A nurse is caring for a client who follows a vegan diet. The nurse should identify that the client is at risk for which of the following deficiencies?

Choice A reason: Bran cereal is high in phosphorus, containing about 34% of the DV per cup (118 g) ( 1 ). Phosphorus is a mineral that helps build strong bones and teeth, but too much of it can cause problems for people with kidney disease. The kidneys normally filter out excess phosphorus from the blood, but when they are damaged, phosphorus can build up and cause bone loss, itching, and calcification of blood vessels and organs ( 2 ).

Choice B reason: A medium apple is low in phosphorus, containing only 3% of the DV per 182 g ( 3 ). Apples are also a good source of fiber, vitamin C, and antioxidants. They can help lower blood pressure, cholesterol, and blood sugar levels, which are beneficial for people with kidney disease ( 4 ).

Choice C reason: Scrambled eggs are moderate in phosphorus, containing about 12% of the DV per large egg (50 g) ( 5 ). Eggs are also high in protein, which can increase the workload of the kidneys and worsen kidney function. People with kidney disease should limit their protein intake to 0.8 g per kg of body weight per day, unless advised otherwise by their doctor ( 6 ).

Choice D reason: Ground turkey is high in phosphorus, containing about 16% of the DV per 3 oz (85 g) ( 7 ). Ground turkey is also high in protein, which can have the same negative effects as eggs on kidney function. People with kidney disease should choose lean meats and poultry, and eat them in moderation.

Choice C reason: This statement shows that the client has understood the importance of vitamin D and calcium for bone health. Fortified milk, fatty fish, and cheese are good sources of both nutrients, which help to maintain bone density and prevent osteoporosis.

Choice A reason: This statement is incorrect, as vitamin A supplementation can have adverse effects on bone health. Excessive intake of vitamin A can increase the risk of fractures and reduce bone mineral density.

Choice B reason: This statement is partially correct, as calcium supplementation can help to meet the daily requirement of calcium for bone health. However, calcium alone is not enough, as vitamin D is also needed to facilitate the absorption of calcium and prevent its loss from the bones.

Choice D reason: This statement is irrelevant, as none of the foods mentioned are particularly beneficial for bone health. Orange juice, lean meats, and egg whites are good sources of vitamin C, protein, and biotin, respectively, but they do not provide significant amounts of vitamin D or calcium.