An active male patient who weighs 180 lb (81.65 kg) has undergone dietary instruction. The patient reports that his current diet consists of 60 g of fat, 200 mg of cholesterol, and 5 g of sodium per day. What a nurse advises the patient to do?

1. A

   Increase his cholesterol

2. B

   Increase his sodium

3. C

   Decrease his cholesterol

4. D

   Decrease his sodium

Appeared in: JIPMER Nursing Officer-2017

Explanation

• The patient's sodium intake is 5 g (5000 mg), which is significantly higher than the American Heart Association's recommended daily limit of less than 2.3 g (2300 mg).
• High sodium intake is a primary modifiable risk factor for developing hypertension, which increases the risk of heart attack, stroke, and kidney disease.
• The nurse's priority is to address the most immediate health risk, which in this case is the excessive sodium consumption.
• The patient's cholesterol (200 mg) and fat (60 g) intakes are within acceptable ranges, making sodium the only nutrient requiring immediate reduction.

Why Other Options Were Wrong

• Option A: The patient's cholesterol intake of 200 mg is within the recommended healthy limit of less than 300 mg per day. There is no clinical reason to advise an increase.
• Option B: This advice is dangerous. The patient's sodium intake is already more than double the recommended maximum, putting him at high risk for hypertension and cardiovascular complications.
• Option C: While not harmful, this is not the priority. The patient's cholesterol intake is within a healthy range. The most critical issue to address is the excessive sodium.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Dietary guidelines and patient education helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Nurses are at the forefront of patient education for chronic disease prevention. Accurately assessing a patient's diet and providing targeted, evidence-based advice is a core nursing function.
• This scenario highlights the importance of prioritizing interventions. While multiple dietary factors exist, the nurse must identify and address the one posing the greatest immediate risk.
• What if? If the patient also had Chronic Kidney Disease (CKD), the advice would be even more stringent. Sodium would still need to be decreased, but potassium intake (often encouraged in hypertension management like the DASH diet) would likely need to be restricted as well.

How to Approach the Question

• First, identify all the numerical data in the question: the patient's intake of fat (60 g), cholesterol (200 mg), and sodium (5 g).
• Convert all units to be consistent for easy comparison. Recognize that 5 g of sodium is 5000 mg.
• Recall the standard recommended daily limits for these nutrients for a healthy adult. Sodium should be less than 2300 mg, and cholesterol should be less than 300 mg.
• Compare the patient's intake to the recommended limits. Notice that the sodium intake (5000 mg) is more than double the recommended amount, while cholesterol (200 mg) is within the limit.
• Determine which dietary component poses the most significant health risk. The excessively high sodium is the clear priority.
• Select the option that provides the correct advice for the highest-risk factor, which is to decrease sodium.

Concept Tested & Keywords

• Concept Tested: Dietary guidelines and patient education
• Stem keywords: active male, dietary instruction, 60 g of fat, 200 mg of cholesterol, 5 g of sodium
• Lead-in keywords: advises
• Clinical cues: Sodium intake of 5g is the key abnormal value requiring intervention.
• Negative lead-in flag: false

Question ID

Q56GDPUIpNrAT9n26SjAeH

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 96-98

E6 Nutrition Kumud Khanna 2e p. 300-302