A nurse is caring for a client who has anorexia nervosa. Which of the following findings should the nurse identify as an indication of refeeding syndrome?

A. While some clients may experience improved energy as nutritional intake improves, this is not a sign of refeeding syndrome. Refeeding syndrome is a metabolic complication characterized by dangerous shifts in fluids and electrolytes, not subjective energy changes. Increased energy alone does not reflect electrolyte disturbances or cardiac/neurological risks associated with the syndrome. B. Peripheral edema is a key early clinical indicator of refeeding syndrome. When a severely malnourished client begins to receive nutrition (especially carbohydrates), insulin secretion increases. This causes a rapid intracellular shift of electrolytes such as phosphate, potassium, and magnesium, leading to hypophosphatemia, hypokalemia, and hypomagnesemia. Sodium and fluid retention often accompany these shifts, resulting in edema—commonly in the extremities. Edema may appear as swelling of the feet, ankles, or legs and can indicate impending complications such as cardiac failure, arrhythmias, or respiratory distress. Identifying edema early allows the nurse to slow feeding rates, monitor electrolytes closely, and prevent life-threatening complications. C. An increased appetite is expected during nutritional rehabilitation but is not specific to refeeding syndrome. While it may reflect recovery from malnutrition, it does not indicate dangerous fluid or electrolyte shifts. D. A gradual weight gain of 0.5–1 kg per week is generally considered safe in clients with anorexia nervosa. Rapid or excessive weight gain could increase the risk for refeeding complications, but this measured increase alone is not indicative of refeeding syndrome.