Editing Nutrition – RN Practice Questions (section)

==Question 6==
A nurse on a medical unit receives report on four clients. Which client should the nurse assess '''first'''?
# A client receiving TPN whose temperature is 101.8°F (38.8°C) with new chills.
# A client on a 2 g sodium diet who ate canned soup brought in by a family member.
# A client receiving continuous tube feeding with a gastric residual volume of 180 mL and no abdominal distention.
# A client whose prealbumin is 13 mg/dL and who has eaten 40% of meals.

'''Answer:''' 1. The client receiving TPN with a fever of 101.8°F and new chills.

''Rationale:'' New fever with chills in a client with a central line receiving TPN indicates catheter-related bloodstream infection until proven otherwise, and sepsis can deteriorate within hours. This client requires immediate assessment, blood cultures from the catheter and a peripheral site, and provider notification. Option 2 requires teaching and sodium and weight monitoring but is not an emergency. Option 3 describes a residual well below common hold thresholds with no other signs of intolerance; current guidance does not support holding feeding for residuals under 500 mL absent symptoms. Option 4 is a chronic, expected finding in a poorly eating client and warrants a dietitian referral, not an urgent response.