# Complete the plan for initiating parenteral nutrition in a severely malnourished client.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=513952&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

Complete the plan for initiating parenteral nutrition in a severely malnourished client.

Because the final infusate is 1050 mOsm/L, use a ::선택::short peripheral cathetercentral venous cathetersubcutaneous infusion siteintraosseous line for long-term therapy. Begin nutrition ::선택::at full rate without titrationonly after 7 days of fastinggradually according to the prescribed planas an intravenous push while monitoring ::선택::glucose, phosphorus, potassium, and magnesiumvisual acuity and hearing onlyamylase onlyskin testing only.

## Explanation

An infusate at or above 900 mOsm/L requires central access. Nutrition should advance gradually while glucose and electrolytes are monitored for refeeding complications.

## In-depth explanation

Quick answer
Use a central catheter, advance gradually, and monitor glucose plus phosphorus, potassium, and magnesium.

Why this is correct
The CLINIMIX E label bases central versus peripheral delivery on final osmolarity and warns about refeeding complications, hyperglycemia, and electrolyte imbalance. High-risk clients need gradual initiation and laboratory surveillance.

Easy analogy or mental picture
A concentrated solution needs a larger highway, and a depleted metabolism needs a gradual restart with dashboard monitoring.

Memory hook
High osmolarity goes central; high refeeding risk goes slow with labs.

NCLEX decision rule
Match vascular access to final osmolarity and match advancement speed to metabolic risk.

Why the other choices are wrong
A peripheral line is inappropriate for this osmolarity, and rapid full-rate nutrition can worsen refeeding shifts.References
1DailyMed: CLINIMIX ERoute selection by osmolarity and refeeding monitoring

## Clinical scenario

Parenteral-nutrition start
Verify final osmolarity, vascular route, glucose, fluid status, and phosphorus, potassium, and magnesium before and during advancement.

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_For study reference only. Always follow current clinical guidelines and your institution’s protocols._