A nurse is reinforcing teaching with an older adult client who has osteoporosis.
Which of the following recommendations should the nurse include?

Choice A rationale

Fluid retention in chronic renal failure (CRF) is primarily managed by restricting sodium and fluid intake, not by a low-protein diet. Protein intake primarily impacts nitrogenous waste production, not the homeostatic mechanisms of antidiuretic hormone and aldosterone that regulate fluid volume retention.

Choice B rationale

Protein breakdown yields nitrogenous waste products, primarily in the form of urea. In chronic renal failure, the damaged nephrons lose their capacity to efficiently filter and excrete these wastes, causing them to build up in the bloodstream, leading to symptoms of uremia and an increased BUN.

Choice C rationale

Protein does not impair potassium storage. Hyperkalemia (high potassium) is a common, life-threatening complication of chronic renal failure, often resulting from the kidney's inability to excrete potassium, especially when coupled with certain medications or high dietary intake of potassium.

Choice D rationale

High protein intake, particularly from animal sources, can contribute to calcium loss by increasing the body's acid load. The body then buffers this acid by releasing calcium from the bones, a process unrelated to calcium retention, which is often impaired in renal failure due to Vitamin D metabolism issues.

Choice A rationale

Enoxaparin (a low-molecular-weight heparin) and warfarin (a vitamin K antagonist) are anticoagulants that prevent the formation of new fibrin clots or the enlargement of existing ones, but they do not dissolve established clots; that is the function of thrombolytic agents like tissue plasminogen activator. Administering both aims for adequate anticoagulation until warfarin is fully effective. The correct response emphasizes discontinuing enoxaparin when warfarin is therapeutic.

Choice B rationale

Warfarin, an oral anticoagulant, inhibits vitamin K-dependent clotting factors (II, VII, IX, X), requiring several days to reach a therapeutic effect, which is monitored by the International Normalized Ratio (INR) (therapeutic range typically 2.0–3.0). Enoxaparin, an injectable anticoagulant with immediate onset, is continued concurrently to maintain protection until the INR is therapeutic and adequate anticoagulation is achieved via warfarin alone, a process called bridging.

Choice C rationale

Enoxaparin and warfarin have distinct mechanisms of action and do not enhance each other's effects synergistically; rather, they inhibit different points in the coagulation cascade. Enoxaparin mainly inhibits Factor Xa, while warfarin inhibits Vitamin K-dependent clotting factor synthesis. They are used together to provide immediate anticoagulation (enoxaparin) while awaiting warfarin's delayed onset.

Choice D rationale

While patient education is crucial, responding by deferring the client's question is not therapeutic and does not address the client's need for understanding their therapy. The nurse should explain the rationale for concurrent therapy (bridging) and the planned discontinuation of the injectable drug once the oral medication is within its therapeutic range.