The nurse is providing discharge teaching on nutritional therapy to a patient with stage 3 chronic kidney disease. Which statement by the patient suggests to the nurse that additional teaching is required?

"It's important for me to avoid foods that are high in sodium such as canned soups and processed meats."

"I should limit my intake of high-potassium foods like bananas and tomatoes."

"I will eat a high-protein diet with lots of dark green, leafy vegetables."

"I need to monitor my fluid intake to prevent fluid overload."

Answer and Explanation

The Correct Answer is C

Choice A reason: Avoiding foods that are high in sodium such as canned soups and processed meats is correct. High sodium intake can worsen fluid retention and hypertension, which are concerns in chronic kidney disease.

Choice B reason: Limiting intake of high-potassium foods like bananas and tomatoes is correct. High potassium levels can lead to dangerous cardiac arrhythmias in patients with chronic kidney disease.

Choice C reason: Eating a high-protein diet with lots of dark green, leafy vegetables is incorrect. While protein is important, excessive protein intake can increase the workload on the kidneys. Patients with chronic kidney disease often need to limit protein intake to prevent further kidney damage. Additionally, dark green, leafy vegetables are high in potassium, which should be limited.

Choice D reason: Monitoring fluid intake to prevent fluid overload is correct. Fluid overload can lead to hypertension, edema, and heart failure in patients with chronic kidney disease.

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Correct Answer is C

Explanation

Choice A reason: Reminding the patient that they will be responsible for caring for the ileostomy after discharge may increase their anxiety and reluctance. It does not address the underlying concerns or feelings.

Choice B reason: Reassuring the patient that the procedure will be reversed in a few months is not always accurate and may provide false hope. Each patient's situation is unique, and not all ileostomies are temporary.

Choice C reason: Acknowledging the patient's reluctance and initiating a discussion to explore their feelings is the most appropriate response. This approach allows the nurse to understand the patient's concerns, provide emotional support, and offer practical solutions to help the patient feel more comfortable with ostomy care.

Choice D reason: Discussing the need for a psychiatric referral during interdisciplinary rounds is not the immediate step. The nurse should first address the patient's feelings and concerns directly and provide support.

A. Normal blood pressure, deep respirations B. Increased alertness, normal heart rhythm C. High urine specific gravity, normal temperature D. Blood glucose of 250 mg/dL, disorientation

Correct Answer is B

Explanation

Choice A reason:

Normal blood pressure may indicate improved hydration, but deep respirations (often seen in metabolic acidosis or DKA) suggest that the patient is still experiencing distress. This combination does not reliably signal effective treatment for HHS.

Choice B reason:

Increased alertness shows that the patient’s mental status is improving, reflecting better cerebral perfusion and hydration.
A normal heart rhythm indicates that potassium levels are stable (thanks to the potassium chloride in the IV fluids) and that the insulin therapy is not causing dangerous shifts.
Together, these findings are the best indicators that the treatment is effective.

Choice C reason:

A high urine specific gravity reveals that the urine is still concentrated, which means dehydration persists.
Although the temperature is normal, the continued dehydration is not consistent with effective treatment of HHS.

Choice D reason:

A blood glucose of 250 mg/dL suggests that hyperglycemia is being corrected; however, persistent disorientation indicates that the patient’s mental status has not improved, meaning that the treatment has not fully resolved the critical aspects of HHS.

Thus, Choice B (Increased alertness, normal heart rhythm) is the best indicator of effective treatment.

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The nurse is providing discharge teaching on nutritional therapy to a patient with stage 3 chronic kidney disease. Which statement by the patient suggests to the nurse that additional teaching is required?

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Naxlex Comprehensive Predictor Exams

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