A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client’s diet to maximize the therapeutic effect and minimize the risks of complications. The client’s diet should include which of the following modifications?

Increased potassium intake

Increased protein intake

Decreased phosphorus intake

Decreased calcium intake/supplementation

Answer and Explanation

The Correct Answer is C

Choice A reason: Increased potassium intake is dangerous in ESRD, as impaired kidneys cannot excrete potassium, leading to hyperkalemia. This can disrupt cardiac membrane potentials, causing arrhythmias or cardiac arrest. ESRD diets require strict potassium restriction to prevent life-threatening electrolyte imbalances, making this modification inappropriate.

Choice B reason: Increased protein intake is often recommended in ESRD patients on hemodialysis to replace protein lost during dialysis and prevent malnutrition. However, it must be balanced to avoid excess urea production, which can worsen uremia. This is not the primary focus compared to phosphorus management in this context.

Choice C reason: Decreased phosphorus intake is critical in ESRD, as kidneys cannot excrete phosphate, leading to hyperphosphatemia. This causes vascular calcification and secondary hyperparathyroidism, increasing cardiovascular risk. Dietary phosphorus restriction, often with phosphate binders, prevents these complications, making it a key dietary modification for hemodialysis patients.

Choice D reason: Decreased calcium intake is not recommended in ESRD, as patients often have hypocalcemia due to impaired vitamin D activation and phosphate retention. Calcium supplementation or adequate intake is needed to prevent bone disease and secondary hyperparathyroidism, making this modification incorrect for ESRD management.

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Correct Answer is D

Explanation

Choice A reason: Apologizing for the question may imply it was inappropriate, undermining the therapeutic intent to explore emotions. Homelessness is a valid topic in mental health care, and apologizing could discourage further discussion, disrupting trust and the client’s ability to process and express difficult emotions.

Choice B reason: Encouraging a list of concerns shifts focus to problem-solving prematurely, potentially overwhelming the client who is processing emotions. This action disregards the client’s need for reflection, which is critical in therapeutic communication to facilitate emotional expression and address underlying psychological distress effectively.

Choice C reason: Diverting the subject avoids the client’s emotional response, missing a therapeutic opportunity to explore feelings about homelessness. This can signal discomfort with the topic, reducing trust and hindering the client’s ability to process trauma, which is essential for mental health recovery and coping.

Choice D reason: Sitting quietly allows the client time to process complex emotions about homelessness, fostering a safe therapeutic environment. Silence supports reflection, enabling the client to articulate feelings at their pace, which enhances trust and facilitates deeper emotional exploration, making it the most therapeutic response in this context.

A. A client with schizophrenia living in a single-family home with siblings B. A homeless client arrested for petty theft of groceries from a convenience store C. A client addicted to alcohol who has two driving under the influence offenses D. A client with depression who was laid off from three jobs in the last 6 months

Correct Answer is C

Explanation

Choice A reason: Schizophrenia alone does not typically warrant court-mandated outpatient treatment unless associated with criminal behavior. Living with family suggests stability, reducing the likelihood of court intervention. Mandates are linked to legal infractions, not diagnosis alone, making this client less likely for mandated treatment.

Choice B reason: Petty theft may lead to legal consequences, but courts typically mandate treatment for offenses directly tied to mental health or substance use, like DUI. A single theft may not justify mandated outpatient mental health treatment unless it explicitly stems from a diagnosable condition requiring intervention.

Choice C reason: Two DUI offenses indicate repeated substance use (alcohol) posing public safety risks. Courts often mandate outpatient treatment for substance abuse in DUI cases to address addiction and prevent recidivism, making this client the most likely to receive a court-ordered treatment mandate for outpatient care.

Choice D reason: Job loss due to depression does not typically result in court-mandated treatment, as it lacks a criminal component. Treatment may be recommended, but courts intervene when behavior poses legal or safety risks, like DUI, making this client less likely for mandated outpatient treatment.

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A client with end-stage kidney disease is scheduled to begin hemodialysis. The nurse is working with the client to adapt the client’s diet to maximize the therapeutic effect and minimize the risks of complications. The client’s diet should include which of the following modifications?

Nursing Test Bank

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Correct Answer is D

Explanation

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Correct Answer is C

Explanation

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