A nurse is providing teaching to the parent of a newborn who has gastroesophageal reflux. Which of the following instructions should the nurse include?

Choice A reason: Acute stress causes an increase in metabolism, as the body activates the sympathetic nervous system and releases hormones such as adrenaline and cortisol. These hormones increase the heart rate, blood pressure, and oxygen consumption, and mobilize glucose and fatty acids for energy. The nurse should explain to the clients that acute stress can have beneficial effects, such as enhancing alertness, memory, and performance, but it can also have harmful effects, such as impairing digestion, immunity, and growth.

Choice B reason: Stress causes a negative nitrogen balance in the body, not a positive one. Nitrogen balance is the difference between the amount of nitrogen ingested and the amount of nitrogen excreted. A positive nitrogen balance means that the body is retaining more nitrogen than it is losing, which indicates growth, healing, or pregnancy. A negative nitrogen balance means that the body is losing more nitrogen than it is retaining, which indicates malnutrition, illness, or injury. The nurse should inform the clients that stress can cause a negative nitrogen balance, as the body breaks down protein for energy and loses nitrogen through urine, sweat, and wounds.

Choice C reason: Protein requirements increase in times of stress, not decrease. Protein is essential for tissue repair, immune function, and hormone synthesis. The nurse should advise the clients that stress can increase the protein needs of the body, as the body loses protein through catabolism, inflammation, and infection. The nurse should recommend the clients to consume adequate amounts of high-quality protein, such as eggs, milk, cheese, meat, fish, poultry, soy, and nuts.

Choice D reason: Glucose is broken down more quickly during times of stress, not more slowly. Glucose is the main source of energy for the brain and the muscles. The nurse should educate the clients that stress can increase the glucose levels in the blood, as the body releases glucose from the liver and muscles to provide fuel for the stress response. The nurse should also warn the clients that chronic stress can lead to insulin resistance, diabetes, and cardiovascular disease.

Choice A reason: Administering antiemetics following the meal is not an appropriate action for a client who is at risk for malnutrition. Antiemetics are medications that prevent or treat nausea and vomiting, which can interfere with oral intake and hydration. However, antiemetics should be given before the meal, not after, to reduce the likelihood of postprandial nausea and vomiting. ¹²

Choice B reason: Providing mouth care before feeding is an appropriate action for a client who is at risk for malnutrition. Mouth care can improve the client's appetite, taste, and comfort, as well as prevent oral infections and dental problems that can affect food intake. ³⁴

Choice C reason: Assessing for pain prior to mealtime is an appropriate action for a client who is at risk for malnutrition. Pain can reduce the client's appetite, mood, and ability to eat comfortably. The nurse should assess the client's pain level and provide adequate pain relief before offering food. ⁵⁶

Choice D reason: Removing the bedpan from the client's sight is an appropriate action for a client who is at risk for malnutrition. The presence of a bedpan or other unpleasant stimuli can cause the client to lose appetite, feel nauseated, or associate food with negative emotions. The nurse should create a pleasant and comfortable environment for the client to eat. ⁷⁸

Choice E reason: Discouraging snacks between meals is not an appropriate action for a client who is at risk for malnutrition. Snacks can provide additional calories, protein, and micronutrients that the client may not get from regular meals. Snacks can also help prevent hunger, fatigue, and hypoglycemia between meals. The nurse should encourage the client to have healthy snacks that are high in energy and nutrient density.