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: 1 slice of bread is equivalent to 1 oz of grains, not protein. Bread is a good source of carbohydrates, fiber, and B vitamins, but it does not provide enough protein for a toddler.

Choice B reason: 1 scrambled egg is equivalent to 1 oz of protein. Egg is a complete protein, meaning it contains all nine essential amino acids that the body cannot make. Egg is also a good source of iron, choline, and vitamin D.

Choice C reason: 1/2 cup peas is equivalent to 1/2 oz of protein and 1/2 cup of vegetables. Peas are an incomplete protein, meaning they lack some essential amino acids. Peas are also a good source of fiber, vitamin C, and folate.

Choice D reason: 2 tbsp peanut butter is equivalent to 2 oz of protein. Peanut butter is an incomplete protein, but it can be combined with bread or crackers to form a complete protein. Peanut butter is also a good source of fat, magnesium, and niacin.

Choice A reason: Checking blood glucose level is an appropriate action for the nurse to take because it can help determine if the client has hypoglycemia or hyperglycemia, which are both complications of diabetes mellitus that can cause dizziness and weakness. Blood glucose level should be checked using a glucometer and compared with the normal range of 70 to 130 mg/dL before meals and less than 180 mg/dL after meals.

Choice B reason: Giving insulin injection is not an appropriate action for the nurse to take without checking blood glucose level first because it may cause hypoglycemia, which is a condition in which blood glucose level drops below 70 mg/dL and can cause dizziness, weakness, confusion, sweating, and seizures. Insulin injection should be given according to the prescribed dose, type, and schedule.

Choice C reason: Offering orange juice is not an appropriate action for the nurse to take without checking blood glucose level first because it may cause hyperglycemia, which is a condition in which blood glucose level rises above 180 mg/dL and can cause dizziness, weakness, thirst, polyuria, and ketoacidosis. Orange juice should be offered only if the client has hypoglycemia and is conscious and able to swallow.

Choice D reason: Applying cold compress is not an appropriate action for the nurse to take because it does not address the underlying cause of dizziness and weakness in a client who has diabetes mellitus. Cold compress may worsen the symptoms by reducing blood flow and oxygen delivery to the brain. Cold compress should be applied only if the client has fever, inflammation, or pain.