Which statement by a nurse may undermine a patient’s feelings and belittle the patient’s concerns?

Choice A reason: Improved nutritional status could cause weight gain but is unlikely in AKI with minimal urine output. AKI patients often have anorexia or dietary restrictions, and weight gain from nutrition would not align with oliguria, which suggests fluid retention rather than increased tissue mass from improved nutrition.

Choice B reason: A 3-pound weight gain in 48 hours with minimal urine output is clinically significant in AKI, indicating fluid retention. Normal weight fluctuations are minimal, and this rapid gain, coupled with oliguria, suggests impaired kidney function, potentially leading to fluid overload complications like hypertension or pulmonary edema.

Choice C reason: Early AKI recovery involves increased urine output (diuresis phase), not minimal output. Weight gain with oliguria indicates ongoing kidney dysfunction, not recovery. Recovery would show improved glomerular filtration and urine production, reducing fluid retention, making this finding inconsistent with AKI recovery.

Choice D reason: In AKI, minimal urine output (oliguria) reflects impaired kidney filtration, leading to fluid retention. A 3-pound weight gain in 48 hours corresponds to approximately 1.5 liters of fluid, indicating fluid overload. This can cause hypertension, pulmonary edema, or heart failure, making fluid retention the most likely explanation.

Choice A reason: Increased potassium intake is dangerous in ESRD, as impaired kidneys cannot excrete potassium, leading to hyperkalemia. This can disrupt cardiac membrane potentials, causing arrhythmias or cardiac arrest. ESRD diets require strict potassium restriction to prevent life-threatening electrolyte imbalances, making this modification inappropriate.

Choice B reason: Increased protein intake is often recommended in ESRD patients on hemodialysis to replace protein lost during dialysis and prevent malnutrition. However, it must be balanced to avoid excess urea production, which can worsen uremia. This is not the primary focus compared to phosphorus management in this context.

Choice C reason: Decreased phosphorus intake is critical in ESRD, as kidneys cannot excrete phosphate, leading to hyperphosphatemia. This causes vascular calcification and secondary hyperparathyroidism, increasing cardiovascular risk. Dietary phosphorus restriction, often with phosphate binders, prevents these complications, making it a key dietary modification for hemodialysis patients.

Choice D reason: Decreased calcium intake is not recommended in ESRD, as patients often have hypocalcemia due to impaired vitamin D activation and phosphate retention. Calcium supplementation or adequate intake is needed to prevent bone disease and secondary hyperparathyroidism, making this modification incorrect for ESRD management.