Sudden weight gain of 2 to 3 lb in a day or 5 lb in a week signals fluid retention and must be reported.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client with cirrhosis and ascites is on a sodium-restricted diet. Which food selection by the client indicates the teaching has been effective?
Answer: B. Sodium restriction reduces fluid retention and ascites. Fresh fruit such as a sliced apple and a baked skinless chicken breast are naturally low in sodium and appropriate. Canned soup, deli or smoked meats, and pickled or brined foods are very high in sodium and should be avoided. Choosing fresh, unprocessed foods demonstrates correct understanding.
Question 2 of 5
A client is prescribed a 2-gram sodium (low-sodium) diet. The nurse teaches the client to avoid:
Answer: B. Low-sodium diets avoid processed/canned foods, cured/smoked meats, salty snacks, and table salt. Fresh fruits, vegetables, and unprocessed foods are encouraged.
Question 3 of 5
A client on a cardiac (low-sodium, heart-healthy) diet should be taught to:
Answer: B. Limit sodium, saturated/trans fats, and processed foods; choose fruits, vegetables, whole grains, and lean protein. Adding salt and eating fried/processed foods works against the diet.
Question 4 of 5
A client with the syndrome of inappropriate antidiuretic hormone (SIADH) has dilutional hyponatremia. Which intervention should the nurse anticipate?
Answer: B. SIADH causes water retention and dilutional hyponatremia, so the mainstay is fluid restriction. Encouraging fluids or giving hypotonic IV fluids would worsen the dilution. A high-sodium diet alone does not correct the excess water retention.
Question 5 of 5
A patient is prescribed an isotonic IV fluid for volume replacement. Which solution is isotonic?
Answer: B. 0.9 percent sodium chloride (normal saline) is isotonic and stays in the intravascular space, making it appropriate for volume replacement. 0.45 percent saline is hypotonic, 3 percent saline is hypertonic, and D10W is hypertonic. (D5W is isotonic in the bag but becomes hypotonic once dextrose is metabolized.)
Keep the streak going with more questions like these, each with a full rationale.
What is low-sodium diet?
Typical restriction is 2,000 to 3,000 mg/day (about 2 grams), with stricter limits for advanced disease. Less sodium means less water held in the body, easing the workload on the heart.
Key points to remember
- Sodium pulls water with it, so restricting it reduces edema, ascites, and preload on the heart.
- Processed, canned, smoked, and cured foods are the biggest hidden sodium sources, not the salt shaker.
- Lunch meats, bacon, ham, pickles, olives, soy sauce, and canned soups are high-sodium and should be avoided.
- Fresh fruits, fresh vegetables, fresh meats, and unsalted starches are naturally low in sodium.
- Salt substitutes often contain potassium chloride and are dangerous in renal failure or with potassium-sparing diuretics.
Nursing priorities
- Teach the patient to read food labels and target items with less than 140 mg sodium per serving.
- Monitor daily weights, intake and output, and for edema to evaluate fluid status.
- Assess blood pressure trends and breath sounds for fluid overload.
- Coordinate with the dietitian to make the restriction realistic and palatable.
- Verify with the provider before allowing any salt substitute.
Labs & values
Patient teaching
- Flavor food with herbs, spices, lemon, vinegar, and garlic instead of salt.
- Rinse canned vegetables to remove some surface sodium, or choose fresh and frozen without sauce.
- Check sodium content of over-the-counter medications and antacids.
- Eat out less often, and request no added salt when dining out.
Red flags: report now
- Sudden weight gain of 2 to 3 lb in a day or 5 lb in a week signals fluid retention and must be reported.
- New or worsening dyspnea, crackles, or peripheral edema indicates fluid overload.
- Never recommend potassium-based salt substitutes for patients with kidney disease or on potassium-sparing diuretics.
References
Clinical references for this topic
