A nurse is reviewing the laboratory reports of a client who is undergoing nutritional screening due to a risk for chronic kidney disease. The nurse should identify that which of the following results indicates the need for further assessment?

Choice A reason: Feedings should not be accompanied by nonnutritive sucking. Nonnutritive sucking is the act of sucking on a pacifier, finger, or other object without getting any nutrition. Nonnutritive sucking can interfere with the establishment of breastfeeding, cause nipple confusion, and reduce milk supply.

Choice B reason: Feedings should be on demand. On demand feeding means feeding the newborn whenever they show signs of hunger, such as rooting, sucking, or crying. On demand feeding helps the newborn regulate their appetite, meet their nutritional needs, and bond with their caregiver.

Choice C reason: Feedings should not begin within 1 hr after birth. This instruction is applicable for breastfeeding, not bottle feeding. Breastfeeding should begin within 1 hr after birth to initiate milk production, stimulate uterine contractions, and transfer colostrum to the newborn. Bottle feeding can be delayed until the newborn is stable and alert.

Choice D reason: Feedings may not occur in clusters. Cluster feeding means feeding the newborn more frequently and for longer periods of time during certain times of the day or night. Cluster feeding is common in breastfed newborns, especially during growth spurts or developmental leaps. Bottle fed newborns may not exhibit cluster feeding, as they tend to have more consistent and predictable feeding patterns.

Choice A reason: Limiting high-calorie supplements to between meals is not a good strategy for managing anorexia while receiving radiation therapy because it can reduce the appetite and intake of regular meals, which are more nutritious and balanced. High-calorie supplements should be used as an addition to, not a replacement for, regular meals.

Choice B reason: Avoiding overeating during 'good' days is not a good strategy for managing anorexia while receiving radiation therapy because it can cause discomfort, nausea, or vomiting, which can worsen anorexia and affect the tolerance of radiation therapy. Eating should be based on hunger and satiety cues, not on good or bad days.

Choice C reason: Consuming nutrition-dense foods first is a good strategy for managing anorexia while receiving radiation therapy because it can ensure adequate intake of calories, protein, vitamins, and minerals, which are essential for healing and recovery. Nutrition-dense foods are those that provide high amounts of nutrients per serving, such as eggs, cheese, nuts, beans, and meat.

Choice D reason: Eating hot foods rather than cold foods is not a good strategy for managing anorexia while receiving radiation therapy because it can irritate the mouth and throat, which may be inflamed or sore due to radiation therapy. Cold foods are more soothing and refreshing for the mouth and throat, such as ice cream, yogurt, smoothies, and popsicles.