A nurse is providing teaching to a client who recently had a hemoglobin A1c level obtained. Which of the following statements should the nurse include in the teaching?

A. Offer the client a selection of beverages at each meal: Providing a variety of beverages may offer hydration and a sense of control, but clients with anorexia nervosa often use fluids to avoid calorie-dense solid foods. This approach can reinforce avoidance behaviors and does not contribute meaningfully to nutritional rehabilitation or psychological recovery.
B. Inform the client that a weight gain of 2.3 kg (5 lb) per week is expected: A weight gain goal of 2.3 kg per week is too aggressive and may provoke anxiety or resistance from the client. A slower, more gradual goal of 0.5 to 1 kg (1 to 2 lb) per week is considered safer and more psychologically tolerable. Unrealistic expectations can harm rapport and may lead to nonadherence or relapse.
C. Arrange for someone to remain with the client for 30 min after meals: Monitoring after meals is essential to prevent purging or other compensatory behaviors. The standard is 60 to 90 minutes post-meal observation to address delayed attempts at purging or exercising. Thus, while well-intentioned, this time frame is insufficient.
D. Encourage the client to participate in developing dietary goals: Involving the client in setting dietary goals promotes a sense of autonomy, collaboration, and ownership in the recovery process. This approach is therapeutic, reduces power struggles, and helps build trust between the nurse and the client.

A. Hypothyroidism: Phenylketonuria (PKU) screening helps detect elevated phenylalanine levels, which, if untreated, can lead to irreversible intellectual disability. Early dietary intervention prevents neurodevelopmental delays, a hallmark consequence of untreated PKU that mimics effects seen in congenital hypothyroidism.
B. Growth restriction: While PKU may indirectly affect growth if untreated, the primary concern is neurological damage, not intrauterine or postnatal growth restriction, which is influenced by multiple other factors.
C. Sickle cell anemia: Sickle cell anemia is a genetic blood disorder involving abnormal hemoglobin structure. It is screened for separately from PKU and is unrelated to phenylalanine metabolism.
D. Hypoglycemia: Hypoglycemia in newborns typically results from conditions like maternal diabetes or endocrine disorders. It is not a complication of phenylalanine metabolism and is unrelated to PKU screening.