A nurse is working in an outpatient clinic. A patient states that they have heard the best way to lose weight is with a high protein diet. The nurse’s response to this is which of the following statements?

Choice A reason: High protein diets (>2.0 grams/kg daily) increase nitrogen from amino acid metabolism, forming urea that kidneys must excrete. Excessive nitrogen load can strain kidneys, potentially causing damage in susceptible individuals (e.g., those with renal disease), as filtration demands exceed normal capacity, leading to renal stress.

Choice B reason: Sodium is primarily linked to fluid balance and blood pressure, not protein metabolism. While high sodium intake can strain kidneys, it is not the primary substance excreted in high protein diets, which produce nitrogen waste, making sodium an incorrect choice for this context.

Choice C reason: Water is essential for kidney function, aiding waste excretion, but it is not a substance produced by protein metabolism. High protein diets increase water needs indirectly, but the kidneys excrete nitrogen-based urea, not water, making this an incorrect choice for the question.

Choice D reason: Potassium is involved in electrolyte balance, not directly linked to protein metabolism. High protein diets do not significantly increase potassium excretion compared to nitrogen, which forms urea, the primary waste product taxing kidneys, making potassium an incorrect choice for this question.

Choice A reason: Positive nitrogen balance occurs when nitrogen intake exceeds excretion, promoting muscle growth, as seen in athletes or pregnancy. In elderly clients with muscle wasting, protein breakdown exceeds synthesis, leading to muscle loss, making this an incorrect assumption for the observed condition.

Choice B reason: Gluconeogenesis is the liver’s process of synthesizing glucose from non-carbohydrate sources, like amino acids, during starvation or low carbohydrate intake. While it may occur in muscle wasting, it is not the primary cause or indicator, as muscle loss is driven by protein catabolism.

Choice C reason: Negative nitrogen balance indicates protein breakdown exceeds intake, common in elderly clients with muscle wasting due to inadequate protein consumption, illness, or reduced absorption. This leads to muscle loss, as amino acids are not sufficiently replaced, aligning with the observed symptoms.

Choice D reason: Ketosis occurs when the body burns fat for energy, producing ketones, typically during low-carbohydrate diets. While it may accompany malnutrition, it is not directly linked to muscle wasting, which is primarily driven by protein deficiency and catabolism in this context.