護理師正在評估一名慢性腎臟病（CKD）第四期病患對飲食限制的理解。下列哪項餐點選擇顯示病患理解衛教內容？
A nurse is evaluating a client's understanding of dietary restrictions for chronic kidney disease (CKD) Stage 4. Which meal selection indicates that the client understands the instructions?
- AGrilled chicken breast with white rice and steamed green beans✓ 正解烤雞胸肉配白飯與清燙四季豆
- BBaked potato with skin, topped with chili and shredded cheese帶皮烤馬鈴薯，頂部加辣椒醬與碎起司
- CA large bowl of spinach salad with almonds and feta cheese一大碗菠菜沙拉配杏仁與菲達起司
- DA ham and cheese sandwich on whole wheat bread全麥麵包火腿起司三明治
慢性腎臟病（CKD）晚期的飲食衛教核心為「低鈉、低磷、低鉀、適量優質蛋白」。選項 A 中的烤雞胸肉提供優質蛋白質，白米飯相對於全穀類（D）含磷量較低，四季豆則是鉀含量較適中的蔬菜。選項 D 的火腿（加工肉）鈉含量極高，全麥麵包磷含量高。選項 C 的菠菜、杏仁和乳酪均含高鉀或高磷。選項 B 的馬鈴薯皮和起司也是高鉀、高磷的來源。護理師需確認病人能辨識隱藏的高磷食物（全穀類、堅果、乳製品），這是延緩腎功能惡化的關鍵。
The dietary teaching focus for late-stage chronic kidney disease (CKD) centers on 'low sodium, low phosphorus, low potassium, and moderate high-quality protein.' In option A, baked chicken breast provides high-quality protein, white rice contains less phosphorus than whole grains (D), and green beans are a vegetable with moderate potassium content. In option D, ham (processed meat) is extremely high in sodium, and whole-wheat bread is high in phosphorus. In option C, spinach, almonds, and cheese all contain high potassium or high phosphorus. In option B, potato skins and cheese are also high in potassium and phosphorus. The nurse needs to confirm that the patient can identify hidden high-phosphorus foods (whole grains, nuts, dairy products), as this is key to slowing the deterioration of renal function.
美國 NCLEX 考試中，CKD 飲食常強調「白飯比全麥好」（磷的考量），這常與一般大眾的健康觀念相反；台灣在 CKD 衛教上亦遵循此原則，但近年來會更強調磷結合劑（Binders）與餐點併用的重要性。