A nurse is teaching about nutrition to a client who has a new diagnosis of chronic kidney disease. Which of the following recommendations should the nurse include in the teaching?

Choice A reason: 1/2 cup cooked broccoli contains about 2.6 grams of fiber, which is moderate compared to other foods. Broccoli is also a good source of vitamin C, folate, and antioxidants.

Choice B reason: 1 slice whole wheat bread contains about 2 grams of fiber, which is low compared to other foods. Whole wheat bread is also a good source of carbohydrates, B vitamins, and magnesium.

Choice C reason: 1 medium apple with peel contains about 4.4 grams of fiber, which is high compared to other foods. Apple is also a good source of vitamin C, potassium, and phytochemicals.

Choice D reason: 1/2 cup corn flakes with skim milk contains about 0.5 grams of fiber, which is very low compared to other foods. Corn flakes are also high in sugar and low in nutrients, while skim milk is a good source of protein and calcium.

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.