Medical Surgical Phosphate #1


The nurse provides care for a client in chronic kidney disease (CKD). Which topics should the nurse provide in the teaching session to help this client control phosphorus levels?


  1. Avoid calcium supplements
    • Rationale:

      This answer is not correct because clients with CKD often require calcium supplements as a result of poor vitamin D metabolism and to prevent hyperphosphatemia. Since phosphorus is high in CKD, calcium is low resulting in hypocalcemia.

  2. Increase intake of dairy products and nuts
    • Rationale:

      This answer is not correct because dairy products and nuts are high in phosphorus. Foods high in phosphorus should be avoided by the client with chronic kidney disease.

  3. Reduce intake of chocolate, meats, and whole grains
    • Rationale:

      This answer is not correct because chocolate, meats, and whole grains are foods high in magnesium, not phosphorus. Foods high in magnesium are healthy choices to eat.

  4. Take an aluminum-based antacid with or after meals
    • Rationale:

      This answer is correct because aluminum based antacids bind to phosphorus thus allowing it to be removed from the body. This is essential for the client with CKD as the kidneys do not function as needed for phosphorus removal.


Phosphorus is a nonmetallic element found in the blood, bones, muscles, nerves, and teeth and is a component of adenosine triphosphate (ATP), the primary energy source for the cells within the body. One major function of phosphorus is needed in the body to produce protein for the repair, growth, and maintenance of tissues and cells.


Learning Outcomes

The normal serum phosphorus level is between 2.5 – 4.5 mg/dL. When a client is diagnosed with CKD, the kidneys cannot remove phosphorus from the blood thus leading to complications; specifically, it causes the body to pull calcium from the bones in an effort to maintain homeostasis. This can cause the bones to become weak and unhealthy which increases the risk for fractures and other complications. Aluminum-based antacids are often prescribed in the treatment of CKD to bind with phosphate and increase elimination through the gastrointestinal tract.

Test Taking Tip

Consider interventions that will decrease serum phosphorus levels to answer this question correctly. Phosphorus and magnesium have an inverse relationship between the two electrolytes.

Video Rationale