# A severely malnourished client begins tube feeding. Twenty-four hours later, phosphorus falls from 3.4 to 1.2 mg/dL and the client develops weakness and paresthesias. Complete the nurse’s interpretation and priority plan. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=396144&lang=en > language: en > subject: Laboratory Values > category: ROR ## Question A severely malnourished client begins tube feeding. Twenty-four hours later, phosphorus falls from 3.4 to 1.2 mg/dL and the client develops weakness and paresthesias. Complete the nurse’s interpretation and priority plan. The cue cluster is most consistent with ::선택::dumping syndromerefeeding syndromelactose intoleranceuncomplicated feeding adaptation. The priority nursing response includes ::선택::advance feeding and recheck phosphorus next weekgive free water without additional assessmentnotify the team, initiate cardiac monitoring, and repeat phosphorus, potassium, and magnesiumstop all monitoring once paresthesias improve. The nurse should anticipate ::선택::routine calorie escalation without supplementationlong-term fasting without electrolyte treatmentprescribed electrolyte replacement and thiamin with reduced or held calorie advancementisolated sodium restriction as the definitive treatment. ## Explanation A substantial phosphorus decrease soon after calorie reintroduction in a severely malnourished client strongly supports refeeding syndrome. The nurse promptly notifies the team, obtains or confirms cardiac monitoring and repeat electrolytes, and assesses for neuromuscular, cardiac, respiratory, and fluid complications. Treatment commonly includes electrolyte replacement, thiamin, and temporary calorie or dextrose reduction with cautious advancement according to severity and the prescribed plan. ## In-depth explanation Correct Answer Recognize refeeding syndrome, escalate with cardiac and electrolyte monitoring, and anticipate electrolyte-thiamin replacement with reduced or held calorie advancement. Why It Fits The timing, severe phosphate decline, malnutrition, and new neuromuscular symptoms form one coherent syndrome. Clinical Picture Insulin-driven intracellular shifts can lower phosphorus, potassium, and magnesium and cause arrhythmia, weakness, respiratory failure, neurologic change, and fluid imbalance. Memory Link Feed starts, electrolytes shift, organs struggle. NCLEX Rule Do not respond to a severe post-feeding electrolyte decline by advancing calories unchanged. Why the Alternatives Fail Dumping syndrome does not explain severe hypophosphatemia; isolated dehydration or food intolerance does not fit the electrolyte timing and symptoms. Sources 1ASPEN Consensus Recommendations for Refeeding Syndrome 22026 NCLEX-RN Test Plan ## Clinical scenario Calories were recently reintroduced. The nurse reviews phosphorus, potassium, magnesium, glucose, fluid balance, cardiac rhythm, and thiamin administration with the interprofessional team. ## Key concepts - **Refeeding syndrome** — Metabolic and electrolyte disturbances that can occur when calories are reintroduced after severe undernutrition. - **Hypophosphatemia** — An abnormally low serum phosphorus level that can impair neuromuscular, cardiac, and respiratory function. ## Related questions - [A 56-year-old patient presents to the ED with BP 226/132, severe occipital headache, blurr…](https://mymerci.kr/pages/nclex_q.php?qn_id=372715&lang=en) - [A client with diabetic ketoacidosis has pH 7.28, PaCO2 26 mm Hg, and HCO3 12 mEq/L. Using …](https://mymerci.kr/pages/nclex_q.php?qn_id=393370&lang=en) - [The emergency nurse reviews six presentations involving glucose dysregulation. Identify th…](https://mymerci.kr/pages/nclex_q.php?qn_id=393404&lang=en) - [The nurse receives laboratory results for four clients. 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Always follow current clinical guidelines and your institution’s protocols._