A nurse is teaching a client who has a goiter appropriate food choices related to dietary needs. Which of the following client statements indicates an understanding of the teaching?

Choice A reason: Offering the client a selection of beverages at each meal is not a good action to include in the plan, as it may reduce the client's appetite and intake of solid foods. The nurse should limit the client's fluid intake before and during meals, and encourage the client to consume high-calorie and high-protein drinks, such as milkshakes or smoothies, after meals.

Choice B reason: Informing the client that a weight gain of 2.3 kg (5 lb) per week is expected is not a good action to include in the plan, as it may cause anxiety and resistance in the client. The nurse should set realistic and individualized weight goals for the client, and monitor the client's weight and vital signs regularly. The nurse should also avoid focusing on the client's weight, and instead emphasize the client's health and well-being.

Choice C reason: Arranging for someone to remain with the client for 30 min after meals is a good action to include in the plan, as it can prevent the client from purging or exercising excessively. The nurse should provide a supportive and nonjudgmental environment for the client, and supervise the client's eating and toileting behaviors. The nurse should also educate the client and the family about the complications and treatment of anorexia nervosa.

Choice D reason: Encouraging the client to participate in developing dietary goals is a good action to include in the plan, as it can increase the client's sense of control and motivation. The nurse should collaborate with the client, the dietitian, and the mental health team to create a personalized and flexible meal plan that meets the client's nutritional and psychological needs. The nurse should also praise the client for any progress or achievement, and reinforce the client's positive coping skills.

Choice D reason: A calorie reduction of 500 fewer calories per day can result in a weight loss of about 0.45 kg (1 lb) per week, which is a safe and realistic goal for most clients. A pound of fat contains about 3,500 calories, so reducing the daily intake by 500 calories can create a deficit of 3,500 calories per week.

Choice A reason: A weight loss of 0.45 kg (1 lb) per day is too rapid and unhealthy, as it can cause dehydration, electrolyte imbalance, muscle loss, and metabolic slowdown. It can also be unsustainable and lead to weight regain. A calorie reduction of 500 fewer calories per day cannot achieve such a drastic weight loss.

Choice B reason: A weight loss of 0.23 kg (0.5 lb) per day is also too rapid and unhealthy, for the same reasons as choice A. A calorie reduction of 500 fewer calories per day cannot achieve such a drastic weight loss.

Choice C reason: A weight loss of 0.23 kg (0.5 lb) per week is too slow and unlikely, as it would require a calorie reduction of only 250 fewer calories per day. This is not enough to create a significant deficit and stimulate weight loss. A calorie reduction of 500 fewer calories per day can result in a faster weight loss.