← Back

Chapter 15: Applying Clinical Judgment to Promote Nutrition for Renal Wellness

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 15: Applying Clinical Judgment to Promote Nutrition for Renal Wellness

16 problems · 0 figures

Case Study 15.3.1 §15.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mr. Vasquez is in the clinic for a routine visit following his education session with the renal dietician 2 weeks prior. The nurse reviews his food recall report for the last 3 days (72 hours) to evaluate the need for further education. The client’s diagnoses include obesity, hypertension, diabetes mellitus type 2, and CKD stage 2, so his nutritional education would have included all these issues.

Which dietary selection made by Mr. Vasquez suggests the need for further teaching by the nurse?
  1. a.
    Lunch meats
  2. b.
    Turkey off the bone
  3. c.
    Apples
  4. d.
    Hard-boiled eggs

Answer

A. Lunch meats
Lunch meats are high in sodium and fat which should be avoided in clients with CKD stage 2, hypertension, obesity, and diabetes.

Case Study 15.3.2 §15.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mr. Vasquez is in the clinic for a routine visit following his education session with the renal dietician 2 weeks prior. The nurse reviews his food recall report for the last 3 days (72 hours) to evaluate the need for further education. The client’s diagnoses include obesity, hypertension, diabetes mellitus type 2, and CKD stage 2, so his nutritional education would have included all these issues.

Mr. Vasquez has an upcoming celebration and asks the nurse for a suggestion for a dessert that he could eat. What suggestion is appropriate for the nurse to make?
  1. a.
    Cupcakes
  2. b.
    Fruit salad
  3. c.
    Ice cream
  4. d.
    Chocolate milk

Answer

B. Fruit salad
Fruit salad has the lowest added sugar and carbohydrates. It also is better for the client’s weight.

Case Study 15.4.3 §15.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

At the last visit, Jose Vasquez was educated on nutritional changes that will help preserve kidney function and manage comorbidities. At a recent physical examination, the following are noted:

Mr. Vasquez reports following the nutritional guidelines strictly, and his food diary reflects this to be the case. Lastly, the nurse receives the following lab results from the sample drawn 2 days ago as a preparation for this visit:

Based on these assessment findings, what would the nurse document about the success of the nutritional plan for Mr. Vasquez?
  1. a.
    Plan is effective.
  2. b.
    Plan is ineffective due to client nonadherence.
  3. c.
    Plan is ineffective despite client adherence.
  4. d.
    Unable to judge plan effectiveness with assessment presented.
Table 15.4 in the book ↗
Vital Signs Physical Examination
Temperature: 97.9°F (36.6°C)

• No edema is present.

• Lungs are clear to auscultation in all fields.
Blood pressure: 118/76 mm Hg
Heart rate: 98 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air
Weight: Client has lost 3 lb (5.44 kg) since his last visit 3 months ago
Finger stick glucose level: 100 mg/dL
Table 15.5 in the book ↗
Lab Test Normal Range Mr. Vasquez’s Lab Results
GFR 90–120 mL/min/1.73 m2 52 mL/min/1.73 m2
Potassium 3.5–5.0 mEq/L 6.2 mEq/L
Sodium 135–145 mEq/L 122 mEq/L
Phosphorus 2.5–4.5 mg/dL 5.3 mg/dL

Answer

C. Plan is ineffective despite client adherence.
Subjective and objective data illustrate that the client is doing what the plan requires, but the plan clearly is not adequate for the client’s needs. The client has advanced from stage 2 CKD to stage 3 CKD despite having lost weight, having blood pressure and blood sugar levels within defined limits, presenting no symptoms of fluid overload even with the advancement in CKD stage, and using a food log to demonstrate dietary adherence.

Case Study 15.4.4 §15.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

At the last visit, Jose Vasquez was educated on nutritional changes that will help preserve kidney function and manage comorbidities. At a recent physical examination, the following are noted:

Mr. Vasquez reports following the nutritional guidelines strictly, and his food diary reflects this to be the case. Lastly, the nurse receives the following lab results from the sample drawn 2 days ago as a preparation for this visit:

Which dietary change would Mr. Vasquez need to make if he progressed to stage 3 CKD?
  1. a.
    Increase calcium.
  2. b.
    Restrict fluids.
  3. c.
    Restrict magnesium.
  4. d.
    Increase fats.
Table 15.4 in the book ↗
Vital Signs Physical Examination
Temperature: 97.9°F (36.6°C)

• No edema is present.

• Lungs are clear to auscultation in all fields.
Blood pressure: 118/76 mm Hg
Heart rate: 98 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air
Weight: Client has lost 3 lb (5.44 kg) since his last visit 3 months ago
Finger stick glucose level: 100 mg/dL
Table 15.5 in the book ↗
Lab Test Normal Range Mr. Vasquez’s Lab Results
GFR 90–120 mL/min/1.73 m2 52 mL/min/1.73 m2
Potassium 3.5–5.0 mEq/L 6.2 mEq/L
Sodium 135–145 mEq/L 122 mEq/L
Phosphorus 2.5–4.5 mg/dL 5.3 mg/dL

Answer

A. Increase calcium.
The client does not have symptoms of heart failure, fluid overload, or edema, and will need a diet high in calcium and magnesium.

Case Study 15.4.5 §15.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

It is determined that, despite Mr. Vasquez following the nutritional plan, his condition has worsened. Although this disease process will progress regardless, it is still prudent to address the plan because the client’s disease is now in an advanced stage; the plan requires modifications to prevent further injury.

Now that the client has advanced from stage 2 to 3 CKD, what assessment findings indicate a need to change the current nutritional plan?
  1. a.
    GFR of 51 mL/min/1.73 m2
  2. b.
    Symptoms of heart failure
  3. c.
    No dependent edema
  4. d.
    Glucose levels that are low

Answer

B. Symptoms of heart failure
Symptoms of heart failure create a need to change the plan. In stage 3, if heart failure is present, additional dietary measures are implemented. If they are not present, the same diet can be followed.

Case Study 15.4.6 §15.4 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

It is determined that, despite Mr. Vasquez following the nutritional plan, his condition has worsened. Although this disease process will progress regardless, it is still prudent to address the plan because the client’s disease is now in an advanced stage; the plan requires modifications to prevent further injury.

Which selection is appropriate for the client to include in their diet?
  1. a.
    Quinoa
  2. b.
    Skin-on baked chicken
  3. c.
    Sirloin steak, well-done
  4. d.
    Fried fish

Answer

A. Quinoa
Proteins should be restricted to plant-based proteins and lean, low-fat meat sources.

15-1 §15.RQ source ↗

The nurse provides dietary instruction to a client with kidney disease. The nurse informs the client which nutrient is not directly absorbed by the kidney?
  1. a.
    Calcium
  2. b.
    Sodium
  3. c.
    Magnesium
  4. d.
    Potassium

Answer

A. Calcium
Calcium levels are affected by the kidney through its relationship with the parathyroid gland and the production of calcitriol, but not from direct reabsorption.

15-2 §15.RQ source ↗

Which laboratory value would indicate to the nurse that an adult male client has a potential renal problem?
  1. a.
    Serum creatinine: 1.5 mg/dL
  2. b.
    Blood urea nitrogen: 7 mg/dL
  3. c.
    Glomerular filtration rate: 93 mL/min/1.73 m2
  4. d.
    Potassium: 4.1 mg/dL

Answer

A. Serum creatinine: 1.5 mg/dL
A serum creatinine level of 1.5 mg/dL is above the normal range of 0.74–1.35 mg/dL for adult males and requires prompt attention. The other laboratory values are within normal range.

15-3 §15.RQ source ↗

When should the nurse perform a bladder scan to determine a client’s PVR?
  1. a.
    Before the client voids
  2. b.
    Immediately after the client voids
  3. c.
    One hour after the client voids
  4. d.
    When the client has the urge to void

Answer

B. Immediately after the client voids
Since the PVR is the amount of urine left in the bladder after the client has urinated, the nurse should scan the bladder immediately after the client has urinated.

15-4 §15.RQ source ↗

Which snack choice made by a client indicates to the nurse that the client understands the need to increase complex carbohydrates in the diet?
  1. a.
    Snack cakes
  2. b.
    Crackers
  3. c.
    Muffins
  4. d.
    Fruits

Answer

D. Fruits
Complex carbohydrates are found in foods such as whole grains, fruits, and vegetables.

15-5 §15.RQ source ↗

Which nutritional instruction would the nurse give to a client with CKD who is not on dialysis?
  1. a.
    Decrease calcium intake.
  2. b.
    Use plant sources of protein before animal sources.
  3. c.
    Increase intake of trans fat.
  4. d.
    Reduce dietary fiber.

Answer

B. Use plant sources of protein before animal sources.
The client with CKD should be instructed to use plant sources of protein before animal sources.

15-6 §15.RQ source ↗

When developing a nutritional plan of care, which factor should the nurse consider for improving client adherence to plan?
  1. a.
    Level of engagement
  2. b.
    Age
  3. c.
    Gender
  4. d.
    Comorbidities

Answer

A. Level of engagement
Engagement and participation in creating the plan is the single most important step toward client adherence to the plan because if the client has no desire or motivation to follow the plan it will not matter if they have the means to or not.

15-7 §15.RQ source ↗

Which assessment finding in a client on dialysis is of concern to the nurse?
  1. a.
    Client is not restricting protein intake.
  2. b.
    Client chooses foods that are low in potassium.
  3. c.
    Client drinks large amounts of fluids.
  4. d.
    Client has increased intake of calcium.

Answer

C. Client drinks large amounts of fluids.
The client with CKD who is on dialysis should restrict fluid intake.

15-8 §15.RQ source ↗

What instruction should the nurse give to a client on a fluid restriction secondary to kidney disease who reports increased thirst?
  1. a.
    Suck on hard, sweet candies.
  2. b.
    Use large glasses for drinking.
  3. c.
    Fill drinking glasses completely.
  4. d.
    Sip fluids slowly.

Answer

D. Sip fluids slowly.
They should sip fluids slowly and savor them and not gulp them down quickly.

15-9 §15.RQ source ↗

Which food item on a 72-hour nutritional recall does the nurse identify as appropriate for a client who needs to restrict phosphorous intake?
  1. a.
    Vanilla ice cream
  2. b.
    Potato chips
  3. c.
    Hot dogs
  4. d.
    Chocolate milk

Answer

A. Vanilla ice cream
Vanilla ice cream is low in phosphorus.

15-10 §15.RQ source ↗

Which food selection on a 72-hour recall indicates to the nurse that a client who must restrict potassium and sodium intake requires more instruction?
  1. a.
    Salt substitute
  2. b.
    Cauliflower
  3. c.
    Grapes
  4. d.
    Apple

Answer

A. Salt substitute
Salt substitutes are dangerously high in potassium and should always be avoided when on a potassium restricted diet. Salt substitutions are acceptable.

Loading chapter 16…

Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.