Anune is assessing a client who is receiving total parenteral nutrition (TPN). The nurse should identify which of the following findings as an adverse effect of TPN?

Choice A reason: Abdominal obesity is a risk factor for developing diabetes mellitus. Abdominal obesity, also known as central obesity or visceral fat, is the accumulation of fat around the abdomen and organs. Abdominal obesity can cause insulin resistance, inflammation, and metabolic syndrome, which are all associated with diabetes.

Choice B reason: Elevated HDL level is not a risk factor for developing diabetes mellitus. HDL stands for high-density lipoprotein, which is a type of cholesterol that carries excess cholesterol from the tissues to the liver for disposal. HDL is also known as "good" cholesterol, as it helps protect against heart disease and stroke. A high HDL level is desirable and beneficial for health.

Choice C reason: History of hypotension is not a risk factor for developing diabetes mellitus. Hypotension means low blood pressure, which is usually defined as less than 90/60 mm Hg. Hypotension can cause symptoms such as dizziness, fainting, fatigue, and blurred vision. Hypotension can be caused by dehydration, blood loss, medication side effects, or other conditions.

Choice D reason: History of hyperthyroidism is not a risk factor for developing diabetes mellitus. Hyperthyroidism means overactive thyroid gland, which produces too much thyroid hormone. Thyroid hormone regulates metabolism, growth, and development. Hyperthyroidism can cause symptoms such as weight loss, nervousness, palpitations, heat intolerance, and insomnia. Hyperthyroidism can be caused by Graves' disease, thyroid nodules, or thyroiditis.

Choice A reason: Eating more tuna is not an appropriate food choice for a client who has gout because it is high in purines, which are substances that break down into uric acid in the body. Uric acid can form crystals in the joints and cause inflammation and pain, which are symptoms of gout. Tuna should be limited or avoided by clients who have gout.

Choice B reason: Eating more red meat is not an appropriate food choice for a client who has gout because it is high in purines, which are substances that break down into uric acid in the body. Uric acid can form crystals in the joints and cause inflammation and pain, which are symptoms of gout. Red meat should be limited or avoided by clients who have gout.

Choice C reason: Eating blueberries every morning is an appropriate food choice for a client who has gout because they are low in purines and high in antioxidants, which are substances that protect the cells from damage caused by free radicals. Antioxidants can help reduce inflammation and pain, which are symptoms of gout. Blueberries also provide vitamin C, fiber, and water for the client.

Choice D reason: Eating bananas for a snack is not an appropriate food choice for a client who has gout because they are high in fructose, which is a type of sugar that can increase uric acid levels in the blood. Fructose can worsen gout attacks by triggering inflammation and pain in the joints. Bananas should be limited or avoided by clients who have gout.