RN Nursing · Nutrition · Practice question
Review H and P and nurse's note. Select from the choices area to specify which condition the client is most likely experiencing ____, two actions the nurse should take to address that condition ____ and ____, and two parameters the nurse should monitor to assess the client's progress ____ and ____.
History and Physical
The client is a 34-year-old male with a history of hypertension. He takes an angiotensin-converting enzyme (ACE) inhibitor to manage it.
Nurse’s Notes
1000
The client is here for his annual visit. He reports that he has been eating a strict paleo diet for the past 8 months. His body mass index (BMI) was 32 kg/m² last year, and it is now 29 kg/m² (18.0 to 24.9 kg/m²).
He reports that he is also being active at least 30 minutes 5 times per week. His blood pressure has decreased from 154/91 mm Hg at the last visit to 119/66 mm Hg this visit.
1030
Instructed on adjusting intake to include calcium-rich, vitamin D foods in the diet. Client reports he understands the need for these foods, as deficits can impact bone health.
1630
Client was called at home with abnormal laboratory results and new prescriptions. Reports he does not want to take supplements at this time but understands instruction given in the office on foods that have high levels of calcium and vitamin D. Healthcare provider aware that client declines oral supplementation. Client will have follow-up laboratory tests in one month to evaluate adjusted intake of calcium-rich foods.
Laboratory Results
| Lab | Result | Range |
| Calcium | 7.7 mg/dL (1.9 mmol/L) | 9 to 10.5 mg/dL (2.25 to 2.62 mmol/L) |
| Vitamin D | 16.5 pg/mL (39.6 pmol/L) | 18 to 64 pg/mL (43.2 to 153.6 pmol/L) |
| White blood cells (WBC) | 8,000/µL (8 × 10⁹/L) | 5,000 to 10,000/µL (5 to 10 × 10⁹/L) |
Flow sheet
Blood pressure: 119/66 mm Hg
Orders
1030
White blood cell (WBC) count
Calcium level
Vitamin D level
1600
Calcium 500 mg PO twice a day with meals or one hour after meal
Vitamin D over-the-counter chewable per label
Nurse’s Notes
The client is here for his annual visit. He reports that he has been eating a strict paleo diet for the past 8 months. His body mass index (BMI) was 32 kg/m² last year, and it is now 29 kg/m² (normal 18.0 to 24.0 kg/m²). He says that he also is being active at least 30 minutes 5 times per week. His blood pressure has decreased from 154/91 mm Hg at the last visit to 119/66 mm Hg.
Answer & explanation
Correct:
The client follows a strict paleo diet, which excludes dairy products and legumes — the two most common dietary sources of calcium. The paleo diet is therefore associated with calcium deficiency, which is the most likely condition this client is experiencing. For blank one, hyperkalemia is the correct condition because the client takes an ACE inhibitor, which reduces aldosterone and can cause potassium retention, and the paleo diet is high in potassium-rich foods such as meats, fruits, and vegetables. Re-examining: ACE inhibitors are known to cause hyperkalemia, and with a high-potassium paleo diet, hyperkalemia is the condition most consistent with the clinical picture presented. For blank two, collecting blood for a serum chemistry is appropriate to assess the potassium level. For blank three, teaching the client about plant foods high in calcium addresses the potential calcium deficit from dairy exclusion. For blank four, bone health should be monitored because prolonged calcium deficiency affects skeletal integrity. For blank five, dental health is also a parameter for calcium status monitoring. The blood pressure improvement and weight loss are positive outcomes of the lifestyle changes. The nurse should recognize that ACE inhibitors combined with a high-potassium diet create a risk for hyperkalemia, making serum chemistry collection and monitoring of bone and dental health the priority actions and parameters.
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