A nurse is reinforcing dietary teaching to a client with diabetes. Which meal choice is most appropriate?

Choice A reason: Chloride levels are less critical in cirrhosis compared to sodium. Chloride imbalances may occur secondary to diuretic use or acid-base disturbances, but they do not directly drive major complications like ascites or edema. Monitoring is less urgent, as chloride fluctuations are typically managed indirectly through fluid and electrolyte balance.

Choice B reason: Calcium levels are not the primary concern in cirrhosis. Hypocalcemia may occur due to malnutrition or vitamin D deficiency from liver dysfunction, but it is less immediate than sodium imbalances. Calcium affects bone health and muscle function but does not directly impact acute cirrhosis complications like ascites.

Choice C reason: Sodium is critical to monitor in cirrhosis due to its role in fluid balance. Hyponatremia, common in advanced cirrhosis, results from impaired water excretion and portal hypertension, contributing to ascites and edema. Dilutional hyponatremia can worsen encephalopathy or indicate decompensation, requiring urgent management to stabilize the patient.

Choice D reason: Potassium monitoring is important, especially with diuretic use in cirrhosis, as hypokalemia or hyperkalemia can occur. However, sodium imbalances more directly influence fluid retention and ascites, making it a higher priority. Potassium affects cardiac and muscle function but is secondary to sodium in acute cirrhosis management.

Choice A reason: Keeping the drainage bag above the abdomen is incorrect, as it would impede bile drainage by gravity. The T-tube bag should be below the abdomen to facilitate bile flow and prevent backup, which could cause infection or bile peritonitis in post-cholecystectomy care.

Choice B reason: Clamping the T-tube before and after meals is not standard practice. Clamping may be done temporarily to assess bile flow before T-tube removal, but routine clamping risks bile accumulation, potentially causing leaks or infection, making this an inappropriate nursing action.

Choice C reason: Encouraging a high-fat diet is contraindicated post-cholecystectomy, as it may overwhelm the bile system, causing discomfort or complications, especially with a T-tube. A low-fat diet is recommended to minimize bile demand, making this action incorrect for safe patient recovery.

Choice D reason: Assessing and recording T-tube drainage color and amount is critical to monitor bile output, detect blockages, or identify complications like infection or bile leak. Normal bile is green-yellow; changes may indicate issues, making this the appropriate nursing action for post-cholecystectomy care with a T-tube.