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- Notify the provider immediately; this could be refeeding syndrome
- Check a blood glucose immediately; this could be hyperglycemia
- Check a blood glucose immediately; this could be hypoglycemia
- Notify the provider immediately; this could be hypervolemia
- Check a blood glucose immediately; this could be refeeding syndrome
-"Notify the provider immediately; this could be refeeding syndrome" and "Check a blood glucose immediately; this could be hyperglycemia" are correct. Based on the symptoms described in the question, this could be two complications associated with parenteral nutrition: Refeeding syndrome or hyperglycemia. With refeeding syndrome, the severely malnourished patient has a rapid drop in potassium, magnesium and phosphate levels. This electrolyte shift causes cardiovascular, neurological and respiratory problems that present as shallow respirations, confusion, weakness, bleeding tendencies and even seizures. Sharing some of the same symptoms as refeeding syndrome is extreme hyperglycemia. In hyperglycemia, the patient experiences confusion, weakness, Kussmaul respirations, restlessness, excessive thirst and diaphoresis.
-"Check a blood glucose immediately; this could be hypoglycemia" is incorrect because the patient is not demonstrating signs of low blood glucose levels. With low blood glucose, while the patient WILL experience weakness and confusion, a change in respirations is not displayed. Rather, as hypoglycemia worsens, the patient begins to have blurred vision and can slip into a coma.
-"Notify the provider immediately; this could be hypervolemia" is incorrect because none of the symptoms described are consistent with hypervolemia. Hypervolemia signs/symptoms include lung crackles, a bounding pulse, jugular venous distention and increased blood pressure. Additionally, if the nurse suspects hypervolemia, she will first slow or stop the infusion, THEN notify the provider.
-"Check a blood glucose immediately; this could be refeeding syndrome" is incorrect because, while these are symptoms consistent with refeeding syndrome, blood glucose levels are not impacted by the suspected condition. The two parts of this statement do not go together, so this answer is incorrect.
Silvestri, L. A. (2017). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier
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