A nurse is reviewing the laboratory findings of a client who has heart failure. Which of the following findings indicates that the client is experiencing fluid volume excess?

Choice A reason: Recommending a total fat intake of 12 g each day is not an appropriate action for the nurse to take because it is too low for most adults. The recommended dietary allowance (RDA. for fat is 20 to 35% of total calories per day, which translates to about 44 to 78 g of fat per day for an average adult who consumes 2,000 calories per day.

Choice B reason: Referring the client to a weight-loss support group is not an appropriate action for the nurse to take because the client does not need to lose weight. A body mass index (BMI) of 22 is within the normal range, which is 18.5 to 24.9. A weight-loss support group is more suitable for clients who have a BMI of 25 or higher, which indicates overweight or obesity.

Choice C reason: Advising the client to add 500 calories per day to the diet is not an appropriate action for the nurse to take because it may lead to weight gain. A client who has a BMI of 22 does not need to increase their caloric intake unless they have other medical conditions or nutritional needs that require more calories. Adding 500 calories per day to the diet can result in gaining about one pound per week, which can increase the risk of obesity and its complications.

Choice D reason: Encouraging the client to continue current daily caloric intake is an appropriate action for the nurse to take because it can help maintain a healthy weight. A client who has a BMI of 22 has a balanced energy intake and expenditure, which means that they consume enough calories to meet their metabolic needs and physical activity level. Continuing current daily caloric intake can prevent weight loss or gain and promote health and wellness.

Choice A reason: Dietary restrictions will not eventually allow the intake of gluten to resume. Gluten is a protein found in wheat, barley, rye, and some oats. It causes damage to the small intestine in people with celiac disease. The only treatment for celiac disease is a lifelong gluten-free diet.

Choice B reason: This condition may cause secondary lactose intolerance. Lactose is a sugar found in milk and dairy products. It is broken down by an enzyme called lactase in the small intestine. People with celiac disease may have reduced levels of lactase due to the damage to the small intestine caused by gluten. This can lead to lactose intolerance, which is the inability to digest lactose properly. Symptoms of lactose intolerance include bloating, gas, diarrhea, and abdominal pain after consuming dairy products.

Choice C reason: Nutritional therapy for this condition does not include limiting proteins and calories. People with celiac disease need adequate amounts of proteins and calories to maintain their health and prevent malnutrition. They also need to ensure that they get enough vitamins, minerals, and fiber from gluten-free sources.

Choice D reason: A normal diet cannot resume after a period of remission. Celiac disease is a chronic autoimmune disorder that does not have a cure. Even if the symptoms improve or disappear, the damage to the small intestine can still occur if gluten is consumed. Therefore, a strict gluten-free diet must be followed for life.