A nurse is providing teaching to a client who reports smoking 3 packs of cigarettes per day and has a prescription for nicotine gum. Which of the following instructions should the nurse include in the teaching?

B. Daily weight monitoring helps assess fluid balance and the effectiveness of TPN therapy. Sudden weight changes can indicate fluid retention or inadequate nutrition delivery, necessitating adjustments in TPN components.

A. TPN solutions are highly concentrated and need precise control over infusion rates to prevent complications such as hyperglycemia or fluid overload. Using an infusion pump allows for accurate delivery according to prescribed rates.

C. TPN therapy is tailored to meet nutritional needs based on specific patient factors such as weight, metabolic requirements, and clinical condition rather than blood pressure alone. Adjustments are typically based on nutritional assessments and lab values rather than blood pressure readings.

D. TPN solutions contain dextrose, which can significantly affect blood glucose levels. Regular monitoring (often several times a day initially and then less frequently based on stability) helps detect hyperglycemia or hypoglycemia promptly and allows for timely adjustments in TPN dextrose concentrations or insulin therapy.

The client is at risk for decreased absorption due to medication interactions.

Rationale

Esomeprazole works by reducing the production of stomach acid, thereby raising the pH level in the stomach. Levothyroxine, like many other medications, is absorbed primarily in the upper part of the small intestine where a more acidic environment is optimal for absorption. When stomach acid production is reduced by esomeprazole, the pH of the stomach increases, which can decrease the dissolution and absorption of levothyroxine.