# A severely malnourished client develops new findings after parenteral nutrition is started. Which plan is best?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522662&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A severely malnourished client develops new findings after parenteral nutrition is started. Which plan is best?

History

Vitals

Labs

Orders

Notes

Minimal intake for 10 days with marked recent weight loss; parenteral nutrition started yesterday

(데이터 없음)

(데이터 없음)

Nutrition advancement and electrolyte replacement require clinical reassessment

(데이터 없음)

1

Advance immediately to the full calorie goal and defer electrolyte replacement.

✕

2

Slow or pause calorie advancement, replace deficient electrolytes, provide ordered thiamine, and monitor closely.

✕

3

Remove all phosphorus from the nutrition formula because the serum level fell.

✕

4

Treat the edema with unrestricted sodium and stop checking cardiac rhythm.

✕

## 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.

## In-depth explanation

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.

Memory hook
Product, access, compatibility, infusion cue, protective action, and reassessment.

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
2DailyMed: CLINIMIX sulfite-free parenteral nutritionHyperglycemia, refeeding syndrome, infection, laboratory monitoring, and safe discontinuation considerations

## Clinical scenario

Blood product, nutrition, and intravenous-fluid safety review
Verify the product, prescription, route, access device, filter or tubing, compatibility, baseline findings, emerging adverse cues, response plan, and measurable follow-up.

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