A nurse is reinforcing teaching about foods that are high in folic acid with a client who is at 8 weeks of gestation. Which of the following foods should the nurse recommend as the best source of folic acid?

Rationale:

A. Tilt the client's head forward during meals: Tilting the head forward, also known as the chin-tuck technique, helps close the airway and reduce the risk of aspiration in clients with dysphagia. This position facilitates safer swallowing by improving bolus control and airway protection.

B. Encourage socialization during meal times: While social interaction is generally beneficial, clients with dysphagia require focused attention during meals to prevent choking or aspiration. Distractions can compromise concentration on swallowing techniques and safety precautions.

C. Elevate the head of the client's bed to 30": Although elevating the head of the bed helps reduce aspiration risk, a 30" elevation is not optimal for swallowing. A 45–90 degree upright position is typically recommended during meals to support safer swallowing mechanics.

D. Provide three large meals per day: Clients with dysphagia benefit more from small, frequent meals to reduce fatigue and lower the risk of aspiration. Large meals can overwhelm their ability to chew and swallow safely, increasing the risk of complications.

Rationale:

 • Seizures: The client’s significantly elevated T3 (230 ng/dL), T4 (3.4 ng/dL), and TSI (150%) levels, along with symptoms such as anxiety, heat intolerance, insomnia, and irritability, suggest hyperthyroidism and risk for thyroid storm. This hypermetabolic state can lead to neurological complications including seizures due to increased cerebral excitability.

 • Pneumonia: The client has no respiratory distress, maintains a clear airway, has normal respiratory rate and oxygen saturation, and shows no pulmonary abnormalities. There are no signs to suggest a risk for infection or hypoventilation.

 • Paralytic ileus: There are no gastrointestinal symptoms such as abdominal distension, absent bowel sounds, or nausea. The client has normal GI function with a good appetite and soft brown stools, ruling out risk of ileus.

 • thyroid storm: The clinical picture unplanned weight loss, exophthalmos, goiter, hyperreflexia (suggested by irritability), and insomnia aligns with Graves’ disease and severe thyrotoxicosis. Surgery can precipitate a thyroid storm if thyroid hormone levels are not well controlled beforehand.

 • hypoparathyroidism: While this is a known risk after thyroidectomy due to parathyroid injury, the client has not yet had surgery at the time of the lab results and symptoms. No signs of hypocalcemia (e.g., tingling, cramps) are present either.

 • laryngeal nerve damage: This is an intraoperative complication, generally presenting as hoarseness or voice changes. There are no findings suggesting vocal cord involvement, and it would not lead to seizures.