A nurse is caring for a client who is receiving chemotherapy treatments. The client states, "I feel so nauseated after my treatments." Which of the following instructions should the nurse provide the client? (Select all that apply)

Choice A reason: Dyspnea is a sign of pulmonary edema, which can occur as a complication of parenteral nutrition due to fluid overload or allergic reaction¹². The nurse should monitor the client's respiratory status and oxygen saturation and report any signs of respiratory distress.

Choice B reason: Parenteral nutrition should not be infused by gravity, as this can cause fluctuations in the infusion rate and lead to hyperglycemia or hypoglycemia¹³. The nurse should use an infusion pump to deliver parenteral nutrition at a constant and controlled rate.

Choice C reason: Parenteral nutrition solution should be administered within 30 min after removing from the refrigerator, as prolonged exposure to room temperature can increase the risk of bacterial contamination and infection¹⁴. The nurse should check the expiration date and inspect the solution for any discoloration, cloudiness, or particulate matter before administration.

Choice D reason: Parenteral nutrition bag and infusion tubing should be changed every 24 hr, not every 72 hr, to prevent the growth of microorganisms and reduce the risk of infection¹⁵. The nurse should use aseptic technique when changing the bag and tubing and follow the facility's protocol for dressing changes and catheter care.

Choice E reason: Parenteral nutrition should be started only after the central venous catheter position is confirmed by radiology, as incorrect placement can cause serious complications such as pneumothorax, hemothorax, or cardiac tamponade¹⁶. The nurse should obtain a chest x-ray and wait for the provider's confirmation before initiating parenteral nutrition.

Choice B reason: Lentils are a rich source of folate, which is a B vitamin that is essential for the development of the neural tube and the prevention of neural tube defects in the fetus . One cup of cooked lentils provides about 358 micrograms of folate, which is 90% of the recommended daily intake for pregnant women.

Choice A reason: Mashed potatoes are not a good source of folate, as they contain only 8 micrograms of folate per cup, which is 2% of the recommended daily intake for pregnant women. Potatoes are mainly a source of carbohydrates, potassium, and vitamin C.

Choice C reason: Green peppers are a moderate source of folate, as they contain 42 micrograms of folate per cup, which is 11% of the recommended daily intake for pregnant women. Green peppers are also a source of vitamin C, vitamin A, and fiber.

Choice D reason: Carrots are a low source of folate, as they contain 24 micrograms of folate per cup, which is 6% of the recommended daily intake for pregnant women. Carrots are mainly a source of vitamin A, beta-carotene, and fiber.