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Flashcards in Chapter 15 Deck (44):
1

1. 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.

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2. 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.

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3. 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.

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4. 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.

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5. 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.

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6. 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.

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7. 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.

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8. 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.

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9. 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.

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10. 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.

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11. 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.

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12. 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.

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13. 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.

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14. 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.

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15. 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.

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16. 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.

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17. 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.

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18. Many clients are concerned about the increased levels of mercury in fish and may be reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to provide?
a. Canned white tuna is a preferred choice.
b. Shark, swordfish, and mackerel should be avoided.
c. Fish caught in local waterways is the safest.
d. Salmon and shrimp contain high levels of mercury.


ANS: B
As a precaution, the pregnant client should avoid eating shark, swordfish, and mackerel, as well as the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. Assisting the client in understanding the differences between numerous sources of mercury is essential for the nurse. A pregnant client may 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. 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, then these fish sources should be avoided, limited to less than 6 ounces per week, or the only fish consumed that week. Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces of commercially caught fish per week. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.

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19. Nutrition 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 is able to evaluate the client’s nutritional status by observing a number of physical signs. Which physical sign indicates to the nurse that the client has unmet nutritional needs?
a. Normal heart rate, rhythm, and blood pressure
b. Bright, clear, and shiny eyes
c. Alert and responsive with good endurance
d. Edema, tender calves, and tingling

ANS: 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, edema in the lower extremities may also be a common physical finding during the third trimester. Completing a thorough health history and physical assessment and requesting further laboratory testing, if indicated, are essential for the nurse. 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 signs of poor nutrition. A client who is alert and responsive with good endurance is well nourished. A listless, cachectic, easily fatigued, and tired presentation would be an indication of a poor nutritional status.

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20. A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. Which recommendation would the nurse make for this particular client after a tennis match?
a. Drink several glasses of fluid.
b. Eat extra protein sources such as peanut butter.
c. Enjoy salty foods to replace lost sodium.
d. Consume easily digested sources of carbohydrate.

ANS: A
If no medical or obstetric problems contraindicate physical activity, then 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. The woman’s caloric intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

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21. A woman in the 34th week of pregnancy reports that she is very uncomfortable because of heartburn. Which recommendation would be appropriate for this client?
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.

ANS: 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.

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22. Which information regarding protein in the diet of a pregnant woman is most helpful to the client?
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.

ANS: A
Good sources for protein, 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.

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23. A client states that she plans to breastfeed her newborn infant. What guidance would be useful for this new mother?
a. The mother’s intake of vitamin C, zinc, and protein can now be lower than during pregnancy.
b. Caffeine consumed by the mother accumulates in the infant, who 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 caloric intake.

ANS: 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 lower during lactation. Lactating women should consume approximately 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

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24. The labor and delivery nurse is preparing a client who is severely obese (bariatric) for an elective cesarean birth. Which piece of specialized equipment will not likely be needed when providing care for this pregnant woman?
a. Extra-long surgical instruments
b. Wide surgical table
c. Temporal thermometer
d. Increased diameter blood pressure cuff

ANS: C
Obstetricians today are seeing an increasing number of morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty, bariatric obstetrics, has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant client of any size.

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25. Which pregnant woman should strictly follow weight gain recommendations during pregnancy?
a. Pregnant with twins
b. In early adolescence
c. Shorter than 62 inches or 157 cm
d. Was 20 pounds overweight before pregnancy

ANS: D
A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight before conception to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which provides for their own growth, as well as for fetal growth. In the past, women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found.

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26. The major source of nutrients in the diet of a pregnant woman should be composed of what?
a. Simple sugars
b. Fats
c. Fiber
d. Complex carbohydrates

ANS: D
Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fiber is primarily supplied by complex carbohydrates.

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27. A pregnant woman’s diet may not meet her increased need for folates. Which food is a rich source of this nutrient?
a. Chicken
b. Cheese
c. Potatoes
d. Green leafy vegetables

ANS: D
Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor sources for folates. Potatoes contain carbohydrates and vitamins and minerals but are poor sources for folates

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28. If a client’s normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy?
a. 5
b. 10
c. 25
d. 30

ANS: C
The recommended intake of protein for the pregnant woman is 70 g. Therefore, additional protein intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than would be necessary and would add extra calories.

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29. Which action is the first priority for the nurse who is assessing the influence of culture on a client’s diet?
a. Evaluate the client’s weight gain during pregnancy.
b. Assess the socioeconomic status of the client.
c. Discuss the four food groups with the client.
d. Identify the food preferences and methods of food preparation common to the client’s culture.

ANS: D
Understanding the client’s food preferences and how she prepares food will assist the nurse in determining whether the client’s culture is adversely affecting her nutritional intake. An evaluation of a client’s weight gain during pregnancy should be included for all clients, not only for clients from different cultural backgrounds. The socioeconomic status of the client may alter the nutritional intake but not the cultural influence. Teaching the food groups to the client should come after assessing her food preferences.

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30. The nurse has formulated a diagnosis of Imbalanced nutrition: Less than body requirements for the client. Which goal is most appropriate for this client to obtain?
a. Gain a total of 30 pounds.
b. Consistently take daily supplements.
c. Decrease her intake of snack foods.
d. Increase her intake of complex carbohydrates.

ANS: A
A weight gain of 30 pounds is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this client and does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be needed and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant client. Although increasing the intake of complex carbohydrates is important for this client, monitoring the weight gain should be the end goal.

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31. Which action is the highest priority for the nurse when educating a pregnant adolescent?
a. Emphasize the need to eliminate common teenage snack foods because they are high in fat and sodium.
b. Determine the weight gain needed to meet adolescent growth, and add 35 pounds.
c. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value.
d. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

ANS: B
Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The client should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.

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1. Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a consultation? (Select all that apply.)
a. Preexisting or gestational illness such as diabetes
b. Ethnic or cultural food patterns
c. Obesity
d. Vegetarian diets
e. Multifetal pregnancy

ANS: 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, as well as an increased risk for perinatal morbidity and mortality, the client with a preexisting or gestational illness 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 are met. The obese pregnant client may be under the misapprehension that, because of her excess weight, little or no weight gain is necessary. According to the Institute of Medicine, a client with a BMI in the obese range should gain at least 7 kg to ensure a healthy outcome. This client may require in-depth counseling on the optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal 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. A multifetal pregnancy can be managed by increasing the number of servings of complex carbohydrates and proteins.

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2. Foodborne illnesses can cause adverse effects for both mother and fetus. The nurse is in an ideal position to evaluate the client’s knowledge regarding steps to prevent a foodborne illness. The nurse asks the client to “teach back” the fours simple steps of food preparation. What are they? (Select all that apply.)
a. Purchase
b. Clean
c. Separate
d. Cook
e. Chill

ANS: B, C, D, E
According to the U.S. Food and Drug Administration (2013), the “four simple steps” are:
• Clean: Frequently cleanse hands, food preparation surfaces, and utensils.
• Separate: Avoid contact among raw meat, fish, or poultry and other foods that will not be cooked before consumption.
• Cook: Cook foods to the proper temperature.
• Chill: Properly store foods, and promptly refrigerate.

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1. The BMI for a woman who is 51 kg before pregnancy and 1.57 m tall is _________.

BMI = 51 kg divided by (1.57 m)2
51 divided by 2.47 = 20.69

35

Which suggestion about weight gain is not an accurate recommendation?
a. Underweight women should gain 12.5 to 18 kg.
b. Obese women should gain at least 7 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.

Ans: D
Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. 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.

36

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.

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

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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

Ans: A
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 and carbohydrate 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, possibly contributing to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient without trying to replace sodium.

38

Women with 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.

Ans: 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 is not associated with inadequate maternal weight gain; an adequate amount of folic acid has been shown to reduce the incidence of this condition. Diabetes mellitus is not related to inadequate weight gain. A mother with gestational diabetes is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of trisomy 21, not inadequate maternal weight gain.

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Which minerals and vitamins are usually 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

Ans: 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 is sometimes supplemented; most women get enough calcium.

40

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.

Ans: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.

41

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.

Ans: D
Constipation can be a problem with iron supplements. Milk, coffee, and tea actually 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.

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A 22-year-old woman pregnant with a single fetus had 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 lbs) since conception. How would the nurse interpret this finding?
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.

Ans: D
During the first trimester, the average total weight gain is only 1 to 2.5 kg. The desirable weight gain during pregnancy varies among women. Weight gain should take place throughout the pregnancy. The optimal rate depends on the stage of the pregnancy. 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’s BMI is within the normal range, and she has gained the appropriate amount of weight for her size at this point in her pregnancy. Although the statements in A through C are accurate, they do not apply to this client.

43

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.

Ans: 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.

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Which findings could be considered to be a barrier to a pregnant woman seeking prenatal care? (Select all that apply.)
a. Patient would prefer to be cared for by a midwife instead of a physician.
b. Economic cost of health care.
c. Patient’s cultural beliefs do not include prenatal care as being valued.
d. Patient speaks several languages.
e. Patient had a bad experience the last time she went to a doctor for care.

Ans: B, C, E
Economic factors can delay the onset of health care treatment. A patient’s cultural beliefs and values may be a barrier to seeking prenatal care if her culture does not perceive any inherent value in prenatal care. If the patient had a bad prior experience with a health care provider, it may be a barrier to seeking future care. The fact that this patient is multilingual does not necessarily represent a barrier to seeking prenatal care. Although the patient may prefer to be cared for by a midwife, this fact cannot be considered a barrier to seeking prenatal care because it demonstrates a patient’s choice.