A nurse is admitting a client with a history of duodenal ulcer. To determine if the client's current symptoms are related to this information, the nurse should assess the client for which manifestations of a duodenal ulcer?

Choice A: Fever and chills Fever and chills are not typically associated with the abrupt cessation of TPN. These symptoms are more commonly related to infections or inflammatory processes in the body. While infections can be a complication of TPN due to the invasive nature of the therapy, they are not a direct result of the discontinuation of the infusion. Total Parenteral Nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to provide most of the nutrients the body needs. The sudden stop in the infusion of TPN can lead to a rapid drop in blood sugar levels, known as hypoglycemia, because the body has become accustomed to the continuous influx of glucose from the TPN solution.

Choice B: Hypertension and crackles Hypertension (high blood pressure) and crackles (sounds heard on lung auscultation indicative of fluid in the air spaces) are not expected clinical manifestations due to the stopping of TPN. These symptoms are more commonly associated with cardiovascular and pulmonary conditions, respectively.

Choice C: Excessive thirst and urination Excessive thirst and urination could be symptoms of hyperglycemia (high blood sugar), which might occur if TPN is infused too quickly or if the patient has an increased insulin requirement. However, these are not the immediate concerns when TPN is abruptly stopped.

Choice D: Shakiness and diaphoresis Shakiness and diaphoresis (sweating) are common signs of hypoglycemia, which can occur if TPN is stopped suddenly. The body may have been receiving a steady supply of glucose from the TPN, and a sudden halt can cause blood sugar levels to drop quickly. This can lead to symptoms such as weakness, shakiness, sweating, and even confusion or loss of consciousness if not addressed promptly. When TPN is abruptly discontinued, the nurse should monitor the client for signs of hypoglycemia, including shakiness and diaphoresis. It is important to restart the TPN infusion as soon as possible or provide an alternative source of glucose to prevent hypoglycemia and its potential complications.

Choice A reason: Bradycardia, which is a slower than normal heart rate, is not a common finding associated with renal calculi. Renal calculi, or kidney stones, typically cause symptoms related to the urinary system rather than directly affecting the heart rate.

Choice B reason: Bradypnea, or abnormally slow breathing, is also not a typical symptom of renal calculi. Patients with kidney stones may experience changes in urination patterns, such as frequency or urgency, but not typically changes in respiratory rate.

Choice C reason: Severe pain is indeed the most common symptom associated with renal calculi. This pain, known as renal colic, is often sudden in onset, very severe, and may radiate from the back down to the lower abdomen or groin. The pain is caused by the stone moving into the ureter and causing a blockage, which leads to increased pressure and stretching of the kidney or ureter. Renal calculi can cause a range of symptoms, with severe pain being the most prominent and often the first symptom that leads individuals to seek medical care. The pain is typically very intense and can be accompanied by other symptoms such as nausea, vomiting, and hematuria (blood in the urine).

Choice D reason: Nocturia, or frequent urination at night, can be a symptom of renal calculi, especially if the stones affect the bladder or cause urinary tract infections. However, the most characteristic symptom of renal calculi is severe pain, not necessarily nocturia.