A severely malnourished client is started on TPN. Forty-eight hours later, the client develops dyspnea, confus…

Question

A severely malnourished client is started on TPN. Forty-eight hours later, the client develops dyspnea, confusion, weakness, and labs show low phosphate, magnesium, and potassium. Which is the priority interpretation and action?

Accepted Answer

Option 1: Refeeding syndrome — reduce caloric load, aggressively replace phosphate/magnesium/potassium, supplement thiamine before resuming, advance nutrition slowly under close monitoring

Correct (2): Refeeding syndrome — when carbohydrates are introduced after starvation, insulin surge drives phosphate, magnesium, potassium intracellularly → severe deficiencies with arrhythmia, respiratory failure, seizures, heart failure. Prevention: start TPN at 25-50% of goal, advance slowly over 4-7 days, give thiamine 100 mg before/during initial feeding, replete phosphate/Mg/K before progressing. (1,3,4) Dangerous.

Answer

Option 2: Discontinue all electrolyte monitoring

Answer

Option 3: Expected normal response

Answer

Option 4: Increase TPN rate for faster correction

A severely malnourished client is started on TPN. Forty-eight hours later, the client develops dyspnea, confusion, weakness, and labs show low phosphate, magnesium, and potassium. Which is the priority interpretation and action?

In-depth explanation

Clinical scenario

Key concepts

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A severely malnourished client is started on TPN. Forty-eight hours later, the client develops dyspnea, confusion, weakness, and labs show low phosphate, magnesium, and potassium. Which is the priority interpretation and action?

In-depth explanation

Clinical scenario

Key concepts

Master the NCLEX-RN with MyMerci