A nurse is caring for a client who is visually impaired. When delivering the client's meal tray, which of the following actions should the nurse take?

Choice A reason: This is not an appropriate action because asking the client's health care surrogate for permission to withhold nourishment can violate the client's autonomy and dignity. The nurse should respect the client's wishes and preferences regarding end-of-life care and document them clearly.

Choice B reason: This is an appropriate action because providing regular oral care for the client with a moist swab can prevent dryness, cracking, or infection of the mouth and lips and enhance comfort and quality of life. The nurse should also apply lip balm or petroleum jelly as needed.

Choice C reason: This is not an appropriate action because requesting a prescription for IV fluids can cause fluid overload, edema, or dyspnea in the dying client and prolong their suffering. The nurse should follow the provider's orders regarding hydration and nutrition and monitor the client's fluid balance status.

Choice D reason: This is not an appropriate action because explaining the importance of oral hydration to the client can be perceived as coercive or insensitive and cause distress or guilt in the dying client. The nurse should acknowledge the client's decision and provide emotional support and education.

Choice A reason: Increased serum glucose levels are a common complication of total parenteral nutrition (TPN), which is a form of intravenous feeding that provides high amounts of calories, proteins, and other nutrients. TPN can cause hyperglycemia, especially in clients who have stress, infection, or diabetes. The nurse should monitor the client's blood glucose levels regularly and adjust the infusion rate or insulin dosage as prescribed.

Choice B reason: Intermittent abdominal pain is not a typical complication of TPN, but it may indicate other problems such as bowel obstruction, perforation, or ischemia. The nurse should assess the client's abdomen for distension, tenderness, rigidity, or guarding and report any abnormal findings to the provider.

Choice C reason: Absent bowel sounds are not a direct complication of TPN, but they may indicate paralytic ileus, which is a temporary loss of bowel motility. Paralytic ileus can occur after surgery, trauma, or burns and can cause nausea, vomiting, constipation, or abdominal distension. The nurse should auscultate the client's bowel sounds every 4 hr and encourage early ambulation and oral intake as tolerated.

Choice D reason: Decreased calcium levels are not a common complication of TPN, but they may occur in clients who have hypoparathyroidism, renal failure, or malabsorption. Low calcium levels can cause muscle cramps, tetany, seizures, or cardiac arrhythmias. The nurse should monitor the client's serum calcium levels and administer calcium supplements as prescribed.