A nurse is caring for a client who has acute kidney injury and has been prescribed total parenteral nutrition (TPN). When educating the client on the use of TPN, which of the following information should the nurse include?

Choice A reason: Administering antiemetics following the meal is not an appropriate action for a client who is at risk for malnutrition. Antiemetics are medications that prevent or treat nausea and vomiting, which can interfere with oral intake and hydration. However, antiemetics should be given before the meal, not after, to reduce the likelihood of postprandial nausea and vomiting. ¹²

Choice B reason: Providing mouth care before feeding is an appropriate action for a client who is at risk for malnutrition. Mouth care can improve the client's appetite, taste, and comfort, as well as prevent oral infections and dental problems that can affect food intake. ³⁴

Choice C reason: Assessing for pain prior to mealtime is an appropriate action for a client who is at risk for malnutrition. Pain can reduce the client's appetite, mood, and ability to eat comfortably. The nurse should assess the client's pain level and provide adequate pain relief before offering food. ⁵⁶

Choice D reason: Removing the bedpan from the client's sight is an appropriate action for a client who is at risk for malnutrition. The presence of a bedpan or other unpleasant stimuli can cause the client to lose appetite, feel nauseated, or associate food with negative emotions. The nurse should create a pleasant and comfortable environment for the client to eat. ⁷⁸

Choice E reason: Discouraging snacks between meals is not an appropriate action for a client who is at risk for malnutrition. Snacks can provide additional calories, protein, and micronutrients that the client may not get from regular meals. Snacks can also help prevent hunger, fatigue, and hypoglycemia between meals. The nurse should encourage the client to have healthy snacks that are high in energy and nutrient density.

Choice A reason: Formula should not be changed to whole milk until the infant is 12 months old, as whole milk does not provide enough iron and other nutrients for the infant's growth and development. Whole milk can also cause intestinal bleeding and increase the risk of allergies in infants younger than 12 months.

Choice B reason: Formula that remains in the bottle should not be used for another feeding, as it can harbor bacteria and cause infection. Any formula that is not consumed within one hour of preparation or feeding should be discarded.

Choice C reason: If the infant turns away after taking most of the feeding, it is a sign that the infant is full and satisfied. The nurse should instruct the parents to stop the feeding and burp the infant. Forcing the infant to finish the bottle can cause overfeeding and vomiting.

Choice D reason: If the infant is gaining weight too rapidly, diluting the formula is not a safe or effective solution. Diluting the formula can cause water intoxication, electrolyte imbalance, and malnutrition in the infant. The nurse should advise the parents to consult with the infant's doctor about the appropriate amount and type of formula for the infant.