakness, and elevated creatine kinase levels is essential to detect and manage myopathy promptly in patients on statin therapy.

Correct Answer: D

Rationale: The symptoms described in the scenario, along with the patient's history of taking valproic acid, suggest a potential case of valproic acid toxicity. Acetylcysteine is the antidote for valproic acid overdose and should be readily available for treatment in case of toxicity. Acetylcysteine works by replenishing depleted glutathione levels caused by valproic acid toxicity. It helps to prevent further liver damage and can improve outcomes in cases of overdose. Administering acetylcysteine in a timely manner can be crucial in managing valproic acid toxicity.

Correct Answer: D

Rationale: Pregnancy category A indicates that adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus. Therefore, the nurse can reassure the patient that the medication is safe to take as directed. The other options either overstate the risk or provide incomplete information. It is important for the nurse to provide accurate and evidence-based guidance to ensure the safety of both the patient and the fetus.

Correct Answer: C

Rationale: The liver, via portal vein metabolism, drives the first-pass effect, reducing oral drug bioavailability (e.g., morphine) before systemic circulation. Bladder and kidneys excrete, not metabolize first. Stomach degrades some, but liver's enzyme activity dominates. First-pass is liver-centric, shaping dosing.