OB Chapter 13
Mrs. M is a 32-year-old female whose prepregnancy weight is considered "normal." She is carrying a single fetus. What is the recommended amount of total weight gain? 15 to 20 pounds 25 to 35 pounds 35 to 40 pounds 20 to 25 pounds
25 to 35 pounds The American College of Obstetricians and Gynecologists recommends a 2- to 4-pound weight gain during the first trimester. Thereafter, the recommended weight gain for a woman of normal weight is approximately 1 pound per week.
The gravid client reports craving and sometimes eating starch. When she questions the nurse about this behavior what information should be included in the nurse's response? Select all that apply. "It sounds like you may be deficient in iron." "Eating things such as starch may be dangerous." "These types of cravings are harmless as long as the rest of the diet intake is balanced." "Nonfood cravings such as this are often tied to nutritional imbalances." "This is known as pica and can be associated with pregnancy."
"Eating things such as starch may be dangerous." "Nonfood cravings such as this are often tied to nutritional imbalances." "This is known as pica and can be associated with pregnancy." Pica refers to the craving and ingestion of nonfood items such as starch or dirt. The phenomena may be seen in pregnancy or children most often. This practice may be tied to vitamin or mineral imbalances. Pica may present danger for both the pregnant woman and her fetus. There is no indication that the client has anemia. It is inappropriate for the nurse to make such a diagnosi
A woman entering her third trimester of pregnancy asks the nurse how much weight she should gain during this trimester. What is the nurse's best answer? 0.5 lb/week 1 lb/week 1.5 lb/week 2 lb/week
1 lb/week A woman of normal prepregnant weight should gain about 10 lb by 20 weeks and about 1 lb/week for the remaining 20 weeks, for a total of 25 to 30 lb.
A client of normal weight and new to the obstetric clinic asks the nurse how much weight to gain during pregnancy. What is the best response the nurse can give? 7 lb over the first 3 months; 7 lb over the second three months; 7 lb over the last three months 5 lb over the first 20 weeks; 2 lb per week after that 5 lb over the first 3 months; 5 lb over the second three months; 10 lb over the last three months 10 lb over the first 20 weeks; 1 lb per week after that
10 lb over the first 20 weeks; 1 lb per week after that A simple rule of thumb for a woman of normal prepregnant weight is to gain about 10 lb by 20 weeks and about 1 lb/week for the remaining 20 weeks, for a total of 25 to 30 lb.
A client presents to the health care clinic for the first prenatal visit. The client's current weight is normal for height. In this situation, what recommendation for weight gain will the nurse provide? 40 to 45 lb (18 to 20 kg) 35 to 40 lb (16 to 18 kg) 25 to 35 lb (12 to 16 kg) 15 to 25 lb (7 to 12 kg)
25 to 35 lb (12 to 16 kg) A client who is of normal weight for height at this point in pregnancy will be encouraged to gain about 25 to 35 lb (12 to 16 kg) during the pregnancy. An client who is classified as overweight should be encouraged to gain no more than 15 to 25 lb (7 to 12 kg). A client who is classified as underweight will be encouraged to gain about 35 to 40 lb (16 to 18 kg). A client with twin gestation will be encouraged to gain about 40 to 45 lb (18 to 20 kg). Inadequate weight gain during pregnancy can lead to intrauterine growth restriction and low birth weight.
The nurse is praising an adolescent for seeking health care as soon as the adolescent found out about being pregnant. Which nursing intervention is the priority for this client in the first trimester of pregnancy? Teach the client about needing 8 to 10 hours of sleep each night. Make sure the client receives nutritional counseling and reinforce the teaching. Instruct on fetal development throughout the pregnancy. Schedule the client for a screening glucose tolerance test.
Make sure the client receives nutritional counseling and reinforce the teaching. There are many important nursing interventions for an adolescent who is pregnant. Nutritional counseling must be emphasized as part of prenatal care for adolescent clients because adolescents already have higher nutritional demands due to their growth status. Nutrition is also a priority due to the fetus' development. Adolescents are not at increased risk for developing gestational diabetes, so the client does not need a glucose tolerance test at this time. Adolescents do need 8 to 10 hours of sleep per night, but this is not the priority education over nutrition education. Instruction on fetal development at the first visit may be overwhelming and is not the priority at this time.
The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client? Walk for 30 minutes 5 days a week. Participate in a daily aerobic dance program. Adhere to a weight reduction diet. Begin lifting weights for 30 minutes per day.
Walk for 30 minutes 5 days a week. For a sedentary client a walking program is an appropriate goal. Dieting/weight reduction is never recommended during pregnancy. A daily aerobic or weight lifting program are not appropriate goals for a sedentary client with a high BMI.
A young woman in her first trimester confesses to the nurse when questioned that she is probably not consuming enough calories. The nurse should explain to this client that deficient nutrition can hinder the baby's growth, which at this point in her pregnancy is primarily via an increase in the number of cells formed. This type of growth is known as which of the following? hyperemesis gravidarum hypercholesterolemia hyperplasia hypertrophy
hyperplasia Early in pregnancy, fetal growth occurs largely by an increase in the number of cells formed (hyperplasia); late in pregnancy, it occurs mainly by enlargement of existing cells (hypertrophy). This means a fetus deprived of adequate nutrition early in pregnancy could be small for gestational age because of an inadequate number of cells formed in the body. Hypercholesterolemia is a condition of high blood cholesterol levels. Hyperemesis gravidarum is nausea and vomiting of pregnancy prolonged past week 16 of pregnancy. Severe dehydration, ketonuria, and significant weight loss occur within the first 12 weeks of pregnancy.
The nurse is caring for a client who is 8 weeks' pregnant and experiencing hyperemesis gravidarum with dry heaving in the morning hours. The client reports this occurs 6 to 8 times each morning. The client states that snacking on crackers in bed before rising is not helping. Which instruction will the nurse stress? providing good oral hygiene measures snacking on crackers prior to falling asleep rising slowly from bed in the morning elevating the head of the bed on blocks
providing good oral hygiene measures Excessive vomiting in clients with hyperemesis gravidarum commonly causes erosion of the tooth enamel. Good oral hygiene is necessary. Unless the client has hypotension, for which there is no evidence in this client, the client should place the feet firmly on the floor before rising. Morning is commonly when nausea occurs, snacking at night would not be helpful. Clients are instructed to elevate the head of the bed on blocks when they have a diagnosis of gastroesophageal reflux disease (GERD). There is no evidence that this client has GERD.
The nurse is caring for a pregnant client who states having a craving for ice. The client reports purchasing an ice tea and dumping out the tea to leave only the ice. As the nurse is reviewing all reports, which report is of most interest? red blood cell and hemoglobin levels to rule out iron deficiency thyroxine levels to rule out iodine deficiency thyroid and thyroid stimulating levels to rule out a thyroid deficiency adrenocorticotropic hormone (ACTH) level to rule out adrenal insufficiency
red blood cell and hemoglobin levels to rule out iron deficiency The nurse is correct to assess for iron-deficiency anemia by consulting the red blood cell count in the complete blood count (CBC) and hemoglobin level. Pica or the ingesting of nonfood items such as ice is a symptom of iron-deficiency anemia. Thyroid deficiencies have signs of fatigue. Iodine deficiencies have signs of a goiter. Adrenal insufficiency has signs of muscle weakness.
A pregnant client is concerned about gaining weight. The nurse explains that the extra calories are needed for which purpose? Select all that apply. building strength for the birth process sustaining the elevated metabolic rate supplying energy to the fetus promoting cellular growth providing energy for increased workload
sustaining the elevated metabolic rate supplying energy to the fetus promoting cellular growth providing energy for increased workload increased maternal caloric intake is needed to provide energy and cellular growth in the fetus as well as to provide for the increased workload and metabolic rate of the maternal body. Increased caloric intake does not build strength for the birth process.
When needed, total parenteral nutrition (TPN) is often administered at home to reduce health care costs. When teaching a client how to safely administer TPN, the home care nurse emphasizes: testing blood glucose every 6 hours keeping the solution cold during administration. testing only fasting blood glucose to decrease the chance of infection. leaving the insertion site open to air to facilitate observation
testing blood glucose every 6 hours Blood glucose is tested every 6 hours because of the hypertonicity of the TPN solution. The solution should be removed from the refrigerator 2 hours before administration to allow passive warming. Proper skin preparation and use of an automated lancet will prevent infection. The catheter insertion site is covered to control infection and is observed at dressing changes.
How can the nurse best counsel a client with pyrosis? "Avoid sleeping in an upright position." "It is important to continue to eat three meals a day." "Avoid lying down 2 hours after eating." "Chest pain is common and is not a concern in pregnancy."
"Avoid lying down 2 hours after eating." For clients with heartburn, it's best to eat smaller, more frequent meals. Sleeping on the left side propped on pillows can aid gastric emptying. Chest pain can be a sign of a serious complication in pregnancy and should always be assessed.
The nurse is conducting a teaching session for breastfeeding mothers. Which statement by a mother requires further clarification by the nurse? "I am glad I can have my two cups of coffee in the morning again." "I will drink a large glass of water each time I nurse my baby." "I will continue to take a prenatal multivitamin as long as I am breastfeeding." "I will continue to add about 300 calories per day to my diet."
"I am glad I can have my two cups of coffee in the morning again." Breastfeeding mothers should avoid caffeine because it delays iron absorption and passes through the milk and can slow infant weight gain. Similarly, spicy foods pass into the breastmilk and can affect the baby. Breastfeeding mothers need added calories and fluids.
A client with a prepregnant BMI of 26 is concerned about gaining weight during pregnancy. Which statement by the client indicates an appropriate goal for this pregnancy? "I will eliminate carbohydrates from my diet to control my weight." "I will eat two large meals with high protein content each day." "I am eating for two now, so the baby will burn the extra calories." "I need to consume at least 1,500 nutrient-dense calories each day."
"I need to consume at least 1,500 nutrient-dense calories each day." An overweight client needs at least 1,500 calories per day. Choosing nutrient-dense calories helps to limit excessive weight gain. Carbohydrates are needed for energy. Small, frequent meals help to maintain a constant blood glucose level and decrease binge eating. While the growing fetus needs nutrients, the fetus does not burn excessive calories ingested by the mother.
The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy? "I need to gain less than 25 pounds (11 kg) during this pregnancy." "I need to gain 0.5 pounds (0.23 kg) per week during this pregnancy." "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." "I need to gain 1 pound (0.45 kg) per week throughout this pregnancy."
"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." A prepregnant BMI of 23 is in the normal category, and this client needs to gain 25 to 35 lbs (11 to 16 kg) during this pregnancy. Lower weight gain would be recommended for women with a BMI of over 25.
A client is 25 weeks' pregnant. The client explains that she is having difficulty getting an adequate amount of protein into the diet because she is a vegetarian. How can the nurse counsel this client? "Because you do not eat meats, eat the equivalent of tofu with each meal." "Because you are a vegetarian, try to eat at least 5 servings of fish or seafood per week. " "In addition to protein from dairy, eat complementary proteins such as beans and rice together, or beans and wheat together." "Eat more leafy greens such as spinach and romaine lettuce and more vegetable oils, almonds, and avocados."
"In addition to protein from dairy, eat complementary proteins such as beans and rice together, or beans and wheat together." It is important for the nurse to understand the vegetarian diet because nutrition is an important teaching point for intrapartal woman. Women who are vegetarian usually do not eat fish and some do not eat eggs. Most proteins from nonanimal sources are incomplete proteins that need to be combined with other nonanimal proteins to become complete proteins. Client education on how to eat complementary proteins such as beans and rice, legumes and rice, or beans and wheat can help vegetarians increase protein in the diet. It is not realistic for the client to eat tofu at every meal.
The recommended weight gain during the first trimester for a woman who was in the normal weight range prepregnancy is 2 to 4 pounds. After the first trimester, what is the recommended weekly weight gain for a woman who was considered normal weight prepregnancy? 0.5 pound 2 pounds 0.66 pound 1 pound
1 pound The American College of Obstetricians and Gynecologists recommends a 2- to 4-pound weight gain during the first trimester. Thereafter, the recommended weight gain for a woman of normal weight is approximately 1 pound per week.
A pregnant client of normal weight is concerned about excessive weight gain during her pregnancy. She states, "I don't want to get fat!" The nurse should inform her that she can expect to gain how much weight during her pregnancy? 35 to 40 pounds 25 to 30 pounds 15 to 20 pounds 20 to 25 pounds
25 to 30 pounds A simple rule of thumb for a woman of normal pre-pregnant weight is that she will gain about 10 pounds by 20 weeks and about 1 lb/week for the remaining 20 weeks, for a total of 25 to 30 pounds.
A nurse is conducting a program at a women's health clinic about nutritional needs and women during pregnancy. When discussing dietary intake, which information would the nurse include?
A woman with twins should gain 1 lb per week Women who are overweight or obese are still advised to gain weight during pregnancy. An obese woman should gain 15 to 25 lbs. A woman should increase her caloric consumption by 300 calories a day. Most of the weight gained in pregnancy comes from an increase in maternal fat stores or from the fetus itself.
Which statement regarding weight and pregnancy is correct? Women who are underweight coming into pregnancy should gain the same amount of weight as women with a normal BMI. Dieting during pregnancy to reduce weight is recommended only for morbidly obese women. Obesity usually occurs from hypothyroidism. An underweight woman should increase her caloric intake by 500 to 1000 calories a day.
An underweight woman should increase her caloric intake by 500 to 1000 calories a day. Obesity usually occurs from diet and lifestyle. Dieting to lose weight is not recommended during pregnancy. Women who are underweight should gain slightly more than women who have a normal BMI.
When interviewing a pregnant client, how can the nurse best assess the client's dietary intake? Ask the client if there is an ethnic style of cooking in the home. Ask the client what foods are desired to include more of in diet. Ask the client to list favorite foods and how often they are eaten. Ask the client to recall what was eaten and drank in the last 24 hours.
Ask the client to recall what was eaten and drank in the last 24 hours. The 24-hour recall is the best way to assess a client's dietary practices. It provides actual eaten foods for a basis of discussion. Asking the client to list favorite foods or if there is an ethnic style of cooking would have to be followed by how often those foods are eaten. Assessing foods the the client would like to have in the diet can be the start of instruction on obtaining and preparing nutritious foods. These foods are not currently part or only a small part of the client's diet.
A client reports prolonged nausea, vomiting every morning for the past week, and no appetite. The pregnancy test comes back positive. What recommendation should the nurse give this client? Select all that apply. Eat a high-protein, low-carb snack during the night. Delay eating breakfast until the nausea and vomiting has passed. Eat a low-fat diet and eliminate all caffeine. Take small amounts of liquids between meals, not with them. Eat a saltine cracker before getting out of bed in the morning.
Delay eating breakfast until the nausea and vomiting has passed. Take small amounts of liquids between meals, not with them. Eat a saltine cracker before getting out of bed in the morning. Eating a saltine cracker before getting out of bed, delaying breakfast, and taking small amount of liquids between meals are all appropriate interventions to cope with morning sickness. Morning sickness is related to hormone levels. The fat, protein, or carbohydrate content of the diet is not the causative factor.
A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend? Use a water-based enema. Eat fiber-rich foods. Take a fiber-based laxative. Insert a glycerin suppository.
Eat fiber-rich foods. Increasing dietary fiber is the best way to address constipation. Laxatives, suppositories, and enemas only provide temporary relief and may stimulate labor.
A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply. Sleep in a semi-Fowler position. Avoid overeating. Limit consumption of food before bedtime. Avoid use of antacids. Consume lots of liquids before bedtime.
Sleep in a semi-Fowler position. Avoid overeating. Limit consumption of food before bedtime. When caring for a pregnant client with heartburn, the nurse should instruct the client to limit consuming foods before bedtime. The nurse should also instruct the client to sleep in a semi-Fowler position and to avoid overeating. The nurse need not instruct the client to avoid the use of antacids. On the contrary, antacids are known to be useful for heartburn even during pregnancy. The nurse should not instruct the client to consume lots of fluids before bedtime. Along with food, even fluids should be limited before bedtime.
When counseling a lacto-ovo-vegetarian client, the nurse would recommend including which source of protein in the diet during pregnancy? fish brown rice eggs chicken
eggs Lacto-ovo-vegetarians eat no animal flesh or fish, but they do eat dairy products, so eggs are a source of protein. Brown rice is not a source of protein.
A client with hyperemesis gravidarum is started on total parenteral nutrition (TPN). What parameter does the nurse need to assess at least twice a day? blood ketones hemoglobin and hematocrit potassium level blood glucose
blood glucose The blood glucose level needs to be tested. If it is elevated, it suggests the concentration of glucose is too high for the body to metabolize.
The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid? hot tea ice water citrus juice low-fat milk
citrus juice The citric acid in juice enhances absorption of iron in the GI tract. Ice water and tea do not enhance iron absorption, and milk can inhibit iron absorption.
A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client? meat, poultry, and fish white bread and rice deep red or orange vegetables dark, leafy green vegetables
dark, leafy green vegetables Dark leafy green vegetables are a source of calcium. Red and orange vegetables contain a variety of vitamins, bread and rice contain carbohydrates, and meat and fish contain protein, but none of these foods are a good source of calcium.
A nurse assesses a primigravida client in the eighth week of gestation. The client reports nausea and vomiting in the mornings. The client tells the nurse, "I'm not able to keep liquids down and I'm eating like a bird." The client also expresses concerns about hormonal changes and how the pregnancy will affect her physical appearance. Which client problem should the nurse assess first? knowledge deficit disturbed body image deficient fluid volume slow weight gain
deficient fluid volume The nurse should identify deficient fluid volume as a risk that needs immediate attention. The client may be at risk for hyperemesis gravidarum if she is dehydrated. Disturbed body image, deficient knowledge, or slow weight gain are not concerns that need immediate attention. The nurse attends to the client's concerns regarding disturbed body image and deficient knowledge by preparing a teaching plan with regard to exercise and hormonal changes during pregnancy. The nurse should prepare a diet plan that would help the client to receive adequate nutrition and achieve the desired weight gain.
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? swelling of extremities lower abdominal pressure excessive vomiting dyspnea
excessive vomiting Excessive vomiting is a warning sign in the first trimester. Dyspnea, lower abdominal pressures, and swelling of face or extremities may occur late in pregnancy.
All of the following are physical signs of protein deficiency in pregnancy except: dull, brittle, and lifeless hair. poor muscle tone or diminished reflexes. fissures at the corner of the mouth or pale mucous membranes. pale or brittle fingernails.
fissures at the corner of the mouth or pale mucous membranes. Pale mucous membranes are a sign of iron deficiency. Fissures at the corners of the mouth are a sign of vitamin A deficiency.
A client with hyperemesis gravidarum is on a clear liquid diet. Which foods would be appropriate for the nurse to serve? Select all that apply. milk and ice chips ginger ale and apple juice oatmeal and egg substitutes tea and gelatin cranberry juice and chicken broth decaffeinated coffee and scrambled eggs
ginger ale and apple juice tea and gelatin cranberry juice and chicken broth A clear liquid diet consists of foods that are clear liquids at room temperature or body temperature, such as ice pops, regular or decaffeinated coffee and tea, gelatin desserts, broth, carbonated beverages, and clear juices, such as apple and cranberry juices. Milk, pasteurized eggs, egg substitutes, and oatmeal are part of a full liquid diet.
When teaching a client about nutrition during pregnancy, the nurse should include which long-term outcomes in the plan of care? Select all that apply. incorporating foods to build bone mass designing a diet consistent with cultural factors developing healthy patterns for a lifetime finding sources of low-fat foods identifying foods to build iron stores
incorporating foods to build bone mass designing a diet consistent with cultural factors developing healthy patterns for a lifetime identifying foods to build iron stores During pregnancy, teaching includes healthy nutrition for the pregnancy, such as building iron stores and bone mass as well as developing healthy patterns for a lifetime; this impacts both the client and her future children. Any teaching about nutrition needs to be consistent with cultural factors. These are long-term outcomes. Finding inexpensive sources of low-fat foods is not consistent with healthy teaching during pregnancy.
A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance? greater fatty acid content more consistent regulation of glucose and insulin provision of a greater amount of calories per gram faster digestion of complex than simple carbohydrates
more consistent regulation of glucose and insulin Advise women to obtain their carbohydrate calories from complex carbohydrates (cereals and grains) rather than simple carbohydrates (sugar and fruits) because complex carbohydrates are more slowly digested. Doing so will help regulate glucose and insulin levels more consistently. All carbohydrates contain roughly the same amount of calories per gram (4 kcal/g). Carbohydrates of any kind are not a significant source of fatty acids.
Women who are obese in pregnancy are at higher risk for developing all of the following except: macrosomia pregnancy-induced hypertension neural tube defects cesarean birth. gestational diabetes
neural tube defects Folic acid deficiency will increase the risk of neural tube defects.
During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy? height and bone structure current weight prepregnancy BMI hemoglobin level
prepregnancy BMI Weight gain goal during pregnancy is based on the client's prepregnant BMI. Current weight and height are part of the BMI calculation. Hemoglobin level only provides information about iron stores, not overall nutritional status.
A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate? serum sodium level serum potassium level serum iron level serum glucose level
serum iron level Pregnant clients who crave ice often have an iron deficiency. A low serum iron level needs to be checked. The client's electrolyte values are not associated with cravings for ice.
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth? poor nutrient intake resulting in poor fetal growth ketonuria resulting in neurologic changes in the fetus class B drugs used to control the vomiting resulting in uterine contractions severe dehydration resulting in hypoperfusion of the placenta
severe dehydration resulting in hypoperfusion of the placenta With severe dehydration there is hypoperfusion to the placenta, and preterm labor may be initiated. Ketonuria impacts the fetus' neurologic development but does not initiate preterm labor. Medications used to control nausea and vomiting do not induce labor.
A client is concerned about the mercury levels in fish and asks the nurse which fish are safe to eat. The best response is: fresh salmon, shark, and swordfish. tilefish, shark, and tuna. mackerel, kingfish, tilefish, and shrimp. shrimp, canned tuna, pollack, and catfish.
shrimp, canned tuna, pollack, and catfish. The larger the fish, the higher the concentration of mercury will be in that fish. Fish such as shrimp, catfish, anchovies, and sardines are small and therefore have small amounts of mercury.
The nurse educates the vegetarian client about which nutritional need during pregnancy? supplementing the diet with vitamins A and C taking a B12 supplement limiting the intake of fiber avoiding high intake of dark green vegetables.
taking a B12 supplement B12 is found almost exclusively in animal proteins and therefore is absent in the vegetarian diet. Fiber and dark green vegetables are needed. Vitamins A and C are not protein based and are found in a vegetarian diet.
A pregnant client states, "I am only 6 weeks pregnant, but the morning sickness is awful. When is it going to stop?" What is the best response by the nurse?
usually after 12 weeks By 12 weeks' gestation, the placenta has grown sufficiently to take over production of progesterone and the corpus luteum is absorbed. Most women who have morning sickness start feeling better once the placenta takes over.