A nurse is planning to administer total parenteral nutrition (TPN) to a client who is malnourished. Which of the following actions should the nurse plan to take? (Select all that apply.)

A. "You should limit your consumption of seafood to avoid exposure to mercury. Certain fish contain high levels of mercury, which can negatively impact fetal brain development. Pregnant individuals are advised to limit consumption of high-mercury seafood and choose safer options like salmon, shrimp, and cod, keeping weekly intake within recommended limits.
B. "You should not eat hard cheeses, such as Romano, Parmesan, and Asiago, to avoid listeriosis."
Hard cheeses are typically safe to eat during pregnancy because they are low in moisture and unlikely to support Listeria growth. It is soft, unpasteurized cheeses like brie and queso fresco that pose a higher listeriosis risk.
C. "You should decrease your salt intake to avoid preeclampsia." There is no strong evidence that reducing salt intake prevents preeclampsia. Pregnant individuals should follow normal dietary guidelines unless otherwise directed by a healthcare provider due to existing hypertension or kidney conditions.
D. "You should start using artificial sweeteners to decrease the risk of gestational diabetes."
Artificial sweeteners do not prevent gestational diabetes and some types may have unclear safety profiles in pregnancy. Emphasis should be placed on balanced nutrition and managing total carbohydrate intake rather than replacing sugar with artificial alternatives.

A. Include supplemental pancreatic enzymes with snacks: Pancreatic enzymes should be taken with all meals and snacks to aid digestion and nutrient absorption. However, the adjustment of dosage is based on stool characteristics rather than just timing with food.
B. Avoid taking water-soluble vitamins with pancreatic enzymes: Water-soluble vitamins (B and C) are not affected by pancreatic enzymes. Fat-soluble vitamins (A, D, E, K) are the ones often supplemented in cystic fibrosis and may be taken with enzymes to enhance absorption.
C. Adjust pancreatic enzymes to achieve three to four stools per day: Pancreatic enzyme dosage is tailored to optimize digestion and minimize steatorrhea. Achieving 1 to 2 well-formed stools in infants or 2 to 3 in older children and teens typically indicates adequate enzyme dosing.
D. Decrease pancreatic enzymes when eating high-fat meals: High-fat meals actually require more pancreatic enzymes for digestion. Decreasing enzyme intake in this situation can worsen malabsorption and weight loss.