A nurse is teaching a group of parents about appropriate food choices for toddlers. Which of the following choices by the parents demonstrates an understanding of the teaching?

The nurse should identify that the client who follows a vegan diet is at risk for deficiencies in Vitamin D, Vitamin B12, and potentially Calcium.
1. Vitamin D: Vitamin D is primarily obtained from sunlight exposure and is also found in animal-based foods such as fatty fish, liver, and egg yolks. Since a vegan diet excludes animal products, it can be challenging to obtain sufficient Vitamin D. Vegans should consider fortified foods (e.g., plant-based milk, breakfast cereals) and may require Vitamin D supplements.
2. Vitamin B12: Vitamin B12 is naturally found only in animal products, such as meat, fish, dairy, and eggs. Vegans are at a high risk of Vitamin B12 deficiency because
plant-based foods do not provide adequate amounts. Vegans should consider taking Vitamin B12 supplements or consuming foods fortified with Vitamin B12, such as certain plant-based milk, meat substitutes, and breakfast cereals.
3. Calcium: Calcium is essential for bone health. While it is possible to obtain calcium from plant-based sources such as fortified plant milk, tofu, leafy green vegetables, and fortified juices, vegan diets may be lower in calcium compared to diets that include dairy products. Vegans should pay attention to their calcium intake and consider supplements if needed.
Regarding the options listed in the question, Vitamin C, Magnesium, and Folic Acid deficiencies are not directly associated with a vegan diet. These nutrients can be adequately obtained from a well-planned vegan diet that includes a variety of fruits, vegetables, whole grains, legumes, nuts, and seeds.

Phenylketonuria (PKU) is an inherited metabolic disorder in which the body cannot properly process an amino acid called phenylalanine. If left untreated, phenylalanine can build up to harmful levels in the body, leading to intellectual disability and other health problems. Managing PKU involves following a strict low-phenylalanine diet.

When discussing anticipatory guidance for a client with PKU who is planning a pregnancy, it is important to focus on monitoring the maternal phenylalanine levels during pregnancy. Serum bilirubin is not directly related to PKU management and would not require specific monitoring in this context.

Regarding the other options:

"Diet sodas should not be consumed more than two or three times per week": While it is generally advisable to limit the consumption of diet sodas due to their artificial sweeteners, this statement does not directly relate to PKU management or pregnancy planning.

"A low-protein diet should be followed for 3 months prior to conception": A low-protein diet is a fundamental aspect of managing PKU. However, the timeline mentioned (3 months prior to conception) is not supported by current guidelines. PKU management should be ongoing and tailored to the individual's needs, with dietary adjustments made as necessary throughout pregnancy.

"Breastfeeding will prevent your baby from developing PKU": This statement is incorrect. Breast milk naturally contains phenylalanine, which could be harmful to an infant with PKU. Infants with PKU must receive a specialized formula that is low in phenylalanine from birth. Breastfeeding is not recommended for infants with PKU unless specifically guided by a healthcare professional.