A nurse in a community health clinic is preparing to administer the inactivated influenza vaccine to a group of clients. The nurse should recognize that this immunization is contraindicated for which of the following clients?

A. Hyperglycemia: TPN contains high concentrations of glucose, which can lead to elevated blood sugar levels. Clients receiving TPN should have frequent blood glucose monitoring, and insulin may be required to manage hyperglycemia.

B. Hyperkalemia: While electrolyte imbalances can occur with TPN, potassium is typically added in controlled amounts to the solution. Hyperkalemia is not a common direct adverse effect unless the formulation is incorrect or the client has impaired renal function.

C. Hypermagnesemia: Magnesium levels in TPN are carefully regulated, and hypermagnesemia is uncommon. Over-supplementation could cause this, but it is not a typical adverse effect for most clients receiving standard TPN.

D. Urine output of 160 mL in 4 hr: This urine output falls within normal limits (approximately 0.5 mL/kg/hr). Oliguria or significantly reduced urine output would be concerning, but 160 mL in 4 hours does not indicate an adverse effect of TPN.

A. Insomnia: Insomnia is not a typical sign of an allergic reaction. It may occur as a nonspecific side effect of illness or other medications but is not indicative of hypersensitivity to sulfamethoxazole-trimethoprim.

B. Photosensitivity: Photosensitivity is a known adverse effect of sulfamethoxazole-trimethoprim but is not an allergic reaction. It results in increased susceptibility to sunburn rather than an immune-mediated response.

C. Hallucinations: Hallucinations are a rare neurologic side effect and are unrelated to allergic reactions. They may occur with severe systemic toxicity but are not typical of hypersensitivity.

D. Wheezing: Wheezing indicates bronchospasm and airway involvement, which are classic signs of an allergic reaction. It reflects hypersensitivity and may progress to anaphylaxis, requiring immediate attention.