hard · NCLEX-RN Psychosocial Integrity

A nurse is caring for a 16-year-old client with anorexia nervosa who is receiving enteral nutrition. The nurse notes a gradual decline in the client's serum potassium to 3.1 mEq/L (3.1 mmol/L) [Reference: 3.5–5.0 mEq/L (3.5–5.0 mmol/L)] and magnesium to 1.3 mg/dL (0.53 mmol/L) [Reference: 1.7–2.2 mg/dL (0.70–0.90 mmol/L)]. Which of the following actions should the nurse perform? Select all that apply.

  1. Administer the prescribed oral potassium chloride and magnesium oxide supplements with food or enteral formula.
  2. Implement continuous cardiac telemetry monitoring.
  3. Request an order to increase the enteral nutrition rate to meet calorie goals faster.
  4. Hold the enteral nutrition and flush the feeding tube with 100 mL of warm water.
  5. Assess the client for muscle weakness, tremors, and hyperreflexia.

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