# Situation: A 72-year-old woman with heart failure is going home after treatment for fluid overload. She takes furosemide 40 mg every morning and lisinopril 10 mg daily and has been told to follow a low-sodium diet. She lives with her daughter, who cooks for the family. She reads well and records her blood pressure readings in a notebook. The nurse teaches her daughter to read food labels. The clinic has limited her mother's sodium intake to 2,000 mg a day. Today's breakfast and lunch already contained 1,400 mg of sodium. For the evening meal, which choice keeps her within the day's limit? The sodium values are taken from each product's label.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629751  
> language: ko  
> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

Situation: A 72-year-old woman with heart failure is going home after treatment for fluid overload. She takes furosemide 40 mg every morning and lisinopril 10 mg daily and has been told to follow a low-sodium diet. She lives with her daughter, who cooks for the family. She reads well and records her blood pressure readings in a notebook.

The nurse teaches her daughter to read food labels. The clinic has limited her mother's sodium intake to 2,000 mg a day. Today's breakfast and lunch already contained 1,400 mg of sodium. For the evening meal, which choice keeps her within the day's limit? The sodium values are taken from each product's label.

## 보기

1. Canned tuna, 250 mg per serving, eating 2 servings **✔ 정답**
2. Crackers, 150 mg per serving, eating 5 servings
3. Instant noodles, 400 mg per serving, eating the 2-serving pack
4. White bread, 180 mg per slice, eating 4 slices

**정답: 1**

## 해설

Label reading takes two steps. First find what is left of the day's limit: 2,000 − 1,400 = 600 mg. Then multiply the sodium per serving by the number of servings actually eaten: tuna 250 × 2 = 500 mg (within 600 mg), crackers 150 × 5 = 750 mg, bread 180 × 4 = 720 mg, and noodles 400 × 2 = 800 mg. A low number per serving can hide a high total when several servings are eaten.

## 심화 해설

Step 1. Calculate the remaining sodium allowance
The prescribed limit is 2,000 mg per day. Breakfast and lunch together already provided 1,400 mg. The amount left for the evening meal is 600 mg (2,000 − 1,400 = 600). The goal of label reading is not to find the lowest number per serving, but to multiply that number by the actual number of servings the patient will eat.

Step 2. Compare each option against the 600 mg ceiling

| Food choice | Sodium per serving | Servings eaten | Total sodium | Within 600 mg? |
| --- | --- | --- | --- | --- |
| Canned tuna | 250 mg | 2 | 500 mg | Yes |
| Crackers | 150 mg | 5 | 750 mg | No |
| Instant noodles | 400 mg | 2 | 800 mg | No |
| White bread | 180 mg | 4 | 720 mg | No |

Watch out! The crackers have the lowest sodium per serving (150 mg), but because five servings are eaten, the total rises to 750 mg and exceeds the limit. A small per-serving value can be misleading when portion size is ignored.

Why this matters in heart failure
Sodium restriction is a core self-care behavior for patients with heart failure because excess dietary sodium promotes fluid retention, which increases ventricular filling pressure and can precipitate dyspnea, edema, and rehospitalization. Teaching caregivers to read labels and compute total sodium per actual portion is a practical nursing intervention that supports adherence without requiring the patient to memorize every food item. A meta-analysis of 16 randomized controlled trials including 2,260 patients examined sodium-restricted diets in heart failure, and the broader literature notes that the effect of strict sodium reduction is not uniformly beneficial; overly aggressive restriction may sometimes be associated with dehydration or adverse outcomes [1]. This does not mean sodium limits should be abandoned, but it does mean the nurse should emphasize individualized, realistic targets rather than extreme avoidance.

Dietary patterns such as the DASH diet, which combines lower sodium intake with higher intake of vegetables, fruits, and whole grains, have been associated with reduced risk of incident heart failure and heart failure-related death in cohort data . In clinical practice, the nurse can connect label-reading skills to this broader pattern: the daughter learns not only to count milligrams, but also to choose foods that are lower in sodium and higher in nutrient quality. Modifiable lifestyle factors, including nutrition, remain central to secondary prevention of cardiovascular disease .

Key point! For a patient on a 2,000 mg sodium limit who has already consumed 1,400 mg, the evening meal must stay at or below 600 mg. Only canned tuna at 2 servings (500 mg) fits. The correct approach is always: sodium per serving × number of servings actually eaten, then compare with the remaining allowance.
References (research sources)

- [1][A low-sodium diet for heart failure: necessary or harmful?]Research articleGerard M, Jullien S, Lang S, Mazuyer M, Brito E, Assyag P, Cohen AA. (2026) · DOI: 10.1016/j.soin.2026.04.008

## 임상 시나리오

Sodium Label Math for Heart FailureCalculate total sodium per actual portion, not per serving
Teach caregivers to first find the remaining daily allowance: subtract what was already eaten from the 2,000 mg limit. If breakfast and lunch contained 1,400 mg, only 600 mg remains for the evening meal.

Then multiply the label's sodium per serving by the actual number of servings eaten. Canned tuna at 250 mg per serving times 2 servings equals 500 mg, which stays within the limit.

CautionA low per-serving number can hide a high total. Crackers at 150 mg per serving seem safe, but 5 servings total 750 mg and exceed the allowance.

## 핵심 개념

- **Sodium restriction** — Limiting dietary sodium intake, commonly to 2,000 mg/day in heart failure, to reduce fluid retention and prevent symptom exacerbation.
- **Fluid overload** — Excess fluid accumulation in the body, often manifested as edema and dyspnea, related to increased ventricular filling pressure in heart failure.
- **Furosemide** — A loop diuretic used to remove excess fluid by increasing renal sodium and water excretion.
- **Label reading** — A practical self-care skill involving checking sodium per serving and multiplying by the actual number of servings consumed.
- **Caregiver education** — Teaching family members to support patient adherence to dietary and medication regimens, especially when they prepare meals.

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