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: Alternating the first breast that is offered to the baby with each feeding is a good practice for breastfeeding because it can ensure equal stimulation and drainage of both breasts, which can prevent engorgement, mastitis, or low milk supply. Alternating breasts can also provide the baby with both foremilk and hindmilk, which have different compositions and benefits.

Choice B reason: Storing breast milk in the refrigerator up to 48 hours is not a good practice for breastfeeding because it can reduce the quality and safety of the milk. Breast milk should be stored in the refrigerator for no longer than 24 hours or in the freezer for no longer than 6 months. Breast milk should also be stored in clean, sterile containers and labeled with the date and time of expression.

Choice C reason: Nursing the baby once every 4 hours is not a good practice for breastfeeding because it can decrease the milk production and supply, which can affect the growth and development of the baby. Breastfeeding should be done on demand or at least every 2 to 3 hours during the day and every 3 to 4 hours at night. Breastfeeding should also last for at least 10 to 15 minutes per breast or until the baby is satisfied.

Choice D reason: Offering the baby water between feedings is not a good practice for breastfeeding because it can interfere with the baby's appetite and intake of breast milk, which can cause dehydration, malnutrition, or failure to thrive. Breast milk contains enough water and nutrients to meet the baby's needs for the first six months of life. Water should be avoided or limited until the baby starts solid foods.

Choice A reason: Checking blood glucose level is an appropriate action for the nurse to take because it can help determine if the client has hypoglycemia or hyperglycemia, which are both complications of diabetes mellitus that can cause dizziness and weakness. Blood glucose level should be checked using a glucometer and compared with the normal range of 70 to 130 mg/dL before meals and less than 180 mg/dL after meals.

Choice B reason: Giving insulin injection is not an appropriate action for the nurse to take without checking blood glucose level first because it may cause hypoglycemia, which is a condition in which blood glucose level drops below 70 mg/dL and can cause dizziness, weakness, confusion, sweating, and seizures. Insulin injection should be given according to the prescribed dose, type, and schedule.

Choice C reason: Offering orange juice is not an appropriate action for the nurse to take without checking blood glucose level first because it may cause hyperglycemia, which is a condition in which blood glucose level rises above 180 mg/dL and can cause dizziness, weakness, thirst, polyuria, and ketoacidosis. Orange juice should be offered only if the client has hypoglycemia and is conscious and able to swallow.

Choice D reason: Applying cold compress is not an appropriate action for the nurse to take because it does not address the underlying cause of dizziness and weakness in a client who has diabetes mellitus. Cold compress may worsen the symptoms by reducing blood flow and oxygen delivery to the brain. Cold compress should be applied only if the client has fever, inflammation, or pain.