A nurse is admitting a client who has diabetic ketoacidosis. Which of the following types of continuous infusions should the nurse initiate?

A. "I will monitor the client's blood glucose level every 8 hours.": Blood glucose should be monitored more frequently, typically every 4–6 hours, because TPN is high in dextrose and can cause rapid hyperglycemia or hypoglycemia if interrupted. Monitoring every 8 hours does not provide adequate safety surveillance.

B. "I will increase the rate of the TPN infusion to ensure the correct amount is given.": Rapidly increasing the infusion rate can cause hyperglycemia, fluid overload, and electrolyte imbalances. TPN should always be titrated according to the provider’s prescription and protocols to avoid complications.

C. "I will obtain the client's weight every other day.": Clients receiving TPN should be weighed daily to accurately monitor fluid status, nutritional progress, and detect early signs of fluid overload or dehydration. Weight assessment every other day is insufficient.

D. "I will hang a new bag of TPN and IV tubing every 24 hours.": Changing the TPN solution and tubing every 24 hours is a critical infection prevention measure. TPN is a high-glucose solution that supports bacterial growth, so adhering to this schedule reduces the risk of catheter-related bloodstream infections.

A. Weight assessment: The client gained 0.68 kg (1.5 lb) in one week, which may indicate rapid fluid retention. In the context of hypertension and edema, this requires follow-up for possible preeclampsia or fluid overload.

B. Respiratory assessment: Respirations are even, non-labored, and oxygen saturation is 95%, which is within acceptable limits for 30 weeks of gestation. No immediate follow-up is indicated based solely on these findings.

C. Fundal height: The fundal height is 29 cm at 30 weeks gestation, 29 cm at 30 weeks is within the expected range (usually +/- 2 cm of the week of gestation).

D. Lower extremity assessment: The client has 1+ dependent edema bilaterally. Combined with hypertension and facial edema, this finding may indicate fluid retention associated with preeclampsia, requiring monitoring and further evaluation.

E. Blood pressure: The client’s blood pressure is 148/94 mm Hg, which is elevated for pregnancy. Hypertension at 30 weeks can indicate preeclampsia and requires prompt assessment and intervention.

F. Nausea: While common in early pregnancy, nausea and vomiting in the third trimester—especially when paired with right upper abdominal pain—suggest liver involvement or Glisson's capsule stretching, which are "severe features" of preeclampsia/HELLP syndrome.

G. Fetal heart tracing: Fetal heart rate is 140/min with no contractions, which is within normal limits for gestation. No immediate follow-up is necessary based on this assessment.

H. DTR: Deep tendon reflexes are 3+ bilaterally, indicating hyperreflexia. This is a concerning sign for preeclampsia and requires prompt follow-up to prevent complications such as seizures.