Chapter 12 Maternal and Fetal Nutrition Test 1 Flashcards Preview

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Flashcards in Chapter 12 Maternal and Fetal Nutrition Test 1 Deck (38):
1

When planning a diet with a pregnant woman, the nurse’s FIRST action would be to:

A. review the woman’s current dietary intake.
B. teach the woman about the food pyramid.
C. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble.
D. instruct the woman to limit the intake of fatty foods.

A. Reviewing the woman's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required. The other options are correct actions on the part of the nurse, but the first action should be to assess the patient's current dietary pattern and practices since instruction should be geared to what she already knows and does.

2

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse’s BEST response would be to tell the woman that her pattern of weight gain should be approximately:

A. a pound a week throughout pregnancy.
B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy.
C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester.
D. a total of 25 to 35 lbs.

B. 2 to 5 lbs during the first trimester, then a pound a week until the end of pregnancy.

A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/wk during the second and third trimesters. These are not accurate guidelines for weight gain during pregnancy. The total is correct, but the pattern needs to be explained.

3

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman:

A. drink warm fluids with each of her meals.
B. eat a high-protein snack before going to bed.
C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed.
D. schedule three meals and one midafternoon snack a day.

B. eat a high protein snack before going to bed

Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about five or six each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

4

A pregnant woman experiencing nausea and vomiting should:

A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
B. eat small, frequent meals (every 2 to 3 hours).
C. increase her intake of high-fat foods to keep the stomach full and coated.
D. limit fluid intake throughout the day.


B. eat small, frequent meals (every 2 to 3 hours)

A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

5

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned regarding what this woman consumes during and after tennis matches. Which is the MOST important?

A. Several glasses of fluid
B. Extra protein sources, such as peanut butter
C. Salty foods to replace lost sodium
D. Easily digested sources of carbohydrate


A. Several glasses of fluid

If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman’s calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

6

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with:

A. spina bifida.
B. intrauterine growth restriction.
C. diabetes mellitus.
D. Down syndrome.


B. intrauterine growth restriction

Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

7

Which minerals and vitamins usually are recommended to supplement a pregnant woman’s diet?

A. Fat-soluble vitamins A and D
B. Water-soluble vitamins C and B6
C. Iron and folate
D. Calcium and zinc


C. Iron and folate

Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.

8

With regard to nutritional needs during lactation, a maternity nurse should be aware that:

A. the mother’s intake of vitamin C, zinc, and protein now can be lower than during pregnancy.
B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
C. critical iron and folic acid levels must be maintained.
D. lactating women can go back to their prepregnant calorie intake.

B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.

Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

9

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that:

A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron.
B. iron absorption is inhibited by a diet rich in vitamin C.
C. iron supplements are permissible for children in small doses.
D. constipation is common with iron supplements.

D. constipation is common with iron supplements.

These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

10

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.)

A. Dried beans
B. Seeds
C. Peanut butter
D. Bagel
E. Eggs

A. B. C. E.

All of the foods listed except a bagel provide protein. A bagel is an example of a whole grain food, not protein.

11

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.)

A. Underweight women should gain 12.5 to 18 kg.
B. Obese women should gain at least 7 to 11.5 kg.
C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale.
D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled.
E. Normal weight women should gain 11.5 to 16 kg.

A. B. C. E.

Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16kg.

12

With regard to protein in the diet of pregnant women, nurses should be aware that:

A. many protein-rich foods are also good sources of calcium, iron, and b vitamins.
B. many women need to increase their protein intake during pregnancy.
C. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet.
D. high-protein supplements can be used without risk by women on macrobiotic diets.

A. many protein-rich foods are also good source of calcium, iron, and b vitamins.

Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

13

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this?
a. This weight gain indicates possible gestational hypertension.
b. This weight gain indicates that the woman’s infant is at risk for intrauterine growth restriction (IUGR).
c. This weight gain cannot be evaluated until the woman has been observed for several more weeks.
d. The woman’s weight gain is appropriate for this stage of pregnancy.


D. The woman’s weight gain is appropriate for this stage of pregnancy is an accurate statement. This woman’s BMI is in the normal range. During the first trimester the average total weight gain is only 1 to 2.5 kg. Although weight gain does indicate possible gestational, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman’s height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Although weight gain does indicate risk for IUGR, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman’s height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy.

14

Which meal would provide the most absorbable iron?
a. Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink
b. Oatmeal, whole wheat toast, jelly, and low-fat milk
c. Black bean soup, wheat crackers, ambrosia (orange sections, coconut, and pecans), and prunes
d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea

C.

Food sources that are rich in iron include liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, and dried fruits. The foods in this group are all good sources of iron. In addition, the vitamin C in ambrosia (orange sections) aids absorption. Dairy products and tea are not sources of iron.

15

Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
a. Energy (kcal)
b. Vitamin A
c. Iron
d. Folic acid

A.
Needs for energy, protein, calcium, iodine, zinc, the B vitamins and vitamin C remain greater than nonpregnant needs.

16

A pregnant woman’s diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this woman’s intake of:
a. Calcium.
b. Protein
c. Vitamin B 12
d. Folic acid

C.

This 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.

17

A pregnant woman experiencing nausea and vomiting should:
a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning.
b. Eat small, frequent meals (every 2 to 3 hours).
c. Increase her intake of high-fat foods to keep the stomach full and coated.
d. Limit fluid intake throughout the day.

B.

Eating small, frequent meals is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated, but should compensate by drinking fluids at other times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried and other fatty foods.

18

Which statement made by a lactating woman would lead the nurse to believe that the woman 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.”

B.
Abdominal cramps and bloating are consistent with lactose intolerance. One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. 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.

19

A pregnant woman’s diet history indicates that she likes the following list of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake?
a. Fresh apricots c. Spaghetti with meat sauce
b. Canned clams d. Canned sardines

D. Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.

20

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman’s total recommended weight gain during pregnancy should be at least:
a. 20 kg (44 lb). c. 12.5 kg (27.5 lb).
b. 16 kg (35 lb). d. 10 kg (22 lb).

C. This woman has a normal BMI and should gain 11.5 to 16kg during pregnancy. A weight gain of 20kg would be unhealthy for most women. A weight gain of 35lb is the high end of the range of weight this woman should gain in her pregnancy. A weight gain of 22lb would be appropriate for an obese woman.

21

A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:
a. Substitute other calcium sources for milk in her diet.
b. Lie down after each meal.
c. Reduce the amount of fiber she consumes.
d. Eat five small meals daily.

D.
Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women, and do not alleviate heartburn.

22

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice:
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 taking regularly.”
d. “Make sure that you include adequate folic acid in your diet.”

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 used, discontinuing all contraception may not be an accurate statement. Losing weight is not appropriate advice. Depending on the type of medication the woman is taking, continuing its use may not be an accurate statement.

23

To prevent gastrointestinal upset, clients should be instructed to take iron supplements:
a. On a full stomach. c. After eating a meal.
b. At bedtime. d. With milk.


B.
Clients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.

24

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with:
a. Spina bifida. c. Diabetes mellitus.
b. Intrauterine growth restriction. d. Down syndrome.


B.
Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Spina bifida, diabetes mellitus, and Down syndrome are not associated with inadequate maternal weight gain.

25

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she 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.”


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 amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

26

Pregnant adolescents are at high risk for _____ because of lower body mass indices (BMIs) and “fad” dieting.
a. Obesity c. Low-birth-weight babies
b. Diabetes d. High-birth-weight babies


ANS: C
Adolescents tend to have lower BMIs because they are still developing and may follow unsafe nutritional practices. In addition, the fetus and 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, diabetes, and high-birth-weight babies are conditions associated with higher BMIs.

27

Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy because:
a. It is very difficult to adjust because of people’s ingrained eating habits.
b. It 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.

28

Which statement about acronyms in nutrition is accurate?
a. Dietary reference intakes (DRIs) consist of RDAs, adequate intakes (AIs), and upper limits (ULs).
b. Recommended dietary allowances (RDAs) are the same as ULs, except with better data.
c. AIs offer guidelines for avoiding excessive amounts of nutrients.
d. They all refer to green, leafy vegetables; whole grains; and fruit.

A.
DRIs consist of RDAs, AIs, and ULs. AIs are similar to RDAs, except that they deal with nutrients about which data are insufficient for certainty (RDA status). ULs are guidelines for avoiding excesses of nutrients for which excess is toxic. Green, leafy vegetables; whole grains; and fruit are important, but they are not the whole nutritional story.

29

With regard to protein in the diet of pregnant women, nurses should be aware that:
a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins.
b. Many women need to increase their protein intake during pregnancy.
c. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet.
d. High-protein supplements can be used without risk by women on macrobiotic diets.

A.
Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

30

Which nutritional recommendation about fluids is accurate?
a. A woman’s daily intake should be eight to ten glasses (2.3 L) 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.

A.
Eight to ten glasses is 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 drunk only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria should avoid aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

31

Which minerals and vitamins usually are recommended to supplement a pregnant woman’s diet?
a. Fat-soluble vitamins A and D c. Iron and folate
b. Water-soluble vitamins C and B6 d. Calcium and zinc


C.
Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc sometimes is supplemented. Most women get enough calcium.

32

Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother?
a. Zinc c. Folic acid
b. Vitamin D d. Vitamin A


D.
Zinc, vitamin D, and folic acid are vital to good maternity and fetal health and are highly unlikely to be consumed in excess. Vitamin A taken in excess causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.

33

With regard to nutritional needs during lactation, a maternity nurse should be aware that:
a. The mother’s intake of vitamin C, zinc, and protein now can be lower than during pregnancy.
b. Caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful.
c. Critical iron and folic acid levels must be maintained.
d. Lactating women can go back to their prepregnant calorie intake.

B.
A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

34

While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as:
a. Preeclampsia. c. Pica.
b. Pyrosis. d. Purging.

C.
The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica.

35

To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she:
a. Try a tart food or drink such as lemonade or salty foods such as potato chips.
b. Drink plenty of fluids early in the day.
c. Brush her teeth immediately after eating.
d. Never snack before bedtime.


A.
Interestingly, some women can tolerate tart or salty foods when they are nauseous. The woman should avoid drinking too much when nausea is most likely, but she should be sure to make up the 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.

36

Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish will adequately supply the recommended amount of protein for the pregnant woman. Many clients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the client in determining which fish is safe to consume would include:
a. Canned white tuna is a preferred choice.
b. Avoid shark, swordfish, and mackerel.
c. Fish caught in local waterways are the safest.
d. Salmon and shrimp contain high levels of mercury.


B.
As a precaution the pregnant client should avoid eating all of these and the less common tilefish. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov. High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. A pregnant client can eat as much as 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. It is a common misconception that fish caught in local waterways are the safest. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, these fish sources should be avoided, limited to less than 6 ounces, or the only fish consumed that week. Commercially caught fish that are low in mercury include salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces per week.

37

Nutrition is one of the most significant factors in influencing the outcome of a pregnancy. It is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse can evaluate the client’s nutritional status by observing a number of physical signs. Which sign would indicate that the client has unmet nutritional needs?
a. Normal heart rate, rhythm, and blood pressure
b. Bright, clear, shiny eyes
c. Alert, responsive, and good endurance
d. Edema, tender calves, and tingling


D.
The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, it may also be a common physical finding during the third trimester. It is essential that the nurse complete a thorough health history and physical assessment and request further laboratory testing if indicated. The malnourished pregnant client may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A client receiving adequate nutrition will have bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae are all signs of poor nutrition. This client is well nourished. Cachexia, listlessness, and tiring easily would be indications of poor nutritional status.

38

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. The nurse or midwife should refer a client to a registered dietitian for in-depth nutritional counseling when the following exist(s)? Choose all that apply.
a. Preexisting or gestational illness such as diabetes
b. Ethnic or cultural food patterns
c. Obesity
d. Vegetarian diets


A, B, C, D
The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia and an increased risk for perinatal morbidity and mortality, this client would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs will be met. The obese pregnant client may be under the misapprehension that because of her excess weight that little or no weight gain is necessary. According to the Institute of Medicine, a client with a body mass index in the obese range should gain at least 7 kg to ensure a healthy outcome. This client may well require in-depth counseling on optimum food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimum combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation.