A nurse is reviewing the medical record of a client who has a stage 2 pressure injury. The nurse should identify that which of the following findings can impair the client's ability to heal?

A. "Provide a small feeding just before bedtime." Feeding just before bedtime can increase the risk of reflux during sleep due to a full stomach and recumbent positioning. It is better to allow time for digestion before lying down to reduce reflux episodes.
B. "Position the newborn at a 20-degree angle after feeding." Keeping the newborn in an upright or slightly elevated position (typically 20 to 30 degrees) after feeding helps reduce gastroesophageal reflux by using gravity to prevent stomach contents from flowing back into the esophagus.
C. "Place the newborn in a side-lying position if vomiting." Side-lying is not the recommended sleeping or resting position due to the risk of sudden infant death syndrome (SIDS). The safest position for infants is on the back, even if they have reflux.
D. "Dilute formula with 1 tablespoon of water." Diluting formula can lead to electrolyte imbalances and inadequate caloric intake. Formula should be prepared according to manufacturer or provider instructions to ensure nutritional needs are met.

A. Offer the client a selection of beverages at each meal: Providing a variety of beverages may offer hydration and a sense of control, but clients with anorexia nervosa often use fluids to avoid calorie-dense solid foods. This approach can reinforce avoidance behaviors and does not contribute meaningfully to nutritional rehabilitation or psychological recovery.
B. Inform the client that a weight gain of 2.3 kg (5 lb) per week is expected: A weight gain goal of 2.3 kg per week is too aggressive and may provoke anxiety or resistance from the client. A slower, more gradual goal of 0.5 to 1 kg (1 to 2 lb) per week is considered safer and more psychologically tolerable. Unrealistic expectations can harm rapport and may lead to nonadherence or relapse.
C. Arrange for someone to remain with the client for 30 min after meals: Monitoring after meals is essential to prevent purging or other compensatory behaviors. The standard is 60 to 90 minutes post-meal observation to address delayed attempts at purging or exercising. Thus, while well-intentioned, this time frame is insufficient.
D. Encourage the client to participate in developing dietary goals: Involving the client in setting dietary goals promotes a sense of autonomy, collaboration, and ownership in the recovery process. This approach is therapeutic, reduces power struggles, and helps build trust between the nurse and the client.