A nurse is caring for a client who is visually impaired. When delivering the client's meal tray, which of the following actions should the nurse take?

Choice A reason: This is not a good statement because refined grains are processed carbohydrates that have low nutritional value and high glycemic index, which can increase blood sugar and insulin levels and promote fat storage. The nurse should advise the client to choose whole grains instead, which are rich in fiber, vitamins, minerals, and antioxidants.

Choice B reason: This is not a good statement because rewarding oneself with special foods can undermine the weight loss efforts and create a negative association between food and achievement. The nurse should suggest other ways of rewarding oneself that are not food-related, such as buying new clothes, going to the movies, or getting a massage.

Choice C reason: This is not a good statement because planning meals so up to 40 percent of calories come from fats can exceed the recommended intake of fats, which is 20 to 35 percent of total calories. The nurse should also emphasize the importance of choosing healthy fats, such as monounsaturated and polyunsaturated fats, over saturated and trans fats, which can increase the risk of cardiovascular disease.

Choice D reason: This is a good statement because consuming 500 fewer calories per day than the estimated calorie needs can create a moderate energy deficit that can lead to a gradual and sustainable weight loss of about one pound per week. The nurse should also encourage the client to increase physical activity to burn more calories and preserve lean muscle mass.

Choice A reason: This is not an appropriate action because asking the client's health care surrogate for permission to withhold nourishment can violate the client's autonomy and dignity. The nurse should respect the client's wishes and preferences regarding end-of-life care and document them clearly.

Choice B reason: This is an appropriate action because providing regular oral care for the client with a moist swab can prevent dryness, cracking, or infection of the mouth and lips and enhance comfort and quality of life. The nurse should also apply lip balm or petroleum jelly as needed.

Choice C reason: This is not an appropriate action because requesting a prescription for IV fluids can cause fluid overload, edema, or dyspnea in the dying client and prolong their suffering. The nurse should follow the provider's orders regarding hydration and nutrition and monitor the client's fluid balance status.

Choice D reason: This is not an appropriate action because explaining the importance of oral hydration to the client can be perceived as coercive or insensitive and cause distress or guilt in the dying client. The nurse should acknowledge the client's decision and provide emotional support and education.