A nurse is planning a mechanical soft diet for a client who has difficulty chewing. Which of the following foods should the nurse plan to include on the client's meal tray?

Choice A reason: Increasing the caloric intake before pregnancy is not an appropriate dietary guideline, as it can lead to excessive weight gain and obesity, which can increase the risk of gestational diabetes, hypertension, and other complications. The nurse should advise the client to maintain a healthy weight and a balanced diet before and during pregnancy.

Choice B reason: Increasing the total intake of seafood to 20 ounces per week is not an appropriate dietary guideline, as it can expose the client to high levels of mercury, which can harm the developing fetus. The nurse should advise the client to limit the intake of seafood to 8 to 12 ounces per week, and avoid fish that are high in mercury, such as shark, swordfish, and king mackerel.

Choice C reason: Decreasing ascorbic acid in the diet is not an appropriate dietary guideline, as it can impair the immune system and the absorption of iron, which are both important for the health of the mother and the fetus. The nurse should advise the client to consume adequate amounts of ascorbic acid, which is found in citrus fruits, tomatoes, broccoli, and other foods.

Choice D reason: Increasing folic acid to 400 micrograms per day prior to getting pregnant is an appropriate dietary guideline, as it can prevent neural tube defects, such as spina bifida and anencephaly, in the fetus. The nurse should advise the client to take a daily prenatal vitamin that contains folic acid, and eat foods that are rich in folate, such as leafy greens, beans, and fortified cereals.

Choice C reason: Flushing the tubing with water after each feeding is important to prevent clogging, maintain patency, and clear any residual formula from the tube. It also helps to prevent bacterial growth and infection.

Choice A reason: Wearing sterile gloves during a feeding is not necessary, as enteral feedings are not considered sterile procedures. Clean gloves are sufficient to prevent contamination and protect the nurse and the client.

Choice B reason: Chilling the feeding prior to administering is not recommended, as cold formula can cause abdominal cramping, discomfort, and diarrhea. The formula should be at room temperature or slightly warmed before giving it to the client.

Choice D reason: Positioning the client upright prior to a feeding is correct, but it is not enough. The client should remain upright for at least 30 minutes after the feeding as well, to prevent aspiration, reflux, and nausea.