A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following nursing actions are appropriate? (Select all that apply.)

Total parenteral nutrition (TPN) is a hypertonic intravenous solution that provides essential nutrients, including glucose, amino acids, lipids, vitamins, and electrolytes, for clients who cannot use the gastrointestinal tract. Because of its high dextrose content and complex formulation, TPN requires strict monitoring to prevent complications such as hyperglycemia, infection, and fluid imbalance. Safe administration depends on accurate verification, continuous metabolic monitoring, and careful assessment of the client’s nutritional status. A. Verifying the TPN solution with another registered nurse is a critical safety step because TPN contains high-risk components that must be accurately prepared and administered. Independent double-checking helps prevent medication errors related to formulation, rate, and patient identification. This is standard protocol for high-alert intravenous solutions. B. Monitoring serum blood glucose during infusion is essential because the high dextrose content in TPN can lead to hyperglycemia. Frequent glucose monitoring allows early detection and management of abnormal blood sugar levels, often requiring insulin adjustments. Maintaining glycemic control is key to preventing metabolic complications. C. Increasing the rate of infusion if administration is delayed is unsafe and should never be done. TPN must be administered at a controlled, prescribed rate because rapid infusion can cause severe fluid overload, hyperglycemia, and metabolic disturbances. Any delay should be reported, not compensated for by adjusting the rate. D. Infusing 0.9% sodium chloride if TPN is unavailable is not appropriate unless specifically ordered by the provider. TPN is a complete nutritional solution and cannot be substituted with normal saline, which lacks calories and essential nutrients. Interrupting TPN requires careful management and often the use of dextrose-containing fluids only if prescribed. E. Obtaining the client’s weight daily is important to evaluate nutritional status and fluid balance during TPN therapy. Weight changes help assess effectiveness of nutritional support and detect fluid overload or dehydration. Consistent daily measurements are a key component of ongoing monitoring.