A nurse is gathering medical history from a client admited for pyelonephritis. Which of the following should the nurse expect the client to report when asked about their medical history?

The correct answer is choice D. “Adding pecans will be a change I can readily make.”

Choice A rationale: Cantaloupe is a fruit that is high in potassium. For individuals with acute kidney injury, it is important to limit potassium intake because their kidneys may not be able to effectively eliminate excess potassium from the bloodstream. Therefore, choosing cantaloupe for a snack would not indicate an understanding of the dietary restrictions necessary for managing potassium levels.

Choice B rationale: Baked potatoes are another food item that contains a significant amount of potassium. Similar to cantaloupe, consuming baked potatoes would not be advisable for someone who needs to control their potassium intake due to impaired kidney function. The client’s statement about adding baked potatoes to their diet does not reflect an understanding of the teaching provided.

Choice C rationale: Yogurt, while a nutritious food, also contains a considerable amount of potassium. For a client with acute kidney injury, eating yogurt could contribute to an undesirable increase in potassium levels, which the damaged kidneys may not be able to process efficiently. Thus, the client’s interest in eating yogurt does not demonstrate a correct understanding of the dietary guidelines given their condition.

Choice D rationale: Pecans are a low-potassium food option, making them a suitable choice for someone with acute kidney injury who needs to monitor and limit their potassium intake. The client’s willingness to add pecans to their diet indicates a proper understanding of the dietary changes necessary to manage their condition effectively. Therefore, this choice is the correct answer.

Choice A reason: A pH of 7.26 indicates acidosis, but an HCO3 of 24 and PaCO2 of 46 suggest a respiratory cause rather than metabolic, which is not typical for AKI.

Choice B reason: A pH of 7.49 indicates alkalosis, and with an HCO3 of 30 and PaCO2 of 40, this suggests metabolic alkalosis, which is not expected in AKI.

Choice C reason: A pH of 7.49 indicates alkalosis. An HCO3 of 24 is normal, and a PaCO2 of 30 would suggest respiratory alkalosis, not typically associated with AKI.

Choice D reason: A pH of 7.26 indicates acidosis, and with an HCO3 of 14, this suggests metabolic acidosis, which is consistent with AKI. The PaCO2 of 30 indicates a compensatory respiratory response to the metabolic acidosis. This ABG result aligns with the expected findings in a patient with AKI, where there is an accumulation of acids and a decrease in bicarbonate due to the kidneys' inability to filter and excrete hydrogen ions effectively.