A nurse is caring for a client who has a gastrostomy tube and is receiving enteral nutrition. The nurse should identify that which of the following complications represents the greatest risk to the client?

Choice A reason: Checking the client's deep tendon reflexes every 4 hr is a appropriate action for a nurse to take for a client who has hypomagnesemia. Hypomagnesemia is a low level of magnesium in the blood, which can cause neuromuscular excitability and hyperreflexia. The nurse should monitor the client's reflexes for signs of increased or decreased response, which can indicate worsening or improving hypomagnesemia.

Choice B reason: Encouraging the client to consume more fiber is not a relevant action for a nurse to take for a client who has hypomagnesemia. Fiber is beneficial for digestive health and blood glucose control, but it has no direct effect on magnesium levels. The nurse should encourage the client to consume foods that are rich in magnesium, such as green leafy vegetables, nuts, seeds, legumes, and whole grains.

Choice C reason: Restricting the client's fluid intake to 500 mL/day is not a safe or effective action for a nurse to take for a client who has hypomagnesemia. Fluid restriction can cause dehydration, electrolyte imbalance, and kidney damage, which can worsen hypomagnesemia. The nurse should maintain the client's fluid balance and monitor their urine output and specific gravity.

Choice D reason: Limiting sodium-containing foods on the client's meal tray is not a necessary action for a nurse to take for a client who has hypomagnesemia. Sodium is not directly related to magnesium levels, and limiting sodium intake can cause hyponatremia, which is a low level of sodium in the blood. The nurse should ensure that the client receives adequate sodium intake from their diet or supplements.

Choice A reason: Crohn's disease is not commonly associated with obesity, although obesity can worsen the symptoms and complications of Crohn's disease. Crohn's disease is a type of inflammatory bowel disease that causes inflammation and ulcers in the digestive tract, especially the small intestine and colon. The exact cause of Crohn's disease is unknown, but it may involve genetic, immune, and environmental factors.

Choice B reason: Celiac disease is not commonly associated with obesity, although obesity can make the diagnosis of celiac disease more difficult. Celiac disease is an autoimmune disorder that causes damage to the small intestine when gluten, a protein found in wheat, barley, and rye, is ingested. The damage interferes with the absorption of nutrients and can lead to malnutrition, anemia, and osteoporosis.

Choice C reason: Peptic ulcer disease is not commonly associated with obesity, although obesity can increase the risk of complications from peptic ulcer disease. Peptic ulcer disease is a condition that causes sores or ulcers in the lining of the stomach or duodenum, the first part of the small intestine. The most common causes of peptic ulcer disease are infection with Helicobacter pylori bacteria and use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Choice D reason: Gastroesophageal reflux disease (GERD) is commonly associated with obesity, as obesity can increase the pressure on the lower esophageal sphincter (LES), the muscle that prevents the backflow of stomach acid into the esophagus. GERD is a condition that causes heartburn, regurgitation, chest pain, and difficulty swallowing due to the reflux of stomach acid into the esophagus. GERD can also lead to esophagitis, Barrett's esophagus, and esophageal cancer.