A client is ordered to receive 2 liters of total parenteral nutrition (TPN) infused daily over 23 hours at 87 mL per hour. After shift change, the nurse discovers that the volume remaining on the bag is still over 1200 mL with only 11 hours left to infuse it. What should the nurse do?

Total parenteral nutrition (TPN) is a complex hypertonic solution containing concentrated dextrose, amino acids, and electrolytes. Sudden changes in the infusion rate can cause severe metabolic instability, specifically regarding blood glucose levels. The nurse must prioritize patient safety over adhering to the strict volume schedule to prevent osmotic shifts and insulin spikes. A. Administering 10% dextrose is only indicated if the TPN bag runs out prematurely and a replacement bag is not immediately available. In this scenario, the nurse still has a significant volume of TPN remaining. Substituting the solution unnecessarily would deprive the patient of essential proteins and lipids required for metabolic support. B. While a medication error or pump malfunction clearly occurred during the previous shift, contacting the previous nurse is a secondary administrative action. It does not address the immediate clinical priority, which is the management of the infusion rate for the current shift to ensure the patient's hemodynamic and metabolic safety. C. The nurse must maintain the prescribed rate of 87 mL per hour. "Catching up" by increasing the rate of a hypertonic solution like TPN carries extreme risks of hyperosmolar hyperglycemic states and fluid overload. The nurse should notify the physician and pharmacy that the bag will not finish on time and follow institutional policy for the next scheduled bag. D. Increasing the rate to 109 mL per hour to "catch up" is dangerous. Rapid infusion of high-glucose concentrations can cause the pancreas to over-secrete insulin, leading to rebound hypoglycemia if the rate is later slowed. Furthermore, the increased osmotic load can cause fluid shifts that stress the cardiovascular and renal systems.