A nurse is providing dietary teaching to a client who has hypocalcemia due to hypoparathyroidism. Which of the following foods should the nurse recommend? (Select all that apply.)

Choice A reason: Sodium. Sodium is not affected by serum phosphate level in chronic kidney disease (CKD) patients. Sodium level is mainly regulated by the renin-angiotensin-aldosterone system and the antidiuretic hormone. Sodium level can be altered by fluid intake, fluid loss, diuretics, or salt restriction, but not by phosphate level.

Choice B reason:

Magnesium. Magnesium is also not affected by serum phosphate level in CKD patients. Magnesium level is mainly influenced by dietary intake, intestinal absorption, renal excretion, and exchange with bone and soft tissues. Magnesium level can be altered by malnutrition, malabsorption, diarrhea, vomiting, diuretics, or alcoholism, but not by phosphate level.

Choice C reason:

Calcium. Calcium is the correct answer because calcium and phosphate have an inverse relationship in the body. When serum phosphate level is elevated, as in CKD patients, serum calcium level tends to decrease. This is because high phosphate level binds to calcium and forms insoluble complexes that are deposited in soft tissues and bones. This reduces the amount of free calcium in the blood and triggers the secretion of parathyroid hormone (PTH), which further lowers the calcium level by increasing its excretion in the urine.

Choice D reason:

Bicarbonate. Bicarbonate is not directly affected by serum phosphate level in CKD patients. Bicarbonate level is mainly determined by the acid-base balance in the body. Bicarbonate level can be altered by metabolic acidosis or alkalosis, respiratory acidosis or alkalosis, renal failure, or diarrhea, but not by phosphate level.

Choice A reason: Pneumothorax: This is a condition where air accumulates in the pleural space, causing the lung to collapse. It can occur during insertion of a central venous catheter if the needle or catheter punctures the lung or the pleura.

Choice B reason:. Air embolism. This is a condition where air bubbles enter the bloodstream and obstruct blood flow. It can occur during insertion, removal or maintenance of a central venous catheter if air enters the catheter or the vein.

Choice C reason:. Catheter-related bloodstream infection. This is an infection that occurs when microorganisms colonize the catheter or the insertion site and enter the bloodstream. It can cause fever, chills, sepsis and other serious complications. It can be prevented by using strict aseptic technique and following infection control guidelines.

Choice D reason:. Catheter occlusion. This is a condition where the catheter lumen becomes blocked by blood clots, fibrin sheaths, precipitates or kinks. It can impair the infusion or withdrawal of fluids and medications. It can be prevented by flushing the catheter regularly with saline or heparin solutions.

Choice E reason: Hematoma formation. This is a condition where blood accumulates under the skin or in the tissues around the insertion site. It can occur due to bleeding from the punctured vein or artery, or from trauma to the site. It can cause pain, swelling, bruising and infection.