A nurse is caring for a patient whose sodium level is 118 mEq/L. Which nursing diagnosis is a priority for this patient?

Choice A Reason: This is correct because phosphorus is a mineral that is essential for bone health, energy metabolism, and acid-base balance. Hypophosphatemia is a low level of phosphorus in the blood, which can cause muscle weakness, bone pain, and confusion. The nurse should request a dietitian consult for selecting foods high in phosphorus, such as dairy products, meat, fish, eggs, nuts, and beans.

Choice B Reason: This is incorrect because poultry, peanuts, and seeds are foods that are high in phosphorus, not low. The nurse should not instruct the patient to avoid these foods, as they can help increase the serum phosphorus level and prevent further complications of hypophosphatemia.

Choice C Reason: This is incorrect because aluminum hydroxide antacids are medications that can lower the serum phosphorus level by binding to phosphorus in the gastrointestinal tract and preventing its absorption. The nurse should not provide aluminum hydroxide antacids as prescribed, as they can worsen the patient's condition and cause aluminum toxicity. The nurse should consult with the provider about alternative medications for treating stomach ulcers that do not affect phosphorus levels.

Choice D Reason: This is incorrect because sodium phosphate is a medication that can raise the serum phosphorus level by providing supplemental phosphorus. The nurse should not instruct the patient to avoid the intake of sodium phosphate, as it can help correct hypophosphatemia and restore normal phosphorus balance. The nurse should administer sodium phosphate as ordered and monitor the patient's serum phosphorus level and renal function.

Choice A: Furosemide (Lasix) is incorrect because it is a diuretic that increases urine output and potassium excretion. However, this medication is not effective for patients with chronic renal failure who have oliguria or anuria.

Furosemide can also cause hypokalemia, which is a low potassium level.

Choice B: Sodium polystyrene sulfonate (Kayexalate) is correct because it is a cation exchange resin that binds to potassium in the gastrointestinal tract and removes it from the body through feces. This medication can lower the serum potassium level and prevent hyperkalemia, which is a high potassium level.

Choice C: Dextrose 10% is correct because it is a hypertonic solution that raises the blood glucose level and stimulates the release of insulin. Insulin helps to move potassium from the extracellular fluid into the cells, thus lowering the serum potassium level.

Choice D: Sodium bicarbonate is correct because it is an alkalizing agent that corrects metabolic acidosis, which is a common complication of chronic renal failure. Metabolic acidosis can cause potassium to shift from the intracellular fluid to the extracellular fluid, thus raising the serum potassium level. Sodium bicarbonate can reverse this effect and lower the serum potassium level.

Choice E: Insulin is correct because it also helps to move potassium from the extracellular fluid into the cells, thus lowering the serum potassium level. Insulin can be given intravenously with dextrose 10% to prevent hypoglycemia, which is a low blood glucose level.