Med Surg Final Examination

31-The nurse is caring for a patient who is preparing to undergo initial screening for BPH. The nurse understands that the patient will have which procedure?

-Digital rectal exam

A client is receiving continuous tube feeding at 70 mL/hr. When the bag is empty, how much formula does the nurse add? (Record your answer using a whole number.) _____ mL

280

Procedure that does not allow for immediate removal of stones?

-Lithotripsy

39-Which assessment findings will the nurse expect for a client who is suspected of having pelvic inflammatory disease? (Select all that apply.)

-Vaginal bleeding -Fever -Lower abdominal pain -Rigid abdomen

-A 30yr old male client is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate?

-You will only need 1 dose of the vaccine

A patient diagnosed with acute pyelonephritis is treated with a full course of ampicillin. The patient asks whether he needs to be doing anything else to treat the infection, even though the symptoms have resolved. What is the appropriate response from the nurse?

"Continue to increase oral fluid intake even if symptoms have resolved."

1-A new graduate nurse is caring for an older adult patient who has acute kidney injury. Which statement made by the new graduate nurse would warrant further teaching? - "The patient should drink plenty of fluids." - "I should educate the patient about the signs and symptoms of AKI." - "The patient is scheduled to see a health care provider in 2 days." -"The patient does not have a fever, so further assessment is not required."

"The patient does not have a fever, so further assessment is not required."

1. Which action will the nurse take when implementing standard precautions?

- Donning gloves prior to administering a patient an IM injection

2-During assessment, a patient with CKD states her or she is taking stinging nettle (herbal supplement) for hay fever. How can the nurse improve the nursing care for this patient? - Initiate dialysis treatment for the patient -Allow the patient to have input regarding his or her care -Discuss the treatment plan and therapeutic regimen while allowing the patient to have input -Discuss alternatives for hay fever treatment that do not modulate fluid volumes or blood pressure -Encourage the patient to continue seeking alternative or natural remedies for the treatment of illness -Inform patient about obtaining health care provider consent before taking herbal preparations and over-the-counter medications

- Initiate dialysis treatment for the patient -Allow the patient to have input regarding his or her care -Discuss the treatment plan and therapeutic regimen while allowing the patient to have input -Discuss alternatives for hay fever treatment that do not modulate fluid volumes or blood pressure -Inform patient about obtaining health care provider consent before taking herbal preparations and over-the-counter medications

26-A student nurse is caring for a patient diagnosed with breast cancer and inquires what is meant by a triple negative breast cancer finding in this patient. Which statement by the nursing instructor is correct?

-"It means that the cancer was tested for receptors to estrogen, progesterone, and HER-2. A negative finding will make the cancer harder to treat and, unfortunately, gives it a poorer prognosis."

1. Which acid-base imbalance manifest with tachypnea and lightheadedness?

- Respiratory alkalosis

32-The nurse is caring for a male patient newly diagnosed with prostate cancer. He reports that the health care provider said his tumor was a stage II and asks the nurse what that means. How should the nurse respond?

-"A stage II tumor is one that can be felt during a digital rectal exam (DRE)."

46-A patient diagnosed with acute pyelonephritis is treated with a full course of ampicillin. The patient asks whether he needs to be doing anything else to treat the infection, even though the symptoms have resolved. What is the appropriate response from the nurse?

-"Continue to increase oral fluid intake even if symptoms have resolved."

21-A patient who will soon begin dialysis requests more information about how dialysis will fit into their life. The patient would like to remain involved with work (full-time) and family activities, including day trips. Which statement by the nurse is most appropriate?

-"Continuous ambulatory peritoneal dialysis (CAPD) is the best option for you."

42-A nurse cares for a middle-aged female client with diabetes mellitus who is being treated for the third episode of acute pyelonephritis in the past year. The client asks, "What can I do to help prevent these infections?" How should the nurse respond?

-"Drink more water and empty your bladder more frequently during the day."

29-A patient was recently diagnosed with early-stage resectable breast cancer and tells the nurse, "I do not want to have my entire breast removed!" How should the nurse respond?

-"Have you discussed your treatment options with your health care provider?"

28-A 21-year-old woman with a family history of ovarian cancer is talking to the nurse about family planning. She is worried about ovarian cancer and asks the nurse if there is anything she can do to help decrease her risk for the disease. Which information should the nurse share with the patient?

-"Having a family early in life could be helpful."

24- A nurse is caring for a patient with chronic kidney disease (CKD) who is on a drug therapy regimen. Which patient statement should prompt the nurse to provide further patient education?

-"I will take my calcium and iron supplements at 3 p.m. since it is between meals."

-A patient with late stage chronic kidney disease (CKD) wants to know why active-form vitamin D has been prescribed. How would the nurse explain the use of this drug therapy to the patient?

-"The kidney is no longer activating vitamin D, which will prevent calcium from being absorbed."

30-The nurse is talking to a patient who is undergoing screening for ovarian cancer. The patient recently tested positive for BRCA-1. The patient has been prescribed an abdominal ultrasound and testing for CA-125. The patient states, "I know this is part of my screening now, but I don't remember why." Which information should the nurse provide?

-"Your genetic history shows you are high risk for ovarian cancer, so adding this testing will enhance early detection."

Which conditions may put a patient at risk for developing a fungal urinary tract infection (UTI)?

-AIDS diagnosis -Renal failure --Chronic bacterial infections

1- Which factors may lead to urinary tract obstruction by stricture? -Abdominal tumor -Recent cystoscopy -Frequent renal calculi -Prostatic hypertrophy -Ureteral inflammation -Pelvic radiation therapy

-Abdominal tumor -Prostatic hypertrophy -Ureteral inflammation -Pelvic radiation therapy

5- A patient presents with a fever of 102° F, fatigue, nausea, and urinary urgency. On percussion during physical examination, the nurse notes costovertebral tenderness on the left side. Urinalysis indicates bacteriuria. Which provider order would the nurse implement first?

-Administer intravenous (IV) ampicillin

41-A patient presents with report of urinary retention, flank pain, and nausea that began 2 hours ago. After collaboration with the care team, which action would the nurse take first?

-Administer intravenous ketorolac

34-A patient and his spouse ask the nurse if they should expect any sexual changes following a TURP. The surgery went as expected and the patient has not experienced any complications. Which information can the nurse provide about expected outcomes following prostate surgery?

-Although sexual outcomes may vary, retrograde ejaculation is expected following TURP.

The nurse is caring for a patient with AKI who has an infection. Which order should the nurse question?

-Antibiotic therapy

19- Which clinical manifestations or lab values would indicate to the nurse that dialysis (renal replacement therapy) may be required for a patient with acute kidney injury (AKI)? -BUN >120 mg/dL -Volume overload -Metabolic acidosis -Respiratory alkalosis -Increased mental acuity -Elevated serum potassium

-BUN >120 mg/dL -Volume overload -Metabolic acidosis -Elevated serum potassium

4- A male patient reports dysuria, urgency, and frequent urination. Urinalysis reveals bacteriuria. Which treatment should the nurse expect to implement for this patient?

-Ceftriaxone

40-Which of the following is important to include in a teaching plan presented to young girls to assist them in preventing toxic shock syndrome?

-Change tampons every 3-6 hours, and wash hands before insertion.

A primary care clinic sees some clients with Sexually Transmitted Infections. Which diseases would the nurse be required to report to the local authority? (Select all that apply)

-Chlamydia -Gonorrhea -Syphilis -Human Immune Deficiency Virus

6- A patient presents with urinary pain and urgency but no systemic symptoms. Urinalysis indicates a bacteria count of 103 CFU/mL. The patient's chart indicates no coexisting obstruction or health concern. However, the patient has been seen for urinary tract infections (UTIs) five times in the last year. Which antibiotic should the nurse expect the provider to prescribe for this patient?

-Ciprofloxacin

A female patient presents with urinary frequency and dysuria. The nurse notes white blood cells in the urine and bacteriuria. What patient education is necessary to prevent future infections?

-Continue taking the medication. -Obtain necessary follow-up care. -wear loose fitting underwear

1. Which normal physiologic process contributes to the need for acid-based balance?

-Continuous metabolic production of free hydrogen ions

9- The nurse is caring for a patient being treated with ciprofloxacin for a catheter-associated urinary tract infection (UTI). Which assessment finding would be most concerning to the nurse?

-Costovertebral angle (CVA) tenderness

47-A patient with a small urinary tract calculus reports symptoms lasting several weeks. The patient is experiencing chronic pain and wants the stone removed "right away." The nurse would give this patient information on which collaborative care treatment?

-Cystoscopy

17-Which interventions does the nurse know are available to manage hyperkalemia in a patient with acute kidney injury (AKI)? Select all that apply.

-Dialysis -Calcium gluconate -Sodium polystyrene sulfonate -Insulin and sodium bicarbonate

35-The nurse is caring for a 19-year-old patient who is newly diagnosed with testicular cancer. What information should the nurse discuss with the health care team when acting as a patient advocate specific to this situation?

-Discuss the option for cryopreservation of sperm before initiating treatment.

49-A 20-year-old client is interested in protection from the human papilloma virus (HPV) since she may become sexually active. Which response from the nurse is the most accurate?

-Either Gardasil or Cervarix can provide protection.

7- A patient presents with suprapubic pain, fever, and chills. The nurse notes heart rate of 112 beats/min, blood pressure of 146/88 mm Hg, and oxygen saturation of 100%. Which assessment findings would be most concerning?

-Elevated white blood cell (WBC) count

44-A 24 yr old female has been diagnosed with genital warts. Which action by the nurse is best?

-Encourage the client to complete STI screening

A nurse is providing dietary teaching to a patient with recurrent oxalate calculi. The nurse should acknowledge the patient's choice of which meal as a good option? - Chicken and spinach salad, grilled salmon, and tea - Marinated steak kabobs with tomatoes and onions, diet cola -Fried pork chops, baked sweet potato, and water with lemon - Steamed clams and mussels, roasted rhubarb salad, and iced coffee

-Fried pork chops, baked sweet potato, and water with lemon

15-The nurse is caring for a patient with colicky flank pain, nausea and vomiting. The nurse notes blood pressure of 168/92 mm Hg, heart rate of 102 beats/min, respiratory rate of 22 breaths/min, and oxygen saturation of 98%. The nurse anticipates which order from the provider to help improve the flow of urine? -Give oral tamsulosin - Insert a Foley catheter. - Administer intravenous morphine. - Administer a bolus of lactated Ringer's solution.

-Give oral tamsulosin

4- A patient undergoes a pyelolithotomy for stone removal. Which postoperative laboratory values would be most concerning to the nurse? -White blood cell (WBC) count of 13 -Hemoglobin of 7 -Serum potassium level of 4.1 -Platelet count of 350,000

-Hemoglobin of 7

38-The nurse is preparing to administer medications to the patient receiving treatment for a gonorrheal infection. The patient questions the nurse about the need for both an injection and oral medications. What should the nurse include in a response? Select all that apply.

-IM ceftriaxone and oral azithromycin are first-line treatments. -Dual therapy is the first-line treatment for gonococcal infections. -Gonococcal infections are becoming increasingly drug resistant, so at least two antibiotics are required.

25- Which signs and symptoms should the nurse tell a patient with chronic kidney disease (CKD) to report immediately?

-Increasing lethargy -Shortness of breath -Weight change from 145 lb to 150 lb -Development of headaches or dizziness

A patient presents with nausea and vomiting with fatigue, headache, and extreme thirst. The nurse notes tenderness over the left flank, pyuria, and a white blood cell count of 15. What collaborative care is a priority for this patient? Hospitalization -Foley catheter -Intravenous (IV) antibiotic therapy -Intravenous (IV) fluid resuscitation -Urinary stent placement

-Intravenous (IV) antibiotic therapy -Intravenous (IV) fluid resuscitation Hospitalization

4- What is the recommendation regarding the use of diuretics for a patient with acute kidney injury (AKI) during the oliguric phase?

-Not recommended, may be harmful

4- The nurse is caring for an older adult patient who complains of cloudy urine. Urinalysis indicates a bacteria count of 5 × 102 CFU/mL. The nurse understands that which treatment is most appropriate for this patient?

-Oral nitrofurantoin therapy

A patient presents with fever, chills, and dysuria with increased urgency. Urinalysis reveals a bacteria count of 105 CFU/mL. The patient has no history of urinary tract infection (UTI) and is otherwise healthy. Which treatment is most appropriate for this patient?

-Oral trimethoprim-sulfamethoxazole (TMP/SMX)

A patient is diagnosed with urinary calculi and is experiencing colicky pain. The patient is prescribed opioid analgesics to manage the pain and is told to take a short walk every hour to encourage movement of the stone. What is the priority nursing goal for this patient? -Patient safety - Pain management - Preventing dehydration - Establishing healthy eating habits

-Patient safety

A patient with AKI presents to the emergency department with burns. What are the major nursing education concerns for this patient upon discharge? -Preventing infection -Preventing fluid loss -Preventing weight gain -Preventing hypertension -Preventing electrolyte imbalances

-Preventing infection -Preventing fluid loss -Preventing electrolyte imbalances

2- Urinary stones contribute to the development of which urinary tract infection (UTI)?

-Pyelonephritis

22-Some patients may feel weak and have low blood pressure immediately following hemodialysis (HD). How would the nurse explain the mechanism that caused these symptoms to the patient?

-Rapid fluid shifts can occur during HD as fluid is removed from the body.

A patient reports urinary retention, nausea, and flank pain rated 10 on a 10-point scale. Which obstructive uropathy does this suggest? -Renal calculi -Urethral stricture -Acute pyelonephritis -Obstructive ureteral stricture

-Renal calculi

16-Which dietary interventions would the nurse institute to prevent hypertension and edema in a patient with acute kidney injury (AKI)?Select all that apply.

-Restrict foods that are high in sodium -Restrict foods that are high in potassium

A patient presents with a urinary stricture. Which factors influence the severity of symptoms?

-Size of the stricture -Location of the stricture -Stricture causing complete obstruction

23- A patient with chronic kidney disease (CKD) complains about being "constantly thirsty" due to fluid restrictions. Which is the best recommendation that the nurse should give to this patient?

-Suck on hard candy

27-A mother of an 11-year-old girl comes into the health clinical and speaks with the nurse about vaccinations. The mother asks, "Why should I give my little girl a vaccine for a sexually transmitted infection?" Which information should the nurse provide to the mother? Select all that apply.

-The HPV vaccine can prevent infection when given before HPV exposure. -The HPV vaccine can help prevent some of the most common forms of cervical cancer. -Giving the vaccine before a person is sexually active can prevent the development of cervical cancer.

33-A nurse is caring for a patient who reports having BPH-like symptoms for many years. More recently the patient has experienced severe low back and hip pain that is radiating down his legs along with the urinary symptoms. How should the nurse interpret these findings?

-These manifestations are consistent with prostate cancer that may have metastasized to the bone.

18- Which statement is the rationale for discontinuing metformin in a patient with chronic kidney disease (CKD) and diabetes who has worsening kidney function?

-To prevent drug accumulation and possible toxicity

A patient presents with a urinary tract infection (UTI) that has not spread beyond the bladder. Which classification of UTI describes this kind of infection?

-Uncomplicated UTI

Which infections of the urinary tract may manifest systemically as symptoms of fever, chills, and flank pain? -Upper urinary tract infection (UTI) -Lower urinary tract infection (UTI) -Urethritis -Acute pyelonephritis - Chronic pyelonephritis

-Upper urinary tract infection (UTI) -acute pyelonephritis

1. Clinical manifestations of a _______________ include mild to moderate colic. This pain may be moderate to severe in intensity if the patient consumes a large volume of fluids (such as alcohol) over a brief period. Infection is unusual unless a calculus or foreign object, such as a stent or nephrostomy tube, is present

-Ureteral Stricture

11- A nurse is caring for a patient with obstructive uropathy who has lower quadrant abdominal pain. The obstruction is likely in which area of the patient's urinary tract?

-Ureterovesical junction

A patient presents after a penile fracture with symptoms including urinary frequency and incomplete bladder emptying. Which condition is suggested by the patient's symptoms?

-Urethral stricture

10-Which urinary symptoms would indicate to the nurse that a urinary tract infection (UTI) has progressed to renal failure? Dysuria -Oliguria -Suprapubic pain -Urinary frequency -Flank pain

-olguria -flank pain (10-10)

benefits of HPV vaccine

-once exposed, it's not as effective but can still prevent other strains of HPV -primary prevention of cervical cancer -The vaccine is best given before any sexual contact, which is why the recommended age is so young. The vaccination takes six months to administer

52-A patient diagnosed with breast cancer asks the nurse what "triple negative" means. An accurate response from the nurse about triple-negative breast cancer should include that

-the tumor is not likely to be responsive to hormone therapy.

50-You are a community health nurse planning a program on breastcancer screening guidelines for women in the neighborhood. To best promote the participants' learning and adherence, you would include (select all that apply)

-written guidelines for mammography and CBE.

54-The nurse is caring for four female clients. Which client does the nurse identify at the risk for breast cancer?

28-year-old African-American with early menarche

1. A nurse assesses a patient who is admitted with an acid-base imbalance. The patient's arterial blood gas values are pH 7.32, PaO2 85 mm Hg, PaCO234 mm Hg, and HCO3- 16 mEq/L (16 mmol/L). What action does the nurse take next?

A. Assess patient's rate, rhythm, and depth of respiration.

A patient with CKD, who receives hemodialysis three times weekly, has a urine output of 200 mL for the day. The nurse calculates the recommended daily fluid intake for this patient to be __ mL of fluid.

800 Urine output + 600 mL [insensible loss] = recommended fluid intake; 200 mL + 600 mL = 800 mL of fluid.

The nurse is caring for several patients who have had surgery to remove renal calculi. Which patient would the nurse see first? - A 67-year-old patient who had surgery 1 hour ago and has not urinated - A 34-year-old patient with 10/10 flank pain and dark red urine - A 48-year-old patient with blood pressure of 114/78 mm Hg who is complaining of nausea -A 29-year-old patient who received morphine and has a respiratory rate of 8 breaths/min

A 29-year-old patient who received morphine and has a respiratory rate of 8 breaths/min

1. The nurse is working with a male client who has gynecomastia. What action by the nurse is most appropriate?

A. Educate him on the side effects of tamoxifen.

1. A nurse assesses a patient who is prescribed a medication that inhibits aldosterone secretion and release. For which potential complications will the nurse assess? (Select all that apply.)

A. Serum potassium level of 5.4 mEq/L (5.4 mmol/L) B. Blood osmolality of 250 mOsm/kg (250 mmol/kg)

A nurse is caring for a patient who is experiencing excessive diarrhea. The patient's arterial blood gas values are pH 7.18, PaO2 98 mm Hg, PaCO2 45 mm Hg, and HCO3- 16 mEq/L (16 mmol/L). Which provider order does the nurse expect to receive?

A. Sodium bicarbonate 100 mEq diluted in 1 L of D5W

2. The nurse is educating a client on the prevention of toxic shock syndrome (TSS). Which statement by the client indicates a lack of understanding? A. "I need to change my tampon every 8 hours during the day." B. "At night, I should use a feminine pad rather than a tampon." C. "If I don't use tampons, I should not get TSS." D. "It is best if I wash my hands before inserting the tampon."

A. "I need to change my tampon every 8 hours during the day."

1. After teaching a client with a history of renal calculi, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the teaching?

A. "I should drink at least 3 L of fluid every day."

1. A nurse teaches a young female client who is prescribed cephalexin for a urinary tract infection. Which statement would the nurse include in this client's teaching?

A. "Use a second form of birth control while on this medication."

1. The nurse assesses a client with a history of urinary incontinence who presents with extreme dry mouth, constipation, and an inability to void. Which question would the nurse ask first?

A. "What medications are you taking?"

1. A woman is interested in alternative and complementary treatments for the nausea and vomiting caused by the side effects of chemotherapy for breast cancer. Which therapies wound the nurse suggest? (Select all that apply.)

A. Acupuncture B. Aromatherapy C. Shiatsu

A 70-kg adult client with chronic kidney disease (CKD) is on a 40-g protein diet. The patient has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would be of most concern to the nurse?

A. Albumin level of 2.5 g/dL (3.63 mcmol/L)

1. A nurse assesses a client who is recovering from extracorporeal shock-wave lithotripsy for renal calculi. The nurse notes an ecchymotic area on the client's right lower back. What action would the nurse take?

A. Apply an ice pack to the site.

A nurse assesses a patient who is experiencing an acid-base imbalance. The patient's arterial blood gas values are pH 7.34, PaO2 88 mm Hg, PaCO2 38 mm Hg, and HCO3- 19 mEq/L (19 mmol/L). Which assessment would the nurse perform first?

A. Cardiac rate and rhythm

1. A nurse is evaluating a patient who is being treated for dehydration. Which assessment result does the nurse correlate with a therapeutic response to the treatment plan?

A. Decreased orthostatic light-headedness and dizziness

1. The nurse is caring for a client who is diagnosed with urinary tract infection (UTI). What common urinary signs and symptoms does the nurse expect? (Select all that apply.)

A. Dysuria B. Frequency C. Burning A. Hematuria

1. A nurse is caring for patients with electrolyte imbalances on a medical-surgical unit. Which clinical manifestations are correctly paired with the contributing electrolyte imbalance? (Select all that apply.)

A. Hypokalemia—Flaccid paralysis with respiratory depression B. Hyponatremia—Decreased level of consciousness

1. A nurse assesses a patient with diabetes mellitus who is admitted with an acid-base imbalance. The patient's arterial blood gas values are pH 7.36, PaO298 mm Hg, PaCO2 33 mm Hg, and HCO3- 18 mEq/L (18 mmol/L). Which manifestation does the nurse identify as an example of the patient's compensation mechanism?

A. Increased rate and depth of respirations

1. A nurse is assessing patients on a medical-surgical unit. Which patient is at risk for hypokalemia?

A. Patient with pancreatitis who has continuous nasogastric suctioning

1. A nurse is planning interventions that regulate acid-base balance to ensure that the pH of a patient's blood remains within the normal range. Which abnormal physiologic functions may occur if the patient experiences an acid-base imbalance? (Select all that apply.)

A. Reduction in the function of hormones B. Fluid and electrolyte imbalances C. Excitable cardiac muscle membranes D. Changes in GI tract excitability

A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time?

b. Are you allergic to penicillin?

1. Which diagnostic test should the nurse anticipate for a patient with hyperkalemia?

Electrocardiogram

What is imperative in the treatment of gonorrhea

It is also imperative to ask about sexual partners so they can be contacted and tested.

A nurse is assessing a client who has acute pancreatitis and is at risk for an acid-base imbalance. For which manifestation of this acid-base imbalance should the nurse assess?

Kussmaul respirations

A nurse is assessing a patient who has acute pancreatitis and is at risk for an acid-base imbalance. For which manifestation of this acid-base imbalance would the nurse assess?

Kussmaul respirations

What indicates that ALL three receptors, estrogen, progesterone, and HER-2, are lacking in the tumor. The tumor is harder to treat, is more aggressive, and has a poorer prognosis.

Triple negative breast cancer finding

Which factors may lead to urinary tract obstruction by stricture? -Abdominal tumor -Recent cystoscopy -Frequent renal calculi -Prostatic hypertrophy -Ureteral inflammation -Pelvic radiation therapy

a. Abdominal tumor b. Prostatic hypertrophy c. Ureteral inflammation d. Pelvic radiation therapy

1. A positive and Trousseau's and Chvostek is indicative of what electrolyte imbalance? a. Hypocalcemia b. Hypercalcemia c. Hyponatremia d. Hypokalemia

a. Hypocalcemia

-A patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The nurse explains: to the patient that this combination is prescribed to:

b. treat any coexisting chlamydial infection.

1-Which menu items would the nurse remove from the meal tray of a patient with chronic kidney disease who is not currently receiving dialysis? -Bananas -White rice -Hard boiled eggs -White bread rolls -Apple slices and grapes -Salad with olive oil and vinegar

bananas hard boild eggs

57-A patient who has been recently diagnosed with benign prostatic hyperplasia (BPH) tells the nurse that he does not want to have a transurethral resection of the prostate (TURP) because it might affect his ability to have sexual intercourse. Which action should the nurse take?

c. Clarify that TURP does not commonly affect erection.

1- Medication used to improve urine flow and treat renal colic

oral tamsulosin

1. A nurse caring for a client with malnutrition assesses which laboratory value as the priority?

prealbumin

3- Which nutritional food group limitations would the nurse recommend to a patient with CKD and renal osteodystrophy in order to help manage the diagnosis?

protien phosphorus

The nurse instructs a patient with CKD and mineral bone disorder to take which medications with food in order to maximize function?

vitamin d calciminmetics phosphate binders