A nurse is assessing a client who is in the second trimester of pregnancy and has a BMI within the expected reference range. Which of the following assessment findings indicates that the client will gain weight within the expected reference range?

Choice A reason: A low-protein diet is essential for clients who have PKU, as they cannot metabolize the amino acid phenylalanine. High levels of phenylalanine can cause intellectual disability and other neurological problems. A low-protein diet should be started before pregnancy and maintained throughout pregnancy to prevent fetal harm.

Choice B reason: Serum bilirubin is not related to PKU. It is a product of red blood cell breakdown and is elevated in conditions such as jaundice, liver disease, or hemolytic anemia. It does not need to be monitored routinely in clients who have PKU.

Choice C reason: Diet sodas are not recommended for clients who have PKU, as they often contain artificial sweeteners such as aspartame, which is a source of phenylalanine. Diet sodas should be avoided completely or consumed very sparingly by clients who have PKU.

Choice D reason: Breastfeeding will not prevent the baby from developing PKU, as PKU is a genetic disorder that is inherited from both parents. If both parents have PKU, the baby will have a 100% chance of having PKU. If one parent has PKU and the other is a carrier, the baby will have a 50% chance of having PKU. If one parent has PKU and the other is not a carrier, the baby will not have PKU but will be a carrier. Breastfeeding may provide some benefits for the baby, such as immunity and bonding, but it will not affect the baby's PKU status.

Choice A reason: Sipping fluids slowly throughout the day can help prevent dehydration and electrolyte imbalance, which can worsen nausea and vomiting. Fluids also help flush out the toxins from the chemotherapy and reduce the risk of kidney damage¹².

Choice B reason: Consuming foods that are served cold can help reduce the stimulation of the chemoreceptor trigger zone (CTZ), which is responsible for triggering nausea and vomiting. Cold foods also have less odor and taste, which can be unpleasant for some clients with CINV³⁴.

Choice C reason: Sitting up for 1 hr after eating meals can help prevent reflux and aspiration, which can cause more nausea and vomiting. Sitting up can also promote gastric emptying and digestion.

Choice D reason: Limiting the use of antiemetics until after the first emesis is not a recommended practice, as it can make nausea and vomiting more difficult to control. Antiemetics should be given before, during, and after chemotherapy, according to the emetogenic potential of the agents and the client's individual response.

Choice E reason: Eating foods low in carbohydrates is not a helpful strategy for CINV, as carbohydrates can provide energy and prevent hypoglycemia, which can also cause nausea and vomiting. Carbohydrates can also help settle the stomach and reduce acid production.