A nurse is teaching a client who has chronic kidney disease about dietary modifications. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason:

A client who has chronic kidney disease should limit the intake of bananas and oranges because they are high in potassium, which can accumulate in the blood and cause hyperkalemia. Hyperkalemia can lead to cardiac arrhythmias and muscle weakness.

Choice B reason:

A client who has chronic kidney disease should not drink at least 3 liters of water every day because this can cause fluid overload and hypertension. Fluid overload can worsen the kidney function and increase the risk of heart failure and pulmonary edema. Hypertension can damage the blood vessels and organs.

Choice C reason:

A client who has chronic kidney disease should not eat more cheese and yogurt because they are high in phosphorus, which can bind with calcium and cause hypocalcemia and hyperphosphatemia. Hypocalcemia can lead to muscle cramps, tetany, and osteoporosis. Hyperphosphatemia can cause soft tissue calcification and itching.

Choice D reason:

A client who has chronic kidney disease should not use salt substitutes instead of table salt because they often contain potassium chloride, which can also increase the potassium level in the blood and cause hyperkalemia. Salt substitutes are not recommended for clients who have kidney disease or who are on potassium-sparing diuretics.

Choice A reason:

Monitoring daily weight is an important action for the nurse to take because it reflects the fluid status of the client. A sudden increase in weight indicates fluid retention, while a sudden decrease indicates fluid loss. The nurse should weigh the client at the same time every day, using the same scale and clothing.

Choice B reason:

Restricting sodium intake is another action that the nurse should take because sodium attracts water and increases fluid volume. The nurse should limit or avoid foods that are high in sodium, such as processed meats, canned soups, cheese, pickles, and salty snacks. The nurse should also educate the client about reading food labels and choosing low-sodium alternatives.

Choice C reason:

Administering diuretics as prescribed is a third action that the nurse should take because diuretics increase urine output and reduce fluid volume. The nurse should monitor the client's electrolyte levels, blood pressure, and urine output before and after giving diuretics. The nurse should also inform the client about the possible side effects of diuretics, such as dehydration, hypotension, hypokalemia, and ototoxicity.

Choice D reason:

Encouraging oral fluids is not an action that the nurse should take because it would worsen the fluid volume excess. The nurse should limit or restrict oral fluids as ordered by the provider. The nurse should also measure and record all fluid intake and output accurately.

Choice E reason:

Elevating the head of the bed is a fourth action that the nurse should take because it improves respiratory function and reduces pulmonary congestion. The nurse should elevate the head of the bed to at least 30 degrees or more, depending on the client's comfort and tolerance. The nurse should also monitor the client's oxygen saturation, breath sounds, and dyspnea.