A nurse is providing dietary teaching for a client who is at 28 weeks of gestation and has phenylketonuria (PKU). Which of the following foods should the client avoid?

A. Elevated erythrocyte sedimentation rate (ESR): An elevated ESR is a nonspecific marker of inflammation. It can be elevated due to a variety of conditions, including infection, autoimmune disease, or chronic illness. In TPN, this finding would require further evaluation but is not a definitive or immediate indicator of a TPN-related complication.
B. Increased bilirubin levels: While increased bilirubin levels may suggest liver dysfunction, they are not uncommon in clients receiving TPN over an extended period due to hepatobiliary complications like cholestasis. However, after just 24 hours of TPN, a rise in bilirubin is unlikely to occur this quickly as a result of TPN alone.
C. Guaiac fecal occult blood test positive: A positive fecal occult blood test indicates the presence of gastrointestinal bleeding, which is not a typical complication associated with TPN initiation. While it is a concerning clinical finding, it is not directly linked to the use of TPN and may be related to other underlying gastrointestinal issues that need separate investigation.
D. Weight gain 1.6 kg (3.5 lb): A rapid weight gain of this magnitude within 24 hours of starting TPN suggests fluid overload, which is a potential complication of TPN therapy especially in clients with compromised cardiac or renal function. This finding indicates the need for immediate intervention to prevent further complications such as pulmonary edema or hypertension.

A. Legumes: Legumes, such as beans and lentils, are rich in protein but do not contain all nine essential amino acids in sufficient amounts, making them incomplete proteins. To achieve a complete amino acid profile, legumes must be combined with other protein sources, such as grains. Therefore, legumes are not classified as complete proteins on their own.
B. Eggs: Eggs are a high-quality source of protein and contain all nine essential amino acids in the appropriate proportions needed by the human body. They are considered one of the most biologically complete protein sources and are often used as the reference standard for evaluating protein quality in other foods.
C. Poultry: Poultry, such as chicken and turkey, provides all the essential amino acids required for protein synthesis in the body. It is classified as a complete protein and is a valuable source of high-quality animal protein in the human diet. Poultry supports tissue repair, immune function, and muscle maintenance.
D. Grains: Grains like rice, wheat, and oats contain some essential amino acids but lack others, such as lysine, making them incomplete proteins. To form a complete protein, grains need to be eaten in combination with other sources, such as legumes. Alone, they do not fulfill the criteria for a complete protein.
E. Nuts: Nuts are rich in healthy fats and protein, but they do not contain all essential amino acids in sufficient quantities. Like legumes and grains, nuts are incomplete proteins and must be combined with other plant-based foods to form a complete protein profile. Therefore, they are not included as complete proteins in this context.