A nurse is teaching a client with diabetes insipidus about the causes of hypernatremia. Which of the following statements by the client indicates a need for further teaching?

• Choice A reason:

• Administering calcium supplements orally or IV is not an appropriate intervention for a client with hypocalcemia. Calcium supplements can cause hypercalcemia, which can lead to cardiac arrhythmias, kidney stones, and constipation. Calcium supplements should only be given if the hypocalcemia is severe or symptomatic and under the supervision of a physician.

• Choice B reason:

• Monitoring the client for signs of tetany and seizures is an appropriate intervention for a client with hypocalcemia. Hypocalcemia can cause increased neuromuscular excitability, which can manifest as muscle spasms, cramps, twitching, or convulsions. Tetany is a condition where the muscles contract involuntarily and can affect the hands, feet, face, or larynx. Seizures are a result of abnormal electrical activity in the brain that can be triggered by low calcium levels. The nurse should monitor the client for these signs and intervene promptly to prevent complications.

• Choice C reason:

• Providing a high-phosphorus diet is not an appropriate intervention for a client with hypocalcemia. Phosphorus and calcium have an inverse relationship in the body, meaning that when one is high, the other is low. A high-phosphorus diet can lower the serum calcium level further and worsen the hypocalcemia. The nurse should advise the client to avoid foods high in phosphorus, such as dairy products, meat, poultry, fish, eggs, nuts, seeds, beans, and cola drinks.

• Choice D reason:

• Avoiding stimulating the facial nerve is not an appropriate intervention for a client with hypocalcemia. Stimulating the facial nerve can elicit a positive Chvostek's sign, which is a facial twitching that occurs when the nerve is tapped near the ear. A positive Chvostek's sign indicates hypocalcemia and increased neuromuscular irritability. However, avoiding stimulating the facial nerve does not prevent or treat hypocalcemia. The nurse should monitor the client for other signs of hypocalcemia and administer calcium as prescribed.

Choice A reason:

Avoiding foods that are high in protein is not necessary for a client with diabetes insipidus. Protein intake does not affect the serum sodium level or the urine output in this condition. Therefore, this statement does not indicate a need for further teaching.

Choice B reason:

Drinking water whenever thirsty is not adequate for a client with diabetes insipidus. This condition causes excessive urine output and dehydration, which can lead to hypernatremia (high sodium level in the blood) The client should drink fluids according to a prescribed schedule and monitor the urine specific gravity to prevent fluid imbalance. Therefore, this statement indicates a need for further teaching.

Choice C reason:

Taking the prescribed medication as directed is important for a client with diabetes insipidus. The medication is usually a synthetic form of antidiuretic hormone (ADH), which helps the kidneys retain water and reduce urine output. This can prevent dehydration and hypernatremia. Therefore, this statement does not indicate a need for further teaching.

Choice D reason:

Limiting the intake of salt and salty foods is advisable for a client with diabetes insipidus. Salt intake can increase the serum sodium level and worsen the fluid imbalance. The client should follow a low-sodium diet and avoid processed foods, canned foods, and table salt. Therefore, this statement does not indicate a need for further teaching.