Need help answering this NCLEX style question

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Specializes in Passion: NICU, Nursery, L&D = (Babies!!).

Can someone help me with this question? I am leaning toward A, but it's a toss against B. What are your thoughts and rationales?

A client has been prescribed Total Parenteral Nutrition (TPN). Which of the following outcomes demonstrates to the nurse that TPN therapy is effective?

A. Client gains one pound per day.

B. Client maintains an albumin level of 5.0 g/100ml.

C. Client's urinary output increases by 800 per day.

D. Client reports less frequent bowel movements

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Specializes in Emergency Room.

I think the correct answer is A, but this is why: After reading the question I asked myself why they would be getting TPN? They may not be able to take nutrients orally, maybe there are GI problems, maybe there is no other nutritional alternative. Out of all the answers, A is the only one that proves that the patient is gaining a stable amount of weight which most likely means they are getting the nutrients they need.

B-The albumin is a measurement of nutrition. The response says the pt maintains an albumin level of 5.0.That makes me think the pt had this level before TPN was even started.

C-The urine output may naturally increase because of all the fluid they are receiving but doesn't let us know whether the TPN is working.

D-Less frequent BM's? I would consider this a problem and not an indicator that the TPN is effective. Something's going on with the GI system.

That is my guess and my rationales...Anybody else have ideas? Kind of a tough question now that I look into it.

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JSlice... that is awesome! Your reasoning for selecting A is very impressive. I guess that is how the questions are asked on the NCLEX. Can't wait to start nursing school and put my critical thinking skills to work.

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Specializes in Telemetry.

I would say the answer is maintaining the albumin level- if the client gains 1 lb / day you are looking at hypervolemia

Average weight gain is like 1-2 lbs / week

Albumin levels indicate nutritional status

Interested to hear what others say:)

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Specializes in Emergency Room.

Hey Rae30.

That's true too. 1 lb/day does seem like a lot. I suppose the lab value would indicate a more accurate reading.

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Specializes in Nursing Education.

A client has been prescribed Total Parenteral Nutrition (TPN). Which of the following outcomes demonstrates to the nurse that TPN therapy is effective?

A. Client gains one pound per day.

B. Client maintains an albumin level of 5.0 g/100ml.

C. Client's urinary output increases by 800 per day.

D. Client reports less frequent bowel movements

I would agree, I think B is right. One of the goals of TPN is to make sure that the pt is getting adequate protein, and their protein needs increase when their body is stressed due to illness.

Answer A is tempting, but it also depends on why they are getting TPN as to whether we would even be concerned about weight gain. And more importantly, as Rae30 pointed out, 1lb/day is usually going to be way too much and probably an indicator of unhealthy fluid retention.

And a note about Answer D, that would actually be an expected outcome, because whenever someone is NPO they're not going to be making as much poop! But even though reduced BM is related to NPO, it is not the correct answer in this case because it is not the reason that TPN is being given, it is simply a 'side effect' so to speak.

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I would also go with B.

Normal Albumin is about 3.5-5 and by maintaining an albumin level of 5 it shows that the therapy is effective.

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Specializes in IMCU.

Albumin level.

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Specializes in Family Medicine.

I would go with B.

Gaining 1 lb per day is A LOT.

Albumin is an indicator of nutritional status.

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I would suggest using an NCLEX book with rationals in the back. When books just give the answer I do not remember why... By reading the rationals I seem to retain more info. Just a suggestion...

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Specializes in being a Credible Source.

Agreed, albumin level.

Metabolic weight gain rarely exceeds 1/2 lb per day. Seven lbs per week indicates fluid overload (hypervolemia is a risk with TPN).

My experience is that if you start trying to mince words and base your answers on a single word like "maintain" then you're likely to be led astray.

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Specializes in Emergency Dept. Trauma. Pediatrics.
I would say the answer is maintaining the albumin level- if the client gains 1 lb / day you are looking at hypervolemia

Average weight gain is like 1-2 lbs / week

Albumin levels indicate nutritional status

Interested to hear what others say:)

I would agree with this also. 1 lb a day is to much rapidly.

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