Chapter 15 Flashcards
- Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a. Energy (kcal)
b. Iron
c. Vitamin A
d. Folic acid
ANS: A
Nutrient needs for energy—protein, calcium, iodine, zinc, B vitamins, and vitamin C—remain higher during lactation than during pregnancy. The need for iron is not higher during lactation than during pregnancy. A lactating woman does not have a greater requirement for vitamin A than a nonpregnant woman. Folic acid requirements are the highest during the first trimester of pregnancy.
- A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. Which dietary requirement is the nurse most concerned about?
a. Calcium
b. Protein
c. Vitamin B12
d. Folic acid
ANS: C
A pregnant woman’s diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending on the woman’s food choices, a pregnant woman’s diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. The nurse should be more concerned with the woman’s intake of vitamin B12 attributable to her dietary restrictions. Folic acid needs can be met by enriched bread products.
- Which statement made by a lactating woman leads the nurse to believe that the client might have lactose intolerance?
a. “I always have heartburn after I drink milk.”
b. “If I drink more than a cup of milk, I usually have abdominal cramps and bloating.”
c. “Drinking milk usually makes me break out in hives.”
d. “Sometimes I notice that I have bad breath after I drink a cup of milk.”
ANS: B
Lactose intolerance, which is an inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine, is a problem that interferes with milk consumption. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. A woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. A client who breaks out in hives after consuming milk is more likely to have a milk allergy and should be advised to simply brush her teeth after consuming dairy products.
- A client states that she does not drink milk. Which foods should the nurse encourage this woman to consume in greater amounts to increase her calcium intake?
a. Fresh apricots
b. Canned clams
c. Spaghetti with meat sauce
d. Canned sardines
ANS: D
Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.
- A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. What is this client’s total recommended weight gain during pregnancy?
a. 20 kg (44 lb)
b. 16 kg (35 lb)
c. 12.5 kg (27.5 lb)
d. 10 kg (22 lb)
ANS: C
This woman has a normal BMI and should gain 11.5 to 16 kg during her pregnancy. A weight gain of 20 kg (44 lb) is unhealthy for most women; a weight gain of 16 kg (35 lb) is at the high end of the range of weight this woman should gain in her pregnancy; and a weight gain of 10 kg (22 lb) is appropriate for an obese woman. This woman has a normal BMI, which indicates that her weight is average.
- A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant. Which guidance should she expect to receive?
a. “Discontinue all contraception now.”
b. “Lose weight so that you can gain more during pregnancy.”
c. “You may take any medications you have been regularly taking.”
d. “Make sure you include adequate folic acid in your diet.”
ANS: D
A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A woman’s folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception that she has been using, discontinuing all contraception at this time may not be appropriate. Advising this client to lose weight now so that she can gain more during pregnancy is also not appropriate advice. Depending on the type of medications the woman is taking, continuing to take them regularly may not be appropriate.
- To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take the recommended iron supplements?
a. On a full stomach
b. At bedtime
c. After eating a meal
d. With milk
ANS: B
Iron supplements taken at bedtime may reduce GI upset and should be taken at bedtime if abdominal discomfort occurs when iron supplements are taken between meals. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.
- After the nurse completes nutritional counseling for a pregnant woman, she asks the client to repeat the instructions to assess the client’s understanding. Which statement indicates that the client understands the role of protein in her pregnancy?
a. “Protein will help my baby grow.”
b. “Eating protein will prevent me from becoming anemic.”
c. “Eating protein will make my baby have strong teeth after he is born.”
d. “Eating protein will prevent me from being diabetic.”
ANS: A
Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of the amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in those with diabetes; protein is one nutritional factor to consider for glycemic control but not the primary role of protein intake.
- Pregnant adolescents are at greater risk for decreased BMI and “fad” dieting with which condition?
a. Obesity
b. Gestational diabetes
c. Low-birth-weight babies
d. High-birth-weight babies
ANS: C
Adolescents tend to have lower BMIs. In addition, the fetus and the still-growing mother appear to compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Obesity is associated with a higher-than-normal BMI. Unless the teenager has type 1 diabetes, an adolescent with a low BMI is less likely to develop gestational diabetes. High-birth-weight or large-for-gestational age (LGA) babies are most often associated with gestational diabetes.
- Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy. Why is this the case?
a. Maternal nutritional status is extremely difficult to adjust because of an individual’s ingrained eating habits.
b. Adequate nutrition is an important preventive measure for a variety of problems.
c. Women love obsessing about their weight and diets.
d. A woman’s preconception weight becomes irrelevant.
ANS: B
Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach. Pregnancy is a time when many women are motivated to learn about adequate nutrition and make changes to their diet that will benefit their baby. Pregnancy is not the time to begin a weight loss diet. Clients and their caregivers should still be concerned with appropriate weight gain.
- With regard to weight gain during pregnancy, the nurse should be aware of which important information?
a. In pregnancy, the woman’s height is not a factor in determining her target weight.
b. Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with women of normal weight.
c. Women with inadequate weight gain have an increased risk of delivering a preterm infant with intrauterine growth restriction (IUGR).
d. Greater than expected weight gain during pregnancy is almost always attributable to old-fashioned overeating.
ANS: C
IUGR is associated with women with inadequate weight gain. The primary factor in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman’s height. Obese women are twice as likely as women of normal weight to give birth to a child with major congenital defects. Overeating is only one of several likely causes.
- Which nutritional recommendation regarding fluids is accurate?
a. A woman’s daily intake should be six to eight glasses of water, milk, and/or juice.
b. Coffee should be limited to no more than 2 cups, but tea and cocoa can be consumed without worry.
c. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns.
d. Water with fluoride is especially encouraged because it reduces the child’s risk of tooth decay.
ANS: A
Six to eight glasses is still the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be consumed only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame. Although no evidence indicates that prenatal fluoride consumption reduces childhood tooth decay, fluoride still helps the mother.
- Which minerals and vitamins are usually recommended as a supplement in a pregnant client’s diet?
a. Fat-soluble vitamins A and D
b. Water-soluble vitamins C and B6
c. Iron and folate
d. Calcium and zinc
ANS: C
Iron should generally be supplemented, and folic acid supplements are often needed because folate is so important in pregnancy. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C is sometimes naturally consumed in excess; vitamin B6 is prescribed only if the woman has a very poor diet; and zinc is sometimes supplemented. Most women get enough calcium.
- Which vitamins or minerals may lead to congenital malformations of the fetus if taken in excess by the mother?
a. Zinc
b. Vitamin D
c. Folic acid
d. Vitamin A
ANS: D
If taken in excess, vitamin A causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy. Zinc, vitamin D, and folic acid are all vital to good maternity and fetal health and are highly unlikely to be consumed in excess.
- While obtaining a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. Which nutritional problem does this behavior indicate?
a. Preeclampsia
b. Pyrosis
c. Pica
d. Purging
ANS: C
The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica. Preeclampsia is a vasospastic disease process encountered after 20 weeks of gestation. Characteristics of preeclampsia include increasing hypertension, proteinuria, and hemoconcentration. Pyrosis is a burning sensation in the epigastric region, otherwise known as heartburn. Purging refers to self-induced vomiting after consuming large quantities of food.
- Assessment of a woman’s nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. Which finding might require consultation to a higher level of care?
a. Oral contraceptive use may interfere with the absorption of iron.
b. Illnesses that have created nutritional deficits, such as PKU, may require nutritional care before conception.
c. The woman’s socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker.
d. Testing for diabetes is the only nutrition-related laboratory test most pregnant women need.
ANS: B
A registered dietitian can help with therapeutic diets. Oral contraceptive use may interfere with the absorption of folic acid. Iron deficiency can appear if placement of an intrauterine device (IUD) results in blood loss. A woman’s finances can affect her access to good nutrition; her education (or lack thereof) can influence the nurse’s teaching decisions. The nutrition-related laboratory test that pregnant women usually need is a screen for anemia.
- Which guidance might the nurse provide for a client with severe morning sickness?
a. Trying lemonade and potato chips
b. Drinking plenty of fluids early in the day
c. Immediately brushing her teeth after eating
d. Never snacking before bedtime
ANS: A
Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade and potato chips are an ideal combination. The woman should avoid drinking too much when nausea is most likely, but she should increase her fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.