The nurse is preparing an adolescent for discharge after a cardiac catheterization. Which statement by the adolescent would indicate the need for further teaching?

The correct answer is choice D: Low in phosphorus.

Choice A rationale:

Supplemented with vitamins A, E, and K is not the characteristic of the diet for a child with chronic renal failure. While vitamin supplementation might be necessary in some cases, the primary dietary considerations in chronic renal failure are related to managing electrolyte imbalances, fluid retention, and waste buildup due to compromised kidney function.

Choice B rationale:

High in protein is not the recommended characteristic of the diet for a child with chronic renal failure. Kidneys affected by chronic renal failure have a reduced ability to filter and excrete waste products from protein metabolism. Excessive protein intake can lead to the accumulation of nitrogenous waste products, potentially worsening the condition and contributing to uremia.

Choice C rationale:

Low in vitamin D is not the primary characteristic of the diet for a child with chronic renal failure. Vitamin D metabolism can be affected by kidney dysfunction, but the focus of the diet in chronic renal failure is primarily on managing electrolyte levels, particularly phosphorus and potassium, as well as controlling fluid intake.

Choice D rationale:

Low in phosphorus is the correct characteristic of the diet for a child with chronic renal failure. Impaired kidney function in chronic renal failure leads to difficulty in excreting phosphorus, which can result in elevated blood phosphorus levels. High phosphorus levels can contribute to bone and mineral disorders and cardiovascular complications. Therefore, a diet low in phosphorus is crucial to prevent these complications and manage the progression of the disease.

The correct answer is choice C. Therapeutic management includes administration of gamma globulin and aspirin.

Choice A rationale:

The child's fever in Kawasaki disease is not usually responsive to antibiotics within 48 hours. Kawasaki disease is an inflammatory condition of blood vessels, and it doesn't typically respond to antibiotics. The fever associated with Kawasaki disease often persists even with appropriate treatment, and the management focuses on reducing inflammation and preventing complications.

Choice B rationale:

Aspirin is not contraindicated in Kawasaki disease. In fact, aspirin is a key component of the therapeutic management of Kawasaki disease. It is used to reduce inflammation and prevent the development of coronary artery aneurysms, a severe complication of the disease. However, the dosing of aspirin in Kawasaki disease is different from its use for pain relief, and it should be administered under medical supervision.

Choice C rationale:

Therapeutic management of Kawasaki disease does include administration of gamma globulin and aspirin. Gamma globulin is given to reduce the risk of coronary artery involvement and aneurysm formation. Aspirin, at a specific dose regimen, is used to decrease inflammation and platelet aggregation, thus preventing clot formation in the coronary arteries.

Choice D rationale:

The principal area of involvement in Kawasaki disease is not the joints. Kawasaki disease primarily affects the blood vessels, particularly the coronary arteries. The inflammation of these arteries can lead to the development of coronary artery aneurysms, which is a critical concern in Kawasaki disease. Joint involvement is not a prominent feature of this condition.