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: Anticholinesterase medications should be taken 30 minutes before meals, not with meals. This is because they enhance the action of acetylcholine, which improves muscle strength and swallowing ability.

Choice B reason: Positioning the head of the client's bed to 40° while eating helps prevent aspiration and facilitates swallowing. This is the best action for the nurse to take for a client who has myasthenia gravis.

Choice C reason: Encouraging the client to lie down after eating is not advisable, as it increases the risk of aspiration and reflux. The client should remain upright for at least 30 minutes after eating.

Choice D reason: Providing the client with food cut into small bites is not enough to ensure safe and adequate nutrition. The client may still have difficulty swallowing and chewing. The nurse should also offer soft, moist, and easy-to-swallow foods, and avoid foods that are dry, sticky, or hard.

Choice A reason: Bran cereal is high in phosphorus, containing about 34% of the DV per cup (118 g) ( 1 ). Phosphorus is a mineral that helps build strong bones and teeth, but too much of it can cause problems for people with kidney disease. The kidneys normally filter out excess phosphorus from the blood, but when they are damaged, phosphorus can build up and cause bone loss, itching, and calcification of blood vessels and organs ( 2 ).

Choice B reason: A medium apple is low in phosphorus, containing only 3% of the DV per 182 g ( 3 ). Apples are also a good source of fiber, vitamin C, and antioxidants. They can help lower blood pressure, cholesterol, and blood sugar levels, which are beneficial for people with kidney disease ( 4 ).

Choice C reason: Scrambled eggs are moderate in phosphorus, containing about 12% of the DV per large egg (50 g) ( 5 ). Eggs are also high in protein, which can increase the workload of the kidneys and worsen kidney function. People with kidney disease should limit their protein intake to 0.8 g per kg of body weight per day, unless advised otherwise by their doctor ( 6 ).

Choice D reason: Ground turkey is high in phosphorus, containing about 16% of the DV per 3 oz (85 g) ( 7 ). Ground turkey is also high in protein, which can have the same negative effects as eggs on kidney function. People with kidney disease should choose lean meats and poultry, and eat them in moderation.