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

Nursing evaluation of a client receiving Total parenteral nutrition focuses on monitoring fluid balance, metabolic status, and potential complications such as infection, electrolyte imbalance, and fluid overload. Because TPN is administered intravenously in a hyperosmolar solution, it can significantly affect intravascular volume and serum osmolality. Excess fluid volume can lead to circulatory overload and neurologic changes due to fluid shifts and reduced oxygen delivery. Early recognition of these signs is essential to prevent complications such as pulmonary edema and impaired cerebral perfusion. Rationale: A. Lungs clear to auscultation indicate normal respiratory status and do not support a diagnosis of excess fluid volume. In fluid overload, the nurse would expect findings such as crackles, decreased oxygen saturation, or signs of pulmonary congestion. Clear lung sounds suggest that no fluid accumulation is currently affecting the pulmonary system. B. Absence of dependent edema in the lower extremities suggests that there is no peripheral fluid accumulation. Excess fluid volume typically presents with swelling in dependent areas due to increased hydrostatic pressure in the vascular system. Therefore, this finding does not indicate fluid overload. C. A weight decrease of 1 kg in 24 hours indicates fluid loss rather than fluid retention. Rapid weight changes are a sensitive indicator of fluid balance, and a decrease suggests negative fluid balance or possible dehydration. This finding is inconsistent with excess fluid volume. D. New onset of confusion is an important indicator of possible excess fluid volume because fluid overload can lead to cerebral edema or altered serum sodium levels, which affect neurological function. Increased intravascular volume may also impair oxygen delivery and cerebral perfusion, resulting in acute changes in mental status. Any sudden confusion in a client receiving TPN requires immediate evaluation.