A nurse is providing dietary teaching to a client who has frequent kidney stones. Which of the following instructions should the nurse include in the teaching?
"Take a vitamin C supplement twice daily."
"Avoid eating tree nuts, such as almonds."
"Increase the amount of protein in your diet."
"Limit your intake of dairy products."
The Correct Answer is B
A. "Take a vitamin C supplement twice daily.” High doses of Vitamin C can be metabolized into oxalate by the body. Since calcium oxalate stones are the most common type of kidney stone, increasing oxalate production increases the risk of stone formation.
B. "Avoid eating tree nuts, such as almonds.” The majority of kidney stones are made of calcium oxalate. Clients prone to these stones should limit foods high in oxalates to reduce the amount of oxalate filtered by the kidneys. High-oxalate foods include tree nuts (almonds, cashews), spinach, rhubarb, beets, and chocolate.
C. "Increase the amount of protein in your diet.” High intake of animal protein increases the excretion of calcium and uric acid while decreasing urinary citrate (which helps prevent stones). This creates an environment conducive to stone formation.
D. "Limit your intake of dairy products.” Calcium in the digestive tract binds to oxalate, preventing the oxalate from being absorbed into the bloodstream. If a client restricts calcium, more unbound oxalate is absorbed and excreted by the kidneys, increasing the risk of stones. Normal calcium intake is recommended.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "Toys that can't be dry cleaned or washed must be thrown out." Non-washable items (like stuffed animals) do not need to be discarded. They can be sealed in a plastic bag for 2 weeks. The lice will die from starvation/lack of a host within that time frame.
B. "All recently used clothing, bedding, and towels must be washed in hot water." Lice and nits (eggs) are killed by exposure to heat. Items used by the child in the 2 days prior to treatment should be machine washed in hot water (>130°F or 54.4°C) and dried on a high heat cycle.
C. "My child must be free from nits before returning to school." While some schools historically had "no nit" policies, the American Academy of Pediatrics (AAP) and CDC now recommend that students can return to school after the first treatment has started. Nits (eggs) are cemented to the hair shaft and are not contagious; only live lice transmit the infestation.
D. "I will treat all the family members to be on the safe side." Prophylactic treatment with pediculicides is not recommended due to exposure to toxic chemicals and the risk of resistance. Only family members who are actually infested (live lice found) or those who share a bed with the infested child should be treated.
Correct Answer is A
Explanation
A. Lower the height of the solution container:Cramping during an enema is usually caused by the solution flowing too fast or the colon distending too rapidly. The speed of the flow is determined by gravity (the height of the bag). Lowering the bag slows the infusion rate, which typically relieves the cramping, allowing the nurse to continue the procedure safely.
B. Allow the client to expel some fluid before continuing:If the client expels the fluid immediately, the enema will not be effective because the solution has not been retained long enough or reached high enough into the colon to break up the fecal impaction.
C. Encourage the client to bear down:Bearing down increases intra-abdominal pressure and promotes defecation. The goal at this stage is retention of the fluid, not expulsion.
D. Stop the enema and document that the client did not tolerate the procedure:Cramping is a common and manageable side effect. Stopping the procedure completely is premature; the nurse should attempt to alleviate the discomfort (by slowing the flow) first.
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