A nurse is reinforcing teaching with a client who is pregnant and does not consume dairy products. Which of the following food options should the nurse recommend as the best source of dietary calcium?

(A) "I will nurse my baby for 5 to 10 minutes on each breast.":
While nursing for 5 to 10 minutes on each breast might work for some babies, it's generally recommended to allow the baby to nurse as long as they are actively sucking and swallowing. The length of time can vary depending on the baby's needs and the mother's milk supply.

(B) "I will make sure that just the nipple is in my baby's mouth.":
This is incorrect because proper latch-on involves the baby having not just the nipple but also a large portion of the areola in their mouth. This ensures effective milk transfer and helps prevent nipple soreness and damage.

(C) "I will apply vitamin E oil to my nipples after each feeding.":
Applying vitamin E oil or any other substance to the nipples is not typically recommended without the advice of a healthcare provider. Some substances can cause irritation or allergic reactions. Instead, if there is nipple soreness, lanolin or expressed breast milk can be used, but it's best to follow guidelines given by a healthcare provider.

(D) "I will lay my baby on a pillow at the level of my breast.":
Using a pillow to support the baby at the level of the breast can help ensure proper positioning and latch during breastfeeding. This position can make breastfeeding more comfortable for both the mother and the baby, promoting effective feeding and reducing the risk of nipple pain.

(a) Serum bilirubin:
While serum bilirubin can provide useful information about liver function, it is not the most immediate concern for a client with hyperemesis gravidarum. This condition primarily involves severe nausea and vomiting, which can lead to dehydration and ketosis.

(b) Liver enzymes:
Liver enzymes can be elevated in hyperemesis gravidarum, but they are not the primary concern. The immediate priority is to assess the extent of dehydration and metabolic disturbances.

(c) Urinalysis for ketones:
This test is the priority because it helps determine the extent of dehydration and ketosis. In hyperemesis gravidarum, severe vomiting can lead to significant fluid and electrolyte imbalances and ketosis, which need to be identified and corrected promptly to prevent further complications.

(d) CBC:
A complete blood count (CBC) provides useful information about overall health and can identify anemia or infection, but it is not the priority for immediate assessment of hyperemesis gravidarum. The immediate need is to evaluate hydration status and ketosis, which is best done through urinalysis for ketones.