Editing Nutrition – RN Practice Questions (section)

==Question 2==
A nurse is initiating enteral nutrition for a client with anorexia nervosa who has eaten almost nothing for three weeks. Which laboratory values should the nurse monitor closely for refeeding syndrome? '''Select all that apply.'''
# Serum phosphorus
# Serum potassium
# Serum magnesium
# Serum albumin
# Serum bilirubin

'''Answer:''' 1, 2, and 3. Serum phosphorus, potassium, and magnesium.

''Rationale:'' When carbohydrate is reintroduced to a starved client, insulin surges and drives phosphate, potassium, and magnesium from the extracellular space into the cells. The hallmark abnormality is hypophosphatemia, and the accompanying hypokalemia and hypomagnesemia produce cardiac dysrhythmias, respiratory muscle weakness, seizures, and death. Thiamine is also depleted and is replaced before feeding begins. Albumin has a half-life of about 18 to 21 days and does not shift acutely, so it is useless for detecting refeeding syndrome. Bilirubin reflects hepatobiliary function and is not part of refeeding monitoring.