An occupational health nurse is discussing health promotion with a client who has a history of obesity. Which of the following comments indicates the client is using rationalization as a coping mechanism?

Choice A reason: The client dressing her affected side first is not a finding that the nurse should report to the interprofessional care team, as it indicates that the client is following the proper technique for dressing after a stroke. Dressing the affected side first helps the client maintain range of motion and prevent contractures of the affected limbs.

Choice B reason: The client bearing weight on their arms when using crutches is not a finding that the nurse should report to the interprofessional care team, as it is a normal and expected way of using crutches. Bearing weight on the arms helps the client balance and support their body weight while walking with crutches.

Choice C reason: The client coughing when swallowing her medications is a finding that the nurse should report to the interprofessional care team, as it indicates that the client may have dysphagia, or difficulty swallowing, which is a common complication of stroke. Dysphagia can increase the risk of aspiration, pneumonia, dehydration, and malnutrition. The nurse should assess the client's swallowing ability and refer them to a speech-language pathologist for further evaluation and intervention.

Choice D reason: The client's caregiver filling a pill organizer weekly is not a finding that the nurse should report to the interprofessional care team, as it is a positive and helpful way of managing the client's medications. Filling a pill organizer weekly can help the client and the caregiver remember the medication names, doses, and schedules, and prevent medication errors or omissions.

The correct answer is D.

Caffeinated beverages should be replaced with caffeine-free beverages. High levels of caffeine can cause low birth weight and may increase the chance of miscarriage. Pregnant women metabolize caffeine more slowly, which can affect the fetus.

Choice A reason: The need for supplemental folic acid is greatest during the first trimester to prevent neural tube defects. The recommended daily dose is 600 mcg.

Choice B reason: Adolescent pregnancy is associated with a higher risk of low birth weight infants, not high birth weight.

Choice C reason: Pregnant adolescents generally need to gain an appropriate amount of weight, similar to adult mothers, to support the growth and development of the fetus. The weight gain recommendations during pregnancy are based on the mother's pre-pregnancy BMI.