A nurse is caring for a client who has acute kidney injury and has been prescribed total parenteral nutrition (TPN). When educating the client on the use of TPN, which of the following information should the nurse include?

Choice A reason: Setting a weight loss goal is an important step in the weight management process, but it is not the first action the nurse should take. The nurse should first assess the client's readiness and willingness to change, as well as the factors that motivate the client to lose weight.

Choice B reason: Identifying the client's motivation is the first action the nurse should take, as it helps the nurse to tailor the interventions to the client's needs and preferences. The nurse should explore the client's reasons for wanting to lose weight, such as improving health, appearance, or self-esteem, and use them as positive reinforcement.

Choice C reason: Discussing behavior modification is a key component of weight management, but it is not the first action the nurse should take. The nurse should first identify the client's motivation and then help the client to develop realistic and specific goals and strategies to change their eating and physical activity habits.

Choice D reason: Referring the client to a dietitian is a helpful action, but it is not the first action the nurse should take. The nurse should first identify the client's motivation and then collaborate with the dietitian to provide individualized and evidence-based dietary advice and education to the client.

Choice B reason: Older adults should decrease their calorie intake as their metabolic rate and physical activity tend to decline with age. Excess calories can lead to weight gain and increase the risk of chronic diseases such as diabetes, cardiovascular disease, and some cancers. Older adults should aim for a balanced diet that meets their nutritional needs without exceeding their energy requirements.

Choice A reason: Older adults should not decrease their vitamin D intake, as vitamin D is essential for bone health and immune function. Older adults are at risk of vitamin D deficiency due to reduced sun exposure, decreased skin synthesis, and impaired absorption. Vitamin D deficiency can cause osteoporosis, fractures, muscle weakness, and infections. Older adults should consume adequate amounts of vitamin D from fortified foods, supplements, or sun exposure.

Choice C reason: Older adults should not decrease their protein intake, as protein is important for maintaining muscle mass, strength, and function. Older adults are prone to sarcopenia, which is the loss of muscle mass and quality due to aging. Sarcopenia can impair mobility, balance, and independence. Older adults should consume enough protein from animal or plant sources to prevent or delay sarcopenia.

Choice D reason: Older adults should not decrease their fiber intake, as fiber is beneficial for digestive health and blood glucose control. Older adults often suffer from constipation, diverticular disease, and diabetes, which can be alleviated by increasing fiber intake. Fiber can also lower cholesterol levels and reduce the risk of heart disease and some cancers. Older adults should consume at least 25 grams of fiber per day from fruits, vegetables, whole grains, legumes, nuts, and seeds.