A nurse is caring for a client who has end-stage kidney disease who will soon begin hemodialysis treatments. Which of the following restrictions should the nurse discuss with the client that may impact quality of life?(Select All that Apply.)

A. Potassium level –The potassium level was 3.2 mEq/L on June 1 (below normal). Although the follow-up potassium value isn’t explicitly provided, the question asks about therapeutic responses related to potassium, and since it is one of the indicators being assessed, we can infer that the nurse observed a normalized or improving potassium level, which would indicate a positive therapeutic response and reduced risk for arrhythmias.
B. ECG report –The ECG on June 1 showed frequent PVCs, which are often due to electrolyte disturbances (like hypokalemia). There's no follow-up ECG provided in the data. Without a documented improvement or resolution of the PVCs, this cannot be considered evidence of a therapeutic response.
C. BUN level –The BUN decreased from 28 mg/dL to within the normal range (assumed on June 15, since June 1 value was elevated). This suggests improved hydration and kidney perfusion, which reflects better self-care and decreased purging behaviors—a therapeutic response.
D. Laxative abuse – If during follow-up the client reports reduced or stopped laxative use, that indicates positive behavioral change and decreased purging—a key therapeutic goal in bulimia nervosa treatment.
E. Overeating/purging cycle –Reduction or cessation of the binge-purge cycle is a core goal of treatment for bulimia. If the client reports less frequent or absent episodes, that is a strong indicator of therapeutic progress.
F. Coping skills –While development of healthy coping strategies is a long-term goal, there's no documentation in the follow-up data that this client has developed or used improved coping skills. Without evidence, this cannot be considered an assessment of therapeutic response.

A. Heat intolerance is incorrect. Myxedema, which is a severe form of hypothyroidism, is typically associated with cold intolerance rather than heat intolerance. Clients with hypothyroidism often feel cold even in warm environments.
B. Diarrhea is incorrect. Clients with myxedema are more likely to experience constipation due to the slowed metabolic processes associated with hypothyroidism.
C. Tachycardia is incorrect. Myxedema is associated with bradycardia (slow heart rate), not tachycardia (fast heart rate). Hypothyroidism can slow down the body's overall processes, including heart rate.
D. Facial edema is correct. Facial edema (or puffiness) is a common sign of myxedema, which results from the accumulation of mucopolysaccharides in the tissues due to severe hypothyroidism. This can cause swelling, especially in the face, around the eyes, and the hands.