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: Checking the client's deep tendon reflexes every 4 hr is a appropriate action for a nurse to take for a client who has hypomagnesemia. Hypomagnesemia is a low level of magnesium in the blood, which can cause neuromuscular excitability and hyperreflexia. The nurse should monitor the client's reflexes for signs of increased or decreased response, which can indicate worsening or improving hypomagnesemia.

Choice B reason: Encouraging the client to consume more fiber is not a relevant action for a nurse to take for a client who has hypomagnesemia. Fiber is beneficial for digestive health and blood glucose control, but it has no direct effect on magnesium levels. The nurse should encourage the client to consume foods that are rich in magnesium, such as green leafy vegetables, nuts, seeds, legumes, and whole grains.

Choice C reason: Restricting the client's fluid intake to 500 mL/day is not a safe or effective action for a nurse to take for a client who has hypomagnesemia. Fluid restriction can cause dehydration, electrolyte imbalance, and kidney damage, which can worsen hypomagnesemia. The nurse should maintain the client's fluid balance and monitor their urine output and specific gravity.

Choice D reason: Limiting sodium-containing foods on the client's meal tray is not a necessary action for a nurse to take for a client who has hypomagnesemia. Sodium is not directly related to magnesium levels, and limiting sodium intake can cause hyponatremia, which is a low level of sodium in the blood. The nurse should ensure that the client receives adequate sodium intake from their diet or supplements.

Choice A reason: Diabetes mellitus is not a likely complication of malnutrition, as it is caused by insufficient insulin production or action, not by inadequate food intake. Malnutrition may worsen the outcomes of diabetes, but it does not cause it.

Choice B reason: Pressure injury is a common complication of malnutrition, as it is caused by impaired tissue perfusion and oxygenation due to poor nutrition. Malnutrition can lead to loss of muscle mass, subcutaneous fat, and skin integrity, which increase the risk of developing pressure ulcers.

Choice C reason: Heat intolerance is not a direct complication of malnutrition, as it is caused by impaired thermoregulation due to hormonal or neurological disorders, not by insufficient food intake. Malnutrition may affect the body's ability to cope with heat stress, but it does not cause it.

Choice D reason: Gastroesophageal reflux disease (GERD) is not a typical complication of malnutrition, as it is caused by the backflow of gastric contents into the esophagus due to a weak or incompetent lower esophageal sphincter, not by inadequate food intake. Malnutrition may aggravate the symptoms of GERD, but it does not cause it.