A nurse is teaching about nutrition to a client who has a new diagnosis of chronic kidney disease. Which of the following recommendations should the nurse include in the teaching?

Choice A reason: Checking gastric residuals every 8 hr is not frequent enough, as it can miss signs of delayed gastric emptying, which can cause aspiration, nausea, vomiting, or abdominal distension. Gastric residuals should be checked every 4 hr.

Choice B reason: Returning gastric contents if residual is less than 250 mL is not advisable, as it can increase the risk of infection, contamination, or electrolyte imbalance. Gastric contents should be discarded if residual is more than 100 mL.

Choice C reason: Measuring the pH of gastric residual every 24 hr is not necessary, as it does not reflect the effectiveness or tolerance of the feeding. The pH of gastric residual should be checked before each feeding or every 6 to 8 hr to confirm tube placement and prevent misconnection.

Choice D reason: Flushing the tube with 15 mL of water every 4 hr is a correct action, as it can prevent clogging, maintain patency, and clear the tube of formula residue. Water should also be used to flush the tube before and after each medication administration.

Choice A reason: Hot dog cut in fourths is not an appropriate food choice for toddlers because it is still a choking hazard. Hot dogs are cylindrical and firm, which can block the airway of a child. Hot dogs should be avoided or cut into thin slices and small pieces before offering to toddlers.

Choice B reason: Cooked spaghetti with sauce is an appropriate food choice for toddlers because it is soft, easy to chew, and provides carbohydrates, protein, and vitamins. Cooked spaghetti can be cut into short strands and mixed with sauce to make it more appealing and moist for toddlers.

Choice C reason: Steak cut into small pieces is not an appropriate food choice for toddlers because it is tough, dry, and hard to chew. Steak can cause choking or difficulty swallowing for toddlers who have not developed their molars and chewing skills. Steak should be avoided or minced and moistened before offering to toddlers.

Choice D reason: Caramel popcorn is not an appropriate food choice for toddlers because it is sticky, sweet, and hard. Caramel popcorn can stick to the teeth and gums, causing dental caries and gum infections. Popcorn can also cause choking or aspiration for toddlers who have not mastered their swallowing reflex. Popcorn should be avoided until the child is at least 4 years old.