A 9-year-old often comes to the school nurse complaining of stomach pains. The teacher says that the child has lately been somewhat aggressive and stubborn in the classroom. What should the school nurse recognize as the possible trigger for these behaviors?

The correct answer is choice D: Low in phosphorus.

Choice A rationale:

Supplemented with vitamins A, E, and K is not the characteristic of the diet for a child with chronic renal failure. While vitamin supplementation might be necessary in some cases, the primary dietary considerations in chronic renal failure are related to managing electrolyte imbalances, fluid retention, and waste buildup due to compromised kidney function.

Choice B rationale:

High in protein is not the recommended characteristic of the diet for a child with chronic renal failure. Kidneys affected by chronic renal failure have a reduced ability to filter and excrete waste products from protein metabolism. Excessive protein intake can lead to the accumulation of nitrogenous waste products, potentially worsening the condition and contributing to uremia.

Choice C rationale:

Low in vitamin D is not the primary characteristic of the diet for a child with chronic renal failure. Vitamin D metabolism can be affected by kidney dysfunction, but the focus of the diet in chronic renal failure is primarily on managing electrolyte levels, particularly phosphorus and potassium, as well as controlling fluid intake.

Choice D rationale:

Low in phosphorus is the correct characteristic of the diet for a child with chronic renal failure. Impaired kidney function in chronic renal failure leads to difficulty in excreting phosphorus, which can result in elevated blood phosphorus levels. High phosphorus levels can contribute to bone and mineral disorders and cardiovascular complications. Therefore, a diet low in phosphorus is crucial to prevent these complications and manage the progression of the disease.

The correct answer is choice C. The child needs opportunities to play with peers.

Choice A rationale:

While it's important for children with congenital heart disease to understand their limitations, it's not the primary concern in this scenario. Allowing the child to interact and play with peers is essential for their social, emotional, and psychological development.

Choice B rationale:

While parents play a crucial role in a child's care, completely isolating the child from peers is not ideal. Overprotectiveness can lead to social isolation and hinder the child's ability to develop important social skills.

Choice C rationale:

Children with congenital heart disease should be encouraged to engage in age-appropriate physical activities and play with peers. Of course, the level of activity should be discussed with the child's healthcare provider, but limiting the child's interactions could have negative consequences on their overall development and emotional well-being.

Choice D rationale:

While supervision is important for any child's safety, constant parental supervision to avoid overexertion might not be necessary or feasible. Educating the child about their limitations and providing opportunities for play while monitoring their comfort level is a more balanced approach.