Which nursing assessment finding would indicate that a client receiving total parenteral nutrition has hyperglycemia?

• A. Paralytic ileus
• B. Respiratory rate below 16
• C. A fruity odor to the breath
• D. Serum glucose of 105 mg/dL

Answer: (C)

The key concept is that total parenteral nutrition delivers a continuous, high glucose load, so monitoring for metabolic disturbances from elevated glucose is essential. A fruity odor on the breath signals ketosis, which can occur when insulin action is insufficient or overwhelmed by the glucose provided by TPN. In this situation, fat breakdown produces ketone bodies, including acetone, leading to the characteristic fruity breath and indicating dysregulated glucose metabolism consistent with hyperglycemia risks in a TPN client.

A normal serum glucose (105 mg/dL) does not indicate hyperglycemia, and respiratory rate or abdominal motility changes are not direct indicators of glucose status.