A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which of the following findings indicates the client is experiencing fluid volume overload?

Total parenteral nutrition (TPN) provides complete nutritional support intravenously and is often administered through a central venous catheter. Because of its high fluid volume and concentrated nutrient content, careful monitoring is required to detect complications such as fluid volume overload, infection, and metabolic disturbances. Fluid overload occurs when excess fluid accumulates in the intravascular and interstitial spaces, affecting cardiovascular and respiratory function. Early recognition helps prevent complications such as heart failure and pulmonary edema. A. +1 pedal pulses indicate diminished but present peripheral pulses and are not a direct sign of fluid volume overload. Fluid overload is more commonly associated with bounding pulses due to increased circulating volume. Therefore, weak pedal pulses do not strongly support the presence of excess fluid volume. B. Urinary output of 20 mL in the past hour suggests decreased renal perfusion or possible renal impairment rather than fluid overload. In fluid overload, urine output may be normal or increased depending on renal function and compensatory mechanisms. Oliguria alone is not the most specific indicator of excess fluid volume in this situation. C. An S3 heart sound is a classic sign of fluid volume overload and occurs when excess blood enters a ventricle that is already volume overloaded. It is often associated with heart failure and indicates increased ventricular filling pressures. In a client receiving TPN, this finding suggests the cardiovascular system is struggling to handle the excess circulating fluid. D. A temperature of 38°C (100.4°F) is more suggestive of infection, especially in a client receiving TPN through a central venous catheter. Fever may indicate catheter-related bloodstream infection or another inflammatory process. It is not a typical finding used to identify fluid volume overload.