The nurse is instructing the client with chronic kidney disease (CKD) to maintain adequate nutritional intake. Which diet would be most appropriate?

Low-protein, high-potassium.

High-calcium, high-potassium, high-protein.

High-carbohydrate, high-protein.

Low-protein, low-sodium, low-potassium.

Answer and Explanation

The Correct Answer is D

Choice A reason: A low-protein diet can be beneficial in reducing the workload on the kidneys by decreasing the production of waste products that need to be excreted. However, high-potassium intake is not recommended for CKD patients because their kidneys may not efficiently excrete potassium, leading to hyperkalemia, which can be dangerous.

Choice B reason: A diet high in calcium, potassium, and protein is not suitable for CKD patients. Excessive protein can increase the production of waste products, calcium intake needs to be monitored to avoid complications like calcification, and high potassium levels can lead to hyperkalemia. This combination could potentially worsen the patient's condition.

Choice C reason: A high-carbohydrate, high-protein diet is not ideal for CKD patients. While carbohydrates can provide energy, high protein intake increases the load on the kidneys. The goal is to reduce the production of waste products that the kidneys need to filter, so a high-protein diet is counterproductive.

Choice D reason: A low-protein, low-sodium, low-potassium diet is most appropriate for CKD patients. Reducing protein intake decreases the production of waste products, low sodium helps control blood pressure and fluid balance, and low potassium prevents hyperkalemia. This diet helps manage the symptoms and progression of CKD more effectively.

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Correct Answer is C,D,A,B

Explanation

Choice A reason: Assessing the client's respiratory status is the top priority action. This ensures that any immediate issues with breathing or oxygenation are identified and managed promptly. Respiratory status can quickly deteriorate in patients with heart failure, and addressing this first can be life-saving.

Choice B reason: Drawing blood to assess the patient's serum electrolytes is important to determine any imbalances that need immediate correction. Electrolyte levels can affect heart function and overall stability, so understanding the patient's current status helps guide further treatment.

Choice C reason: Administering the prescribed intravenous furosemide (Lasix) is critical for managing fluid overload in heart failure. Furosemide helps reduce fluid retention and alleviate symptoms such as pulmonary edema, which can improve respiratory status and overall comfort.

Choice D reason: Asking the patient about an advanced directive is important for understanding their wishes and planning care accordingly. However, it is not an immediate priority compared to stabilizing the patient's respiratory status and addressing urgent medical needs.

A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg. B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg. C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg. D. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg.

Correct Answer is A

Explanation

Choice A reason: The arterial blood gas values pH 7.25, HCO3- 19 mEq/L, and PaCO2 30 mm Hg are indicative of metabolic acidosis, which is commonly seen in chronic kidney disease (CKD). In CKD, the kidneys lose their ability to excrete hydrogen ions and retain bicarbonate, leading to a decrease in blood pH (acidosis) and a reduction in bicarbonate (HCO3-). The PaCO2 value is slightly lower as a compensatory mechanism by the lungs to help balance the pH.

Choice B reason: The values pH 7.30, HCO3- 26 mEq/L, and PaCO2 50 mm Hg suggest a state of respiratory acidosis with partial metabolic compensation. This is not typically expected in chronic kidney disease. Respiratory acidosis occurs when there is hypoventilation, leading to an accumulation of carbon dioxide (CO2) in the blood. The bicarbonate (HCO3-) level is within the normal range, indicating that it is not the primary disorder in this context.

Choice C reason: The values pH 7.50, HCO3- 20 mEq/L, and PaCO2 32 mm Hg are consistent with respiratory alkalosis, where the pH is elevated due to hyperventilation leading to a loss of CO2. This condition is not typically associated with chronic kidney disease. The bicarbonate level is slightly below normal but not enough to indicate a significant metabolic disorder.

Choice D reason: The values pH 7.55, HCO3- 30 mEq/L, and PaCO2 31 mm Hg indicate metabolic alkalosis, which is characterized by an elevated pH and increased bicarbonate. This condition can occur due to excessive loss of acids (e.g., vomiting) or an increase in bicarbonate but is not typically expected in chronic kidney disease.

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