← Back

Chapter 16: Special Nutritional Considerations for Renal Health

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

Chapter 16: Special Nutritional Considerations for Renal Health

18 problems · 0 figures

Case Study 16.1.1 §16.1 source ↗

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

Jennifer Davis had a difficult pregnancy. Prior to conceiving, she lived with type 2 diabetes, hypertension, chronic moderate anemia, and stage 2 CKD. During the pregnancy, despite being very adherent, her kidney disease advanced. She closely followed her nutritional restrictions for low sodium, low sugar, low carbohydrate, low fat, and low protein, and as she progressed closer to kidney failure, she had to restrict fluids as well. Even though she followed these dietary modifications, after delivery she was diagnosed with ESRD and was scheduled to have a catheter placed to start hemodialysis (mechanical waste filtration).

Because of her health issues, she experienced preeclampsia that developed into eclampsia (seizures), requiring an emergency cesarean birth of her infant at 32 weeks’ gestation. Her infant demonstrated effects from Jennifer’s health issues as well. Due to Jennifer’s chronic anemia, nutritional restrictions, and preterm delivery, the infant was of very low birth weight and small for gestational age (SGA) due to intrauterine growth restrictions. She required 8 weeks of care in the NICU after birth.

Kayla Davis is now 1 week old. She weighs 1 kg (2.2 lb) and is 33 cm (13 in.) long.

The nurse caring for Kayla is reviewing her nutritional plan, which is based on the highest normal calorie range daily for a preterm infant. How many calories daily should Kayla receive to meet her nutritional needs?
  1. a.
    130 calories
  2. b.
    270 calories
  3. c.
    2,700 calories
  4. d.
    4,000 calories

Answer

A. 130 calories
130 kcal/kg/day is the highest daily recommended amount for a preterm infant. 130 × 1 kg = 130 calories daily

Case Study 16.1.2 §16.1 source ↗

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

Jennifer Davis had a difficult pregnancy. Prior to conceiving, she lived with type 2 diabetes, hypertension, chronic moderate anemia, and stage 2 CKD. During the pregnancy, despite being very adherent, her kidney disease advanced. She closely followed her nutritional restrictions for low sodium, low sugar, low carbohydrate, low fat, and low protein, and as she progressed closer to kidney failure, she had to restrict fluids as well. Even though she followed these dietary modifications, after delivery she was diagnosed with ESRD and was scheduled to have a catheter placed to start hemodialysis (mechanical waste filtration).

Because of her health issues, she experienced preeclampsia that developed into eclampsia (seizures), requiring an emergency cesarean birth of her infant at 32 weeks’ gestation. Her infant demonstrated effects from Jennifer’s health issues as well. Due to Jennifer’s chronic anemia, nutritional restrictions, and preterm delivery, the infant was of very low birth weight and small for gestational age (SGA) due to intrauterine growth restrictions. She required 8 weeks of care in the NICU after birth.

Kayla Davis is now 1 week old. She weighs 1 kg (2.2 lb) and is 33 cm (13 in.) long.

The nurse is discussing Kayla’s need for energy sources in her nutritional intake. Which macronutrient is the body’s primary energy source from nutrition?
  1. a.
    Water
  2. b.
    Proteins
  3. c.
    Fats
  4. d.
    Carbohydrate

Answer

D. Carbohydrate
Carbohydrate is the preferred energy source for the body.

Case Study 16.1.3 §16.1 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.

Kayla was diagnosed with hydronephrosis (swollen kidney due to urine accumulation) related to uteropelvic junction obstruction (blockage). This resolved on its own after 2 weeks of life. She was transferred from the NICU to the regular pediatric floor for care at 8 weeks of age and was discharged home the following week. Her prematurity and intrauterine growth restriction have resulted in ongoing effects on her development. She was diagnosed with type 1 diabetes because her pancreas is nonfunctioning, and one of her kidneys is nonfunctioning. The kidney is small and undeveloped. The other kidney is functioning despite the hydronephrosis.

Unfortunately, by age 6, Kayla has developed CKD and is in stage 3 when diagnosed.

Which nutritional restrictions will pose the most problems for her growth and development at this stage?
  1. a.
    Protein and calories
  2. b.
    Fluid and potassium
  3. c.
    Phosphorus and calcium
  4. d.
    Magnesium and sodium

Answer

A. Protein and calories
Protein and calories will be the biggest concerns at this age because she will need them to develop and grow appropriately; however, she cannot take in so much that her kidneys will be overloaded and her glucose out of range.

Case Study 16.1.4 §16.1 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.

Kayla was diagnosed with hydronephrosis (swollen kidney due to urine accumulation) related to uteropelvic junction obstruction (blockage). This resolved on its own after 2 weeks of life. She was transferred from the NICU to the regular pediatric floor for care at 8 weeks of age and was discharged home the following week. Her prematurity and intrauterine growth restriction have resulted in ongoing effects on her development. She was diagnosed with type 1 diabetes because her pancreas is nonfunctioning, and one of her kidneys is nonfunctioning. The kidney is small and undeveloped. The other kidney is functioning despite the hydronephrosis.

Unfortunately, by age 6, Kayla has developed CKD and is in stage 3 when diagnosed.

Because this client already has serious issues with their kidneys, the nurse educates the client’s parents on nutritional measures to prevent further kidney issues that can exacerbate their other conditions. Which option would necessitate the need for further education?
  1. a.
    Broccoli
  2. b.
    Whole grain bread
  3. c.
    Cranberries
  4. d.
    Ramen noodles

Answer

D. Ramen noodles
To prevent additional issues like UTIs, kidney stones, and hypertension, which can impact already-poor kidney health, the client should eat a low-sodium, heart-healthy, high-fiber diet, and Ramen noodles are extremely high in sodium.

Case Study 16.1.5 §16.1 source ↗

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

Kayla and her mother have been managing her condition well, and her stage 3 CKD has remained stable. She is now 13 years old and has come into the clinic for a regular check-up. The nurse is planning to provide Kayla with education on continued management of her CKD.

What would the nurse include when teaching a client Kayla’s age how to best promote renal health and slow the progression of CKD?
  1. a.
    Recommendation to increase fiber intake
  2. b.
    STI prevention
  3. c.
    Recommendation to increase fluids
  4. d.
    Recommendation to decrease exercise

Answer

B. STI prevention
Education on preventing STIs should start at age 10 to help ensure renal health. UTIs resulting from STIs can spread silently and asymptomatically, depending on the cause, which could lead to pyelonephritis and damage Kayla’s already weakened kidneys.

Case Study 16.1.6 §16.1 source ↗

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

Kayla and her mother have been managing her condition well, and her stage 3 CKD has remained stable. She is now 13 years old and has come into the clinic for a regular check-up. The nurse is planning to provide Kayla with education on continued management of her CKD.

How many calories would be in the acceptable daily allowance range for Kayla?
  1. a.
    2,000 calories daily
  2. b.
    1,500 calories daily
  3. c.
    2,600 calories daily
  4. d.
    3,000 calories daily

Answer

A. 2,000 calories daily
The requirement is 2,000 calories daily for an adolescent female.

Case Study 16.1.7 §16.1 source ↗

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

At age 18, Kayla becomes pregnant. Her GFR is 49 mL/min/1.73 m2, and she has hypertension, type 1 diabetes, and chronic anemia. Despite the known risks to her and the fetus, she wants to go through with the pregnancy. She is currently not restricting fluids, but she is restricting protein, potassium, phosphorus, sodium, sugar, and carbohydrates. She is following all heart-healthy recommendations.

The nurse is educating Kayla about the potential problems in a pregnancy involving her unique health conditions. What would the nurse include in this education?
  1. a.
    Postterm delivery
  2. b.
    Spina bifida
  3. c.
    Multifetal pregnancy
  4. d.
    Fetal intrauterine growth restriction

Answer

D. Fetal intrauterine growth restriction
Fetal intrauterine growth restriction (IUGR) is a risk for a client with these health conditions.

Case Study 16.1.8 §16.1 source ↗

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

At age 18, Kayla becomes pregnant. Her GFR is 49 mL/min/1.73 m2, and she has hypertension, type 1 diabetes, and chronic anemia. Despite the known risks to her and the fetus, she wants to go through with the pregnancy. She is currently not restricting fluids, but she is restricting protein, potassium, phosphorus, sodium, sugar, and carbohydrates. She is following all heart-healthy recommendations.

When Kayla is being monitored during her pregnancy, which lab value would be concerning and require immediate treatment?
  1. a.
    GFR 56 mL/min/1.73 m2
  2. b.
    GFR 15 mL/min/1.73 m2
  3. c.
    GFR 87 mL/min/1.73 m2
  4. d.
    GFR 92 mL/min/1.73 m2

Answer

B. GFR 15 mL/min/1.73 m2
The client’s original CKD stage was stage 3, which is associated with the GFR range of 30 to 59 mL/min/1.73 m2. During pregnancy, the range is expected to increase, so a lower range would be something to address immediately. At 15 mL/min/1.73 m2, the client would require dialysis as an immediate intervention.

16-1 §16.RQ source ↗

The nurse is caring for a client in the first trimester of pregnancy. Which assessment finding requires follow-up by the nurse?
  1. a.
    Decreased GFR
  2. b.
    Increased fluid retention
  3. c.
    Mild glycosuria
  4. d.
    Proteinuria

Answer

A. Decreased GFR
The GFR increases in early pregnancy, causing a hyperfiltrative state, so a decreased GFR would be considered abnormal.

16-2 §16.RQ source ↗

Which instruction would the nurse give to a client about nutrition during pregnancy?
  1. a.
    Eat 340 calories more each day in the first trimester.
  2. b.
    Start prenatal vitamins in the second trimester.
  3. c.
    Avoid or limit caffeine intake.
  4. d.
    Reduce fluid intake.

Answer

C. Avoid or limit caffeine intake.
The pregnant client should avoid or limit caffeine intake to promote fetal health.

16-3 §16.RQ source ↗

The nurse provides nutrition counseling to the parents of a child with CKD. Which nutritional restriction is most likely to affect growth and development?
  1. a.
    Potassium
  2. b.
    Sodium
  3. c.
    Fluids
  4. d.
    Protein

Answer

D. Protein
Protein is extremely important in growth and development and in repair of muscles and injury, but it is still restricted in the diet of clients with CKD.

16-4 §16.RQ source ↗

The nurse is educating a 14-year-old female adolescent with CKD and her parents about nutrition. Which recommended daily intake for iron should the nurse teach the adolescent and her parents?
  1. a.
    7 mg/day
  2. b.
    9 mg/day
  3. c.
    12 mg/day
  4. d.
    15 mg/day

Answer

D. 15 mg/day
Females are at risk for anemia. The recommended daily iron intake for female adolescents aged 14 to 18 years, including those with CKD, is 15 mg.

16-5 §16.RQ source ↗

The nurse is teaching a client about nutritional interventions for an overactive bladder. Which instruction should the nurse give the client?
  1. a.
    Avoid cola drinks.
  2. b.
    Use artificial sweeteners instead of sugar.
  3. c.
    Reduce fiber intake.
  4. d.
    Avoid foods high in potassium.

Answer

A. Avoid cola drinks.
Coffee, tea, colas, energy drinks, and brown chocolate all contain caffeine, which contains an acid that acts as a bladder irritant and can aggravate OAB symptoms.

16-6 §16.RQ source ↗

The nurse is providing discharge instructions to a client following the removal of a calcium kidney stone. Which instruction will the nurse give this client to prevent future stone formation?
  1. a.
    Avoid foods high in purine.
  2. b.
    Avoid foods high in oxalate.
  3. c.
    Restrict nondairy animal protein.
  4. d.
    Increase sodium intake.

Answer

B. Avoid foods high in oxalate.
The client with calcium stones should avoid foods high in oxalate, such as rhubarb, beets, and potatoes.

16-7 §16.RQ source ↗

The nurse is completing a follow-up assessment of a client with a history of kidney stones. Which of the following dietary habits reported by the client indicates the need for additional instruction related to their kidney stone history?
  1. a.
    Drinks at least 2 L of fluid daily
  2. b.
    Eats a variety of fruits and vegetables
  3. c.
    Consumes a high-protein diet
  4. d.
    Drinks less than 6 oz of fruit juice each day

Answer

C. Consumes a high-protein diet
Protein intake, particularly from red meat or canned sources, can increase the risk of kidney stone development.

16-8 §16.RQ source ↗

The nurse is working at a community health fair, providing information about risk reduction for renal cancer. Which nutritional instruction will the nurse teach to reduce the risk for renal cancer?
  1. a.
    Increase intake of cruciferous vegetables.
  2. b.
    Increase intake of red meat.
  3. c.
    Eat more pan-fried foods.
  4. d.
    Cook meats on the grill.

Answer

A. Increase intake of cruciferous vegetables.
Increased intake of vegetables, especially cruciferous vegetables, decreases the risk of developing renal cancer.

16-9 §16.RQ source ↗

The nurse is developing a teaching plan for a client who has just entered stage 4 CKD. Which instruction will the nurse give the client?
  1. a.
    There are no restrictions on fluid intake.
  2. b.
    Reduce calcium intake.
  3. c.
    Restrict potassium intake.
  4. d.
    Increase magnesium intake.

Answer

C. Restrict potassium intake.
The client with stage 4 CKD should restrict intake of potassium as well as that of magnesium, phosphorus, and sodium.

16-10 §16.RQ source ↗

Which instruction should the nurse give a client with benign prostatic hypertrophy to reduce lower urinary tract symptoms?
  1. a.
    Increase intake of fresh fruits.
  2. b.
    Use butter rather than olive oil.
  3. c.
    Reduce intake of whole grains.
  4. d.
    Drink whole milk.

Answer

A. Increase intake of fresh fruits.
The Mediterranean diet, which includes an emphasis on fresh fruits, can decrease lower urinary tract symptoms.

Loading chapter 17…

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.