# A client receiving parenteral nutrition develops a glucose trend. Select the best interpretation and plan.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522663&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client receiving parenteral nutrition develops a glucose trend. Select the best interpretation and plan.

| Time | Data |
| --- | --- |
| Before parenteral nutrition | Glucose 112 mg/dL; urine output 45 mL/hour; mucous membranes moist |
| Six hours after initiation | Glucose 198 mg/dL; urine output 70 mL/hour |
| Current | Glucose 326 mg/dL; urine output 125 mL/hour; thirst and dry mucous membranes |

Q1. How should the trend be interpreted?

Expected hydration improvement
Parenteral-nutrition-associated hyperglycemia with osmotic fluid loss
Resolution of metabolic risk

Q2. Which plan is appropriate?

Notify the team, review dextrose and insulin therapy, and intensify glucose and fluid monitoring
Double the parenteral nutrition rate to replace urinary losses
Ignore glucose until the next weekly laboratory panel

## Explanation

Progressive hyperglycemia with polyuria and dehydration requires prompt glucose management, review of dextrose delivery and insulin needs, and closer laboratory and fluid monitoring. Ignoring the trend or independently doubling the infusion is unsafe.

## In-depth explanation

Quick answer
Connect rising glucose with the dextrose infusion and osmotic fluid loss.

Why this is correct
Parenteral dextrose can exceed current glucose-handling capacity. Management is individualized and should avoid abrupt, unsupervised changes that create another metabolic hazard.

Easy analogy or mental picture
Treat every infusion as a controlled clinical system: verify the product and access, recognize a changing cue, stop preventable exposure, stabilize the client, and confirm the response.

Memory hook
Product, access, compatibility, infusion cue, protective action, and reassessment.

NCLEX decision rule
Choose the action that prevents the most immediate infusion-related harm while preserving vascular access and the ordered diagnostic evidence.

Why the other choices are wrong
Options that restart a suspect product, bypass a safety device, force an occluded tube, or delay reassessment can convert a reversible warning into serious harm.References
1DailyMed: CLINIMIX sulfite-free parenteral nutritionHyperglycemia, refeeding syndrome, infection, laboratory monitoring, and safe discontinuation considerations

## Clinical scenario

Blood product, nutrition, and intravenous-fluid safety review
Verify the product, prescription, route, access device, filter or tubing, compatibility, baseline findings, emerging adverse cues, response plan, and measurable follow-up.

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