**IMPORTANT** REVIEW Chapter 9: Maternal and Fetal Nutrition NCLEX 59Qw/exp QfromPP

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 (Dried beans, seeds, peanut butter, and eggs provide protein. A bagel is an example of a whole grain food, not protein.)

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

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. DIF: Cognitive Level: Apply REF: p. 361 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance)

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.

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.)

The nurse instructs a pregnant patient to stay away from Brie, Camembert, and the soft Mexican cheeses. What would be the possible clinical reason for giving such advice to the patient? A. Possibility of listeriosis developing B. Physiologic anemia C. Sigmoid diverticulosis D. Phenylketonuria (PKU)

A (Brie, Camembert, and the soft Mexican cheeses are made with unpasteurized milk. Listeriosis is a disease caused by the infection of the bacteria Listeria, which is present in unpasteurized milk. This disease increases the risk for miscarriage, premature birth, and stillbirth in pregnant patients. Thus the nurse instructs the patient to stay away from those products that cause listeriosis. Brie, Camembert, and the soft Mexican cheeses are not associated with physiologic anemia, diverticulosis, and PKU. Pregnant patients with physiologic anemia are instructed to eat iron-rich foods. Pregnant patients are advised to eat fiber-rich food to prevent diverticulosis flare-ups. Pregnant patients with PKU should not use the artificial sweetener aspartame.)

A patient who is 6 months pregnant is diagnosed with diverticulosis. Which diet should the nurse recommend to the patient? A. Whole grains, bran, vegetables, and fruits B. Citrus fruits and dark green leafy vegetables C. Shellfish, liver, meats, whole grains, and milk D. Iodized salt, seafood, milk products, and rolls

A (Diverticulosis is a condition in which the patient develops muscular outpouchings in the colon. Intake of fibrous food reduces the risk for diverticulosis in a pregnant patient. Therefore the nurse should recommend that the patient incorporate the diet containing whole grains, bran, vegetables, and fruits. The intake of citrus fruits and dark green leafy vegetables is recommended for vitamin C deficiency. Shellfish, liver, meats, whole grains, and milk are recommended foods for a zinc deficiency. A diet containing iodized salt, seafood, milk products, and rolls is rich in iodine.)

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.

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.)

During the assessment of a pregnant patient, the nurse instructs the patient to eat eight to ten servings of vegetables and fruits, three servings of milk products, and incorporate low-fat meats daily. What is the most probable reason for giving such instruction? To prevent: A. Hypertension B. Hypercalcemia C. Hypouricemia D. Hypothyroidism

A (Hypertension is caused by decreased levels of potassium and increased intake of sodium. To prevent the risk for hypertension, the nurse instructs the patient to consume 8 to 10 cups of vegetables and fruits, low fat meats, and dairy products. These foods are rich sources of potassium and also reduce the sodium content in the body. This helps prevent hypertension. Milk is a rich source of calcium and does not prevent hypercalcemia. These food choices do not enhance uric acid excretion and therefore do not prevent hypouricemia. Hypothyroidism is caused by the imbalance of thyroid hormones.)

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse should 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 (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.)

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.

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.)

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

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.)

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

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.)

The nurse is assessing a patient who recently delivered a child. The laboratory reports of both the mother and the child show high amounts of lead in the blood. What clinical condition observed in the mother during pregnancy could be the reason for the abnormal levels of lead? A. Pica B. Anemia C. Malnutrition D. Preeclampsia

A (Pica refers to the practice of consuming nonfood substances, such as clay and dirt. Consumption of soil and pulverized pottery causes high levels of lead in the mother and the child because of lead contamination of the soil. Anemia is usually caused by a lack of red blood cells (RBCs). An anemic patient may possibly be at risk for pica and may develop cravings for metallic items but will not show excessive amounts of lead in the body. Malnutrition in the mother leads to several severe risks like premature labor, miscarriage, or lack of nutrition in the child. Preeclampsia is the condition for high blood pressure and excess of protein in the urine of a pregnant woman. Preeclampsia may be caused by an imbalanced diet, but it does not show unusually high levels of lead in the body.)

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."

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.)

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.

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.)

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

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.)

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. Overweight 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 20 kg), but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg.)

What measures should the nurse instruct a pregnant patient to take to relieve the symptoms of morning sickness during the first trimester? Select all that apply. A. Consume food when it is not hot. B. Eat food in smaller portions. C. Include smaller amounts of fluids. D. Include foods that are high in fats. E. Include food high in starch content.

A, B, E (Morning sickness is seen in most women during the first trimester. Hot foods have strong odors, which may stimulate the chemoreceptor trigger zone and cause nausea. Therefore the nurse should advise the patient to ingest the food when it is not too hot. The patient is usually taught to have smaller, more frequent meals every 2 to 3 hours because it prevents stomach distention. Starch reduces the concentration of gastric acid, which aids in preventing nausea. Therefore the nurse should teach the patient to incorporate foods that contain higher quantities of starch. Usually patients are instructed to include higher amounts of fluids during pregnancy to prevent dehydration caused by nausea. Fried foods and foods rich in fats tend to produce more acids that can aggravate nausea and contribute to reflux.)

The nurse instructs a Middle Eastern patient who is pregnant regarding the importance of including a good amount of fruits in the diet to improve folate levels in the body. Which fruits should the nurse recommend to the patient? Select all that apply. A. Grapes B. Peaches C. Apricots D. Star fruit E. Pomegranates

A, C (Grapes and apricots are some of the fruits that are common in the diets followed in the Middle East. Therefore the nurse should teach the patient to include grapes and apricots in the diet to improve the nutritional status. Peaches, star fruit, and pomegranates are not popular fruits in Middle East. Peaches are the most common fruits for Native American groups. Star fruit is a fruit commonly eaten by people in Chinese communities. Pomegranates are popular in Italian communities.)

A pregnant patient does not drink milk because of lactose intolerance. Which foods should the nurse instruct the patient to incorporate in her diet to prevent calcium deficiency? Select all that apply. A. Sardines B. Avocadoes C. Cooked pasta D. Wheat bread E. Refried beans

A, E (Canned sardines and refried beans are rich sources of calcium. Therefore a diet containing these foods should be suggested for patients who do not drink milk. Avocado, cooked pasta, and bread have poor calcium content. These foods are rich sources of folic acid and are suggested to pregnant patients to increase folate levels.)

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 is 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 (A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy is about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb per week during the second and third trimesters. One pound per week is not the correct guideline during pregnancy. One pound per week during the first two trimesters and two pounds per week thereafter is not the correct guideline for weight gain during pregnancy. A total weight gain of 25 to 35 pounds is correct, but the pattern needs to be explained to the woman.)

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 should 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 (A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that can contribute to nausea. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. 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.)

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.

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.)

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 (A pregnant woman experiencing nausea and vomiting should eat small, frequent meals. She should avoid consuming fluids early in the day or when nauseated. She should reduce her intake of fried foods and other fatty foods and should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.)

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.

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 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.

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.)

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.

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.)

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 (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 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.)

The nurse notices that the hemoglobin levels of an infant who is breastfed have reduced drastically since birth. What is the probable reason for the infant to have anemia? A. The infant's mother is still taking folic acid and B vitamins. B. The infant's mother is consuming large amounts of caffeine. C. The infant's mother continues to take oral iron supplements. D. The infant's mother drinks large amounts of water and juices.

B (Caffeine intake leads to reduced absorption of iron into the milk. In turn this reduces the concentration of iron in the milk, which may cause anemia in the newborn. Iron supplements are usually prescribed to prevent anemia in the mother. Iron does not cause anemia in the newborn. Folate supplements help prevent spina bifida (SB) in the newborn. Folate does not cause anemia in the newborn. Excess fluids help maintain the blood volume in the mother and enhance the formation of milk. Excess fluids do not cause anemia in the newborn.)

When assessing a pregnant woman in the second trimester, the nurse finds the patient to be healthy, but the patient reports mild edema. What should the nurse infer from this finding? A. The patient has a vitamin B deficiency. B. This is a normal finding; it results from estrogen. C. The patient is consuming too many calories. D. The nurse should check the blood glucose

B (Edema usually refers to the abnormal accumulation of fluid in the interstitium. In the past it was believed to be caused by an excess of sodium. However, a moderate amount of edema is considered normal. This happens because of higher estrogen levels. Vitamin B deficiency causes neural tube defects. Taking in too many calories does not cause edema; it causes weight gain. Glucose is the basic source for energy, deficiency of which causes hypoglycemia and reduces stamina. However, it does not cause edema.)

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

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.)

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."

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.)

The nurse is preparing a diet chart for a Hispanic pregnant patient who is a vegetarian. The patient complains of leg cramps. What does the nurse ensure to include in the patient's diet? A. Melon fruit B. Turnip greens C. Whole or 2% milk D. Canned sardines

B (Leg cramps during pregnancy result from an imbalance in the calcium levels in the body. Thus the nurse would include a food rich in calcium in the diet. Because the patient is a vegetarian, this can be accomplished by incorporating turnip greens in the diet. Turnip greens are turnip leaves that are rich in calcium. Even though sardines have high calcium content, the patient is a vegetarian and this is considered a meat source. Milk is the richest source of calcium. Hispanic people do not consume milk directly but use it as an additive in coffee. Having too much coffee also affects the pregnant patient's health adversely, so it should not be included. Melon fruit is rich in vitamin A but is not a good source of calcium; therefore the nurse should not suggest it to increase calcium in the patient's diet.)

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.

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.)

The nurse reviews the medical history of a patient and instructs the patient to prevent conception. Which finding led the nurse to make such a decision? The patient is using: A. Sucralose (Splenda). B. Isotretinoin (Accutane). C. Saccharin (Sweet'N Low). D. Aspartame (NutraSweet).

B (The nurse suggests the patient prevent conception because the patient was using isotretinoin (Accutane) for the treatment of acne. It is because isotretinoin (Accutane) is teratogenic and associated with fetal malformations. Sucralose (Splenda), saccharin (Sweet'N Low), and aspartame (NutraSweet) are artificial sweeteners, which have no profound effect on pregnancy. However, aspartame (NutraSweet) contains phenylalanine, which is to be avoided in pregnant patients with phenylketonuria (PKU).)

The nurse observes that a patient has a decreased vitamin D level during a prenatal visit. Which associated risk should the nurse suspect to observe in the patient? A. Goiter B. Tetany C. Ketonuria D. Macrosomia

B (Vitamin D plays a key role in the absorption and metabolism of calcium. A severe deficiency of vitamin D leads to tetany, neonatal hypocalcemia, and hypoplasia of tooth enamel. Thus the patient is most likely to have the risk for tetany. Goiter, ketonuria, and macrosomia are not related to vitamin D deficiency. Goiters occur because of an iodine deficiency. Ketonuria is the presence of ketones in urine and happens in patients with diabetes mellitus. Macrosomia is a risk that can happen with obese women during pregnancy.)

A patient tells the nurse, "I abstained from alcohol throughout my pregnancy, but now that I have delivered my baby, I want to be able to drink alcohol." What should the nurse inform the patient? Select all that apply. A. "You would not be able to produce sufficient milk for the baby." B. "Your child may develop psychomotor retardation if you drink." C. "Your child would not be able to suck milk if you have alcohol." D. "Your child may become anemic if you drink any form of alcohol." E. "Your child would not be able sleep properly if you have alcohol."

B, C (Consumption of alcohol by a lactating mother would affect the health of the infant. Maternal alcohol consumption causes delayed psychomotor development in the infant. Alcohol also inhibits the milk ejection reflex, so the infant may not be able to suck milk. The inability to produce milk is a side effect of smoking. Caffeine intake can lead to a reduced iron concentration in milk and causes the development of anemia in the infant. Caffeine does affect the activity levels of the mother but does not cause insomnia in the infant.)

The nurse instructs the patient to eat nuts, legumes, cocoa, and whole grains during the second trimester of pregnancy. What is the rationale for this instruction? The patient has: A. A diet that is low in zinc. B. A low intake of vitamin A. C. A low intake of magnesium. D. Decreased vitamin D intake.

C (A diet containing nuts, legumes, cocoa, and whole grains is suggested for a pregnant patient to improve the levels of magnesium. Magnesium is essential for energy metabolism, tissue growth, and muscle action. Thus the most appropriate reason for adding these in the diet is to eliminate the risk for magnesium deficiency. Nuts, legumes, cocoa, and whole grains are not rich sources of zinc, vitamin A, or vitamin D. Food sources high in zinc are liver, shellfish, meat, whole grains, and milk. Food sources containing vitamin A are dark green leafy vegetables, liver, fruits, fortified margarine, and butter. Foods rich in vitamin D are fortified milk, cereals, oily fish, butter, and liver.)

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

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.)

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

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.)

The nurse is teaching a patient with anemia when and how to take the prescribed iron supplements. The nurse provides a list of beverages for the patient to stay away from while taking the iron supplement. What is the rationale for this? A. They can affect the process of hematopoiesis. B. They increase red blood cell (RBC) destruction. C. They can decrease iron supplement absorption. D. They can increase the plasma levels of caffeine.

C (Anemia is caused by decreased hemoglobin levels in the blood, which, in turn, is caused by decreased iron intake. Iron supplements are usually given to treat iron deficiency anemia. Tea, coffee, and milk decrease iron absorption, which reduces the efficiency of iron supplements. Therefore the nurse teaches the anemic patient to stop drinking tea, coffee, and milk with the iron supplement. Tea, coffee, and milk do not affect the plasma levels of caffeine, the hematopoiesis process, or cause RBC destruction.)

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.

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 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

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.)

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

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.)

The nurse notices that a pregnant patient is worried about gaining weight and has stayed away from eating foods high in carbohydrates. What should the nurse do to ensure adequate nutrition? A. Inform the patient that lack of proper nutrition may delay the newborn's delivery date. B. Suggest the patient increase her protein intake to compensate for the carbohydrate levels. C. Inform the patient that breastfeeding aids in losing the weight gained during pregnancy. D. Inform the patient that a decreased intake of carbohydrates during pregnancy causes fetal obesity.

C (Some patients decrease their food intake during pregnancy for fear of weight gain. This may affect fetal development. Therefore the nurse should teach the patient to maintain adequate nutrition. When the patient delivers the baby and begins to breastfeed, this will aid postpartum weight loss. However, most of the weight is lost after the child's birth due to reduction of fat. There is no evidence that reduced consumption of carbohydrates may cause fetal obesity. Fetal obesity can happen as a result of maternal obesity. Lack of proper nutrition causes ketonuria, which may lead to preterm delivery, not a delay in the delivery. Ketonuria happens because the body breaks down fats for energy because of the lack of carbohydrates. Carbohydrates and proteins are essential for fetal development. Therefore the nurse should suggest the patient eat a balanced diet, rather than increasing the intake of protein.)

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

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.)

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

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.)

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)

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.)

What question does the nurse ask while assessing the socioeconomic status of a pregnant patient? A. "What prescription medications do you take?" B. "Do you have any factories around your house?" C. "Do you have any medical or dental insurance?" D. "Are there any diseases that run in your family?"

C (When the nurse is assessing a patient's socioeconomic status, the nurse should determine whether the patient has health insurance. Lack of health insurance may mean the patient does not have a job to pay for insurance or the income to pay for it privately. This may affect the patient's prenatal care if she cannot afford services. When the nurse asks about the family's medical history, this falls under the patient's personal history. The nurse asks about the community in which the patient lives when assessing the patient's environment. Medications can affect the fetus in a pregnant patient. Therefore the nurse should ask about the medications taken by the patient when assessing the patient's health status.)

The nurse observes a patient had preeclampsia during the second trimester of her pregnancy. Which is the most likely reason for preeclampsia in this patient? A. Hypervitaminosis B. Severe hypotension C. Lower extremity edema D. Body mass index (BMI) of 34.2 kg/m2

D (A BMI of 34.2 kg/m2 indicates that the patient is obese. Obese patients are more likely to develop preeclampsia as compared with their counterparts who have normal weight. Hypervitaminosis, severe hypotension, and lower extremity edema are not associated with preeclampsia. Deficiency of vitamin B6 is associated with preeclampsia. Hypertension during pregnancy, which is also referred to as gestational hypertension, is associated with preeclampsia. Small amounts of lower-extremity edema are normal in pregnant patients.)

The nurse is providing dietary education to a patient who is 4 months pregnant. Which diet should the nurse suggest to the patient for proper neural development of the fetus? A. Nuts, beans and legumes, cocoa, meats, and whole grains B. Iodized salt, milk and milk products, yeast breads, and rolls C. Citrus fruits, broccoli, melons, strawberries, and tomatoes D. Asparagus, eggs, fortified cereals, and green leafy vegetables

D (A diet rich in vitamin B12 and folic acid is essential for proper neural development of the fetus during pregnancy. Asparagus, fortified cereals, and green leafy vegetables are rich sources of folic acid, and eggs are rich in vitamin B12. Therefore a diet containing these foods is most advisable for the patient to ensure proper neural development of the fetus. Nuts, beans and legumes, cocoa, meats, and whole grains are rich sources of magnesium. Iodized salt, milk and milk products, yeast breads, and rolls contain iodine. Citrus fruits, broccoli, melons, strawberries, and tomatoes are rich sources of vitamin C. Magnesium, iodine, and vitamin C do not affect the neural development of the fetus.)

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."

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.)

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

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.)

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

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.)

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.

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.)

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

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.)

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

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

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

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.)

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

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.)

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.

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.)