# A 19-year-old patient is admitted with severe anorexia nervosa: BMI 13.5, heart rate 38, BP 78/42, potassium 2.9, phosphorus 2.0. The team is initiating medical stabilization with cautious refeeding. Which nursing actions are appropriate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=373260&lang=en  
> language: en  
> subject: Psychosocial Integrity  
> category: PSI

## Question

A 19-year-old patient is admitted with severe anorexia nervosa: BMI 13.5, heart rate 38, BP 78/42, potassium 2.9, phosphorus 2.0. The team is initiating medical stabilization with cautious refeeding. Which nursing actions are appropriate? Select all that apply.

1

Implement supervised meals, monitor for purging behavior, and weigh the patient with their back to the scale at consistent times in a hospital gown.

2

Initiate continuous cardiac monitoring; bradycardia and prolonged QTc place the patient at risk for torsades and cardiac arrest.

3

Replete phosphorus, potassium, and magnesium and continue daily monitoring during the first 1 to 2 weeks to prevent refeeding syndrome.

4

Begin an individualized, cautious refeeding protocol and advance nutrition gradually while monitoring electrolytes and fluid status daily

5

Weigh the patient daily in street clothes after breakfast to track weight changes accurately and adjust nutritional intake accordingly.

## Explanation

Severe anorexia nervosa with hemodynamic instability and electrolyte depletion is a medical emergency. Option 1 is correct: supervised meals, purging precautions, and blind weights in a gown at consistent times support safety and accurate trends. Option 2 is correct because profound bradycardia and electrolyte abnormalities increase the risk of dysrhythmia and cardiac arrest, requiring continuous monitoring. Option 3 is correct because phosphorus, potassium, and magnesium can fall rapidly during refeeding and require repletion and close monitoring. Option 4 is correct because the refeeding prescription must be individualized, advanced cautiously, and adjusted using daily electrolyte and fluid assessment. Option 5 is incorrect because street clothes can conceal objects or fluid loading, and a postmeal weight includes recent intake; weights should be obtained under a consistent protocol, commonly after voiding and before breakfast in a gown.

## In-depth explanation

Refeeding syndrome is the high-yield trap: the body shifts phosphorus into cells when carbohydrates restart, dropping serum phosphorus and triggering cardiac failure. Start LOW calories, ADVANCE SLOW, MONITOR phosphorus DAILY for 1-2 weeks. Blind weighing prevents the patient from weight-checking and engaging in compensatory behaviors.

## Clinical scenario

19-year-old with **severe anorexia nervosa**: BMI **13.5**, HR **38** (bradycardia), BP **78/42**, K+ **2.9**, phosphorus **2.0**. Medical stabilization with **cautious refeeding** initiated.

## Key concepts

- **Refeeding syndrome** — Hypophosphatemia, hypokalemia, hypomagnesemia, fluid shifts, and cardiac failure when calories are reintroduced too quickly in malnourished patients.
- **Anorexia bradycardia** — Heart rate < 40 in severe AN signals cardiac instability and adaptive response to chronic starvation; medical emergency.
- **Blind weighing** — Patient stands backward on the scale at consistent times in hospital gown to prevent obsessive weight focus and behavioral compensation.

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