Free CCHT Nutrition and Fluid Management Questions and Answers 1 — Questions and Answers
Question 1: A patient on hemodialysis is prescribed a phosphate binder. When is the most effective time for the patient to take this medication?
- 30 minutes before meals
- With meals (Correct answer)
- 1 hour after meals
- At bedtime
Correct answer: With meals
Phosphate binders work by binding to phosphorus in food while it is in the gastrointestinal tract, preventing its absorption into the bloodstream. Taking them with meals ensures they are present when the dietary phosphorus is ingested, maximizing their effectiveness.
Question 2: Which of the following foods is highest in potassium and should be limited by most hemodialysis patients?
- Apples
- White rice
- Potatoes (Correct answer)
- Green beans
Correct answer: Potatoes
Potatoes, especially when cooked with the skin, are very high in potassium. Hemodialysis patients often have difficulty excreting potassium, which can lead to dangerous hyperkalemia, so high-potassium foods are typically restricted.
Question 3: What is generally considered a safe interdialytic weight gain (IDWG) for a hemodialysis patient?
- Less than 1% of dry weight
- Less than 5% of dry weight (Correct answer)
- 10% of dry weight
- There is no limit as long as blood pressure is controlled.
Correct answer: Less than 5% of dry weight
A safe IDWG is typically considered to be less than 5% of the patient's estimated dry weight (EDW). Gaining more than this amount between treatments can lead to complications like hypertension, pulmonary edema, and increased cardiovascular strain.
Question 4: The primary reason for restricting sodium intake for patients on hemodialysis is to:
- Prevent hyperkalemia.
- Control thirst and fluid intake. (Correct answer)
- Lower serum phosphorus levels.
- Improve protein absorption.
Correct answer: Control thirst and fluid intake.
Sodium intake is a primary driver of thirst. By restricting sodium, patients can better manage their thirst, which in turn helps control their fluid intake and limit interdialytic weight gain, reducing the risk of fluid overload.
Question 5: Compared to the general population, the protein needs of a patient on maintenance hemodialysis are typically:
- Significantly lower.
- The same.
- Higher. (Correct answer)
- Dependent only on their age.
Correct answer: Higher.
Patients on hemodialysis have higher protein requirements because some amino acids and proteins are lost during the dialysis process. A high-protein diet is essential to maintain muscle mass and overall nutritional status.
Question 6: A low serum albumin level in a hemodialysis patient is a strong indicator of:
- Dehydration.
- Malnutrition and inflammation. (Correct answer)
- Excessive potassium intake.
- Good fluid control.
Correct answer: Malnutrition and inflammation.
Albumin is a protein made by the liver, and low levels (hypoalbuminemia) are a key marker of protein-energy wasting (malnutrition) and inflammation in dialysis patients. It is associated with increased morbidity and mortality.
Question 7: A patient's daily fluid allowance is often calculated based on their previous day's urine output plus a standard amount for insensible losses. What is this standard additional amount?
- 100-200 mL
- 250-400 mL
- 500-1000 mL (Correct answer)
- 1200-1500 mL
Correct answer: 500-1000 mL
For patients who still produce urine, a common method for calculating the daily fluid allowance is to measure the 24-hour urine output and add 500 to 1000 mL. This additional amount accounts for insensible losses from breathing and sweating.
Free CCHT Nutrition and Fluid Management Questions and Answers 1
A patient on hemodialysis is prescribed a phosphate binder.
When is the most effective time for the patient to take this medication?