A nurse is providing teaching about a weight reduction plan to a client who is obese and has type 2 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?

Choice A reason: Warming the formula to room temperature can help reduce the osmotic load and prevent diarrhea in clients receiving enteral nutrition. Cold formula can also cause abdominal cramping and discomfort.

Choice B reason: Increasing the rate of infusion can worsen diarrhea by increasing the osmotic load and the risk of bacterial overgrowth. The rate of infusion should be adjusted based on the client's tolerance and nutritional needs.

Choice C reason: Changing to a low-calorie formula is not indicated for diarrhea. Low-calorie formulas are usually high in osmolality and can cause more water to be drawn into the intestinal lumen, leading to diarrhea. A low-residue or isotonic formula may be more appropriate.

Choice D reason: Replacing the extension tubing every 48 hr is not enough to prevent diarrhea. The extension tubing should be replaced every 24 hr or with each new container of formula to reduce the risk of bacterial contamination and infection.

Choice A reason: Increasing the caloric intake before pregnancy is not an appropriate dietary guideline, as it can lead to excessive weight gain and obesity, which can increase the risk of gestational diabetes, hypertension, and other complications. The nurse should advise the client to maintain a healthy weight and a balanced diet before and during pregnancy.

Choice B reason: Increasing the total intake of seafood to 20 ounces per week is not an appropriate dietary guideline, as it can expose the client to high levels of mercury, which can harm the developing fetus. The nurse should advise the client to limit the intake of seafood to 8 to 12 ounces per week, and avoid fish that are high in mercury, such as shark, swordfish, and king mackerel.

Choice C reason: Decreasing ascorbic acid in the diet is not an appropriate dietary guideline, as it can impair the immune system and the absorption of iron, which are both important for the health of the mother and the fetus. The nurse should advise the client to consume adequate amounts of ascorbic acid, which is found in citrus fruits, tomatoes, broccoli, and other foods.

Choice D reason: Increasing folic acid to 400 micrograms per day prior to getting pregnant is an appropriate dietary guideline, as it can prevent neural tube defects, such as spina bifida and anencephaly, in the fetus. The nurse should advise the client to take a daily prenatal vitamin that contains folic acid, and eat foods that are rich in folate, such as leafy greens, beans, and fortified cereals.