A nurse is caring for a client who is malnourished. The client states, "When I do eat, I usually just eat bread and butter to get something in me." The nurse should recognize that the client is at risk for which of the following complications?

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.

Choice A reason: "I should use butter for cooking vegetables." is not a correct statement, as butter is high in saturated fat and cholesterol, which can increase the risk of heart disease. The nurse should advise the client to use unsaturated oils, such as olive or canola oil, for cooking vegetables.

Choice B reason: "I will choose whole grain bread." is a correct statement, as whole grains are rich in fiber, antioxidants, and phytochemicals, which can lower the risk of heart disease. The nurse should encourage the client to choose whole grain bread over refined bread, and to consume at least three servings of whole grains per day.

Choice C reason: "I should decrease my sodium intake to 3.2 grams per day." is not a correct statement, as 3.2 grams of sodium is equivalent to 8 grams of salt, which is above the recommended limit of 6 grams of salt per day for adults. The nurse should instruct the client to reduce their sodium intake to less than 2.3 grams per day, or 1.5 grams per day if they have high blood pressure, and to avoid processed foods, canned foods, and table salt.

Choice D reason: "I will eat chicken with the skin." is not a correct statement, as chicken skin is high in saturated fat and cholesterol, which can increase the risk of heart disease. The nurse should suggest the client to remove the skin from chicken before eating, and to choose lean cuts of poultry, fish, or meat.