A nurse is providing discharge teaching to a client who is in the first trimester of pregnancy and has chronic nausea. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason: Tilt your head forward while you eat is a correct instruction for dysphagia. This position can help prevent choking by closing the airway and directing food and fluids to the back of the mouth and throat.

Choice B reason: Obtain your vitamins in liquid form is not a correct instruction for dysphagia. Liquid vitamins can be too thin and watery for people with dysphagia, as they can easily enter the airway and cause aspiration. Vitamins should be taken in pill or chewable form, or crushed and mixed with thickened liquids or pureed foods.

Choice C reason: Cool foods down to room temperature before consuming is not a correct instruction for dysphagia. Food temperature does not affect the risk of choking for people with dysphagia, as long as the food is not too hot or too cold. Food texture and consistency are more important factors for safe swallowing.

Choice D reason: Drink water with each bite of food is not a correct instruction for dysphagia. Water can also be too thin and watery for people with dysphagia, as it can also enter the airway and cause aspiration. Water should be thickened to a nectar-like, honey-like, or pudding-like consistency, depending on the individual's needs and preferences.

Choice A reason: Dietary restrictions will not eventually allow the intake of gluten to resume. Gluten is a protein found in wheat, barley, rye, and some oats. It causes damage to the small intestine in people with celiac disease. The only treatment for celiac disease is a lifelong gluten-free diet.

Choice B reason: This condition may cause secondary lactose intolerance. Lactose is a sugar found in milk and dairy products. It is broken down by an enzyme called lactase in the small intestine. People with celiac disease may have reduced levels of lactase due to the damage to the small intestine caused by gluten. This can lead to lactose intolerance, which is the inability to digest lactose properly. Symptoms of lactose intolerance include bloating, gas, diarrhea, and abdominal pain after consuming dairy products.

Choice C reason: Nutritional therapy for this condition does not include limiting proteins and calories. People with celiac disease need adequate amounts of proteins and calories to maintain their health and prevent malnutrition. They also need to ensure that they get enough vitamins, minerals, and fiber from gluten-free sources.

Choice D reason: A normal diet cannot resume after a period of remission. Celiac disease is a chronic autoimmune disorder that does not have a cure. Even if the symptoms improve or disappear, the damage to the small intestine can still occur if gluten is consumed. Therefore, a strict gluten-free diet must be followed for life.