A severely malnourished client develops new findings after parenteral nutrition is started. Which plan is best?
Chart/Exhibit
Choose your responses, then check the answer.
Explanation
A rapid phosphorus decline with weakness, edema, and ectopy after nutrition begins is compatible with refeeding syndrome. The plan reduces the calorie load, corrects electrolytes, supports thiamine needs, and intensifies monitoring.
Quick answer Respond to refeeding physiology before advancing calories.
Why this is correct Insulin-driven intracellular shifts can rapidly deplete phosphorus, potassium, and magnesium and impair cardiac, respiratory, and neurologic function.
Easy analogy or mental picture Treat every infusion as a controlled clinical system: verify the product and access, recognize a changing cue, stop preventable exposure, stabilize the client, and confirm the response.
NCLEX decision rule Choose the action that prevents the most immediate infusion-related harm while preserving vascular access and the ordered diagnostic evidence.
Why the other choices are wrong Options that restart a suspect product, bypass a safety device, force an occluded tube, or delay reassessment can convert a reversible warning into serious harm.
References
1ASPEN Consensus Recommendations for Refeeding SyndromeRisk identification, cautious calorie initiation, electrolyte monitoring and replacement, and thiamine support