Review the metabolic trend after parenteral nutrition begins and determine the safest response.
Trend
Choose your responses, then check the answer.
Explanation
The rapid decline in phosphorus, potassium, and magnesium after calories are introduced, accompanied by edema, weakness, tachycardia, and rising glucose, indicates refeeding syndrome. Insulin-driven intracellular shifts can cause cardiac, respiratory, and neurologic failure. The nurse should notify the nutrition and medical teams, reduce or pause calorie advancement according to the treatment plan, give thiamine, replace electrolytes, and increase clinical and laboratory monitoring. Simply adding more calories or waiting for symptoms to resolve can accelerate deterioration.
Correct Answer The trend is most consistent with evolving refeeding syndrome.
Why It Fits A severely malnourished client develops major phosphate, potassium, and magnesium declines soon after parenteral calories begin.
Clinical Picture Carbohydrate-driven insulin release shifts electrolytes into cells and promotes sodium and fluid retention, threatening cardiac and respiratory function.
Memory Link After starvation, feed slowly and watch phosphorus first.
NCLEX Rule Identify high risk before feeding, provide thiamine, advance calories cautiously, and monitor and replace phosphorus, potassium, and magnesium.
Why the Alternatives Fail Increasing calories, treating edema with fluid restriction alone, or ignoring low electrolytes does not correct the metabolic shift.
Sources
1ASPEN Consensus Recommendations for Refeeding Syndrome
2NCSBN 2026 NCLEX-RN Test Plan
Nutrition support serviceAn adult with negligible intake for 10 days and marked weight loss begins parenteral nutrition. Baseline electrolytes were corrected into the low-normal range, and thiamine was not given before the infusion.
Refeeding syndrome — Potentially dangerous fluid and electrolyte shifts after nutrition is reintroduced to a severely undernourished person.
Hypophosphatemia — A low serum phosphorus level that can impair energy production, muscle function, breathing, and cardiac performance.
Thiamine — Vitamin B1, an essential cofactor in carbohydrate metabolism that should be supplied in clients at high refeeding risk.