OB/Peds Chapter 13 Promoting Nutritional Health During Pregnancy

A hospitalized client with hyperemesis gravidarium has been tolerating small amounts of clear fluids for the past 6 hours. What is the next step in the plan of care?

Add small quantities of dry toast every 2 to 3 hours. Explanation: After clear liquids, the client is given small quantities of dry toast. Juices and milk are avoided because they may irritate the GI tract. Only after tolerating the dry toast if the diet progressed further.

Vitamin B12 deficiency is most likely to be found in which patient?

A vegan Explanation: Vitamin B12 is almost exclusively found in foods that come from animals. Although most vegetarians eat animal products, such as dairy and eggs, vegans do not eat any animal foods. Vegans are at highest risk for vitamin B12 deficiency.

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?

dark, leafy green vegetables Explanation: 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.

At 16 weeks' gestation, a client is vomiting 3 to 5 times per day. The nurse will assess the client for the development of which condition?

hypokalemic alkalosis Explanation: Hypokalemic alkalosis may develop from loss of hydrochloric acid from the stomach and loss of potassium from recurrent vomiting.

A client at 36 weeks' gestation who is 2 years post bariatric surgery would be expected to have a weight gain that is:

less than other pregnant clients at the same gestational age. Explanation: Because the capacity of the GI tract is modified, the amount of nutrient absorption is limited, resulting in lower weight gain.

A client with hyperemesis gravidarium is started on TPN. What parameter does the nurse need to assess at least twice a day?

blood glucose Explanation: 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.

A pregnant client reports chewing on ice throughout the day. Which laboratory value would the nurse evaluate?

serum iron level Explanation: 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.

How can the nurse best counsel a patient with pyrosis?

"Avoid lying down 2 hours after eating." Explanation: For patients 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 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 25 to 35 pounds (11 to 16 kg) during this pregnancy." Explanation: 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 nurse is interviewing a primigravida woman about nutrition during pregnancy. During the interview, the woman asks the nurse about consuming caffeine. Which information would the nurse include when teaching the woman about caffeine intake during pregnancy? Select all that apply.

"Pregnant women should limit the amount of caffeine to 200 mg or less per day." "Although it includes significantly smaller amounts, chocolate also contains caffeine." "If you want to reduce the amount of caffeine you drink, drink green tea instead of black tea." Explanation: Caffeine is a central nervous system stimulant that will increase heart rate. Black tea has more caffeine than green tea. Many beverages such as water, milk, and juices are naturally caffeine free

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?

1 lb/week Explanation: A woman of normal prepregnant weight should gain about 10 lbs by 20 weeks and about 1 lb/week for the remaining 20 weeks, for a total of 25 to 30 lbs.

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?

25 to 35 pounds Explanation: The American College of Obstetricians and Gynecologists recommend a 2- to 4-pound weight gain during the first trimester. Thereafter, the recommended weight gain for normal-weight women is approximately 1 pound per week.

What is the recommended amount of protein (grams/day) in pregnancy?

71 g/d Explanation: A pregnant woman should consume 71 grams of protein per day.

At 32 weeks' gestation a client with a BMI of 23 has gained 24 lb (11 kg). What is the nurse's recommendation for weight gain for the remainder of this pregnancy?

Continue to gain approximately 1 lb (.45 kg) per week during this pregnancy. Explanation: Expected weight gain is 1.5 lb (0.68 kg) per month in the first trimester and 1 lb (.45 kg) week for the second and third trimester. This client needs to continue to gain 1 lb (.45 kg) per week. Restricting weight gain near the end of pregnancy can negatively impact fetal growth.

A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond?

Fats are essential during pregnancy, and vegetable oils are a good source. Explanation: Omega-3 fatty acids, particularly linoleic acid, are fats that are essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed, fatty fish, omega-3 infused eggs, and omega-3 infused spreads are all good sources. Pregnant women should ingest between 200 and 300 mg daily. Because some fish may be contaminated by mercury, alert women that the American Pregnancy Association (APA) recommends that marlin, orange roughy, tilefish, swordfish, shark, king mackerel, and bigeye and ahi tuna should be avoided during pregnancy.

Pica is a craving for nonfood items such as laundry starch, clay, or ice. What problem is associated with pica?

Iron deficiency Explanation: Iron deficiency was thought to be a risk factor for pica but iron deficiency may be a consequence. Eating clay or soil may displace the intake of iron-rich foods from the diet and may interfere with iron absorption. The other choices are not associated with pica.

The nurse is teaching about an iron supplement that client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid?

citrus juice Explanation: 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.

When counseling a lacto-vegetarian client, the nurse would recommend including which source of protein in the diet during pregnancy?

eggs Explanation: Lacto-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 nurse is assessing a client's nutritional intake during pregnancy. What is the best method for accomplishing this?

enacting a 24-hour nutrition recall Explanation: Although all of the answers refer to interventions that the nurse should include in her assessment, the 24-hour nutrition recall is the best single method for assessing her nutritional intake.

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?

excessive vomiting Explanation: 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.

Nausea and vomiting are common reports during pregnancy. What nutritional action can be used to lessen nausea and vomiting?

limiting intake of heavy, greasy foods Explanation: Nausea and vomiting can be lessened by limiting intake of fatty and greasy foods and eating small frequent meals every 2 to 3 hours. Other interventions include eating carbohydrate foods such as dry crackers, Melba toast, dry cereal, or hard candy before getting out of bed in the morning. Avoid drinking liquids with meals; avoid coffee, tea, and spicy foods; and eliminate individual food intolerances. Drinking liquids, increasing fluid intake, and limiting carbohydrate intake does not lessen nausea and vomiting.

Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth?

severe dehydration resulting in hypoperfusion of the placenta Explanation: With severe dehydration there is hypoperfusion to the placenta, and preterm labor may be initiated. Ketouria impact the fetus' neurologic development, but does not initiate preterm labor. Medications used to control nausea and vomiting do not induce labor.

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." Explanation: 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 need to consume at least 1,500 nutrient-dense calories each day." Explanation: 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.

A 22-year-old female is 25 weeks pregnant. She explains that she is having difficulty getting an adequate amount of protein into her diet because she is a vegetarian. How can the nurse best counsel this patient?

"In addition to getting protein from eating dairy, eat complementary proteins such as beans and rice together, or beans and wheat together." Explanation: Women who are vegetarian usually do not eat fish and sometimes do not eat eggs either. Most proteins from non-animal sources are incomplete proteins that need to be combined with other non-animal proteins to become complete proteins. Patient 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 their diet.

The nurse is teaching an active pregnant woman about nutritional needs to maintain a healthy pregnancy. The nurse determines that the teaching was successful when the woman states that she need about how many calories per day?

2,500 calories per day Explanation: The average recommended daily allowance (RDA) of calories for women of childbearing age is 2,200. An additional 300 calories, or a total caloric intake of 2,500 calories, is recommended to meet the increased needs of pregnancy. Changes in daily physical activity are individual, leading either to an increase or a decrease in energy used throughout the pregnancy.

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?

25 to 30 pounds Explanation: 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.

Which of the following is true regarding problems that commonly affect nutritional health in pregnancy?

50% of women report pyrosis at some point in pregnancy. Explanation: Fifty percent of pregnant women have nausea and vomiting. Only 1 in 200 or 1 in 300 women develop hyperemesis gravidarum (severe nausea and vomiting). Hypercholesterolemia predisposes women to development of cholelithiasis (gallstones).

When counseling a Japanese American about nutrition and diet in pregnancy, it would be important to include

A list of foods that contain calcium Explanation: Because dairy products often are not a part of the Japanese American diet, it can be helpful to point out alternative sources of calcium. A Japanese American diet is typically high in sodium and low in fat but rich in nutrients. Meat portions tend to be small, but fish is often consumed; therefore, the diet is adequate in omega-3 fatty acids.

A nurse is reviewing the medical records of several women who come to the prenatal clinic for care. The nurse plans to increase the number of teaching sessions on nutrition for the women at risk for poor nutritional status. Which woman would the nurse most likely identify as needing the additional sessions. Select all that apply.

A woman who is 42-years of age A woman whose prepartum weight was less 85% of ideal weight. A woman who shows a weight gain of 2 or more pounds per week. Explanation: Risk factors for poor nutritional status include low or deficient hemoglobin and hematocrit levels. Other risk factors include teens and women older than 40 years of age, prepartum weight less than 85% or more than 120% of ideal weight, and weight gain of 2 or more pounds per week.

Which of the following statements regarding weight and pregnancy is correct?

An underweight woman should increase her caloric intake by 500 to 1000 calories a day. Explanation: 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.

A nurse is teaching a 32-year-old primigravida woman about nutrition during pregnancy. Which information would the nurse include in the teaching plan? Select all that apply:

Caloric intake should be increased 300 cal/day. Protein intake should be increased by more than 30 g/day. Intake of all minerals, especially iron, should be increased. Explanation: A pregnant woman should increase her caloric intake by 300 cal/day. The protein requirements (76 g/day) of a pregnant woman exceed those of a nonpregnant woman by 30 g/day. All mineral requirements, especially iron, are increased in a pregnant woman. The woman should increase her intake of all vitamins and a prenatal vitamin is usually recommended. Folic acid intake is particularly important to help prevent fetal anomalies such as neural tube defects. Intake should be increased to 800 mg/day.

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?

Deficient fluid volume Explanation: 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.

A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?

Eat dry crackers or toast before rising. Explanation: The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn

All of the following are physical signs of protein deficiency in pregnancy EXCEPT Pale or brittle fingernails Dull, brittle, and lifeless hair Fissures at the corner of the mouth or pale mucous membranes Poor muscle tone or diminished reflexes

Fissures at the corner of the mouth or pale mucous membranes Explanation: Pale mucous membranes are a sign of iron deficiency. Fissures at the corners of the mouth are a sign of vitamin A deficiency.

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?

Hyperplasia Explanation: 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 or so severe dehydration, ketonuria, and significant weight loss occur within the first 12 weeks of pregnancy.

Nutritional requirements generally go up during pregnancy. Which nutritional requirement proportionally increases the most during pregnancy?

Iron Explanation: The Dietary Reference Intake for iron increases by 50% during pregnancy to support the increase in maternal blood volume and to provide iron for fetal liver storage, which sustains the infant for the first 4 to 6 months of life.

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.

Limit consumption of food before bedtime. Sleep in a semi-Fowler's position. Avoid overeating. Explanation: 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's 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, so the nurse need not instruct the client to avoid them. The nurse should not instruct the client to consume lots of fluids before bedtime. Along with food, even fluids should be limited before bedtime.

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?

More consistent regulation of glucose and insulin Explanation: 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

Neural tube defects Explanation: Folic acid deficiency will increase the risk of neural tube defects.

A woman whose body mass index (BMI) is 32 has just learned that she is pregnant. Which of the following should the nurse advise her regarding her weight over the course of her entire pregnancy?

She should gain 11 to 20 lb Explanation: Women whose weight falls into the obese BMI category (over 30 ), should aim to gain 11 lb to 20 lb; normal weight women (18.5-24.9) should aim to gain 25 lb to 35 lb; underweight women (BMI is less than 18.5) should aim to gain 28 lb to 40 lb; overweight women (BMI over 25-29.9), should aim to gain 15 lb to 25 lb.

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:

Tea and gelatin Ginger ale and apple juice Cranberry juice and chicken broth Explanation: 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 needed, total parenteral nutrition (TPN) is often administered at home to reduce health care costs. When teaching a patient how to safely administer TPN, the home care nurse emphasizes

Testing blood glucose every 6 hours Explanation: 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.

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, when the placenta starts managing the production of progesterone, morning sickness ends." Explanation: 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.

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. Explanation: 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.

During the examination of a pregnant client, the nurse observes pale mucous membranes and cracks at the corners of the mouth. The nurse recognizes that these findings suggest what type of deficiency?

vitamin A Explanation: These signs are consistent with a vitamin A deficiency. A vitamin C deficiency manifests as easy bruising and swollen/bleeding gums. An iron deficiency presents as fatigue and low energy, and a calcium deficiency would impact the calcification of fetal bones.

A client who is 28 weeks' pregnant asks the nurse if it is safe to use mineral oil to relieve constipation. What is the best response by the nurse?

"No, mineral oil may interfere with the absorption of fat-soluble vitamins from your diet." Explanation: Mineral oil should be avoided because it interferes with the absorption of fat soluble vitamins that are needed by the fetus. It does not alter the absorption of water soluble vitamins, change the bulk of the stool, or cause preterm labor.

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?

1 pound Explanation: The American College of Obstetricians and Gynecologists recommend a 2- to 4-pound weight gain during the first trimester. Thereafter, the recommended weight gain for normal-weight women is approximately 1 pound per week.

A patient 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?

10 lbs over the first 20 weeks; 1 lb per week after that Explanation: A simple rule of thumb for a woman of normal prepregnant weight is to gain about 10 lbs by 20 weeks and about 1 lb/week for the remaining 20 weeks, for a total of 25 to 30 lbs.

Mrs. M is now 20 weeks' gestation. At conception her weight was considered "normal." Approximately how much weight should she have gained by this time?

11 to 12 pounds Explanation: The American College of Obstetricians and Gynecologists recommend a 2- to 4-pound weight gain during the first trimester. Thereafter, the recommended weight gain for normal-weight women is approximately 1 pound per week. The approximate amount of weight an adult woman who was of normal weight at conception should have gained at 20 weeks' gestation is 11 to 12 pounds.

You are discussing weight gain with a group of pregnant women at the clinic. One woman is very thin and her prepregnancy weight falls below the normal weight range for her height. What is her recommended weight gain during her pregnancy?

28 to 40 pounds Explanation: Current weight gain recommendations for pregnancy are based on prepregnancy body mass index (BMI). Recommended weight gain is 25 to 35 pounds in women of normal weight, 28-40 pounds for underweight women, 15 to 25 pounds for overweight women, and at least 15 pounds for women who are obese at the time of conception.

A nurse is conducting a program at women's health clinic about nutritional needs and women during pregnancy. When discusing dietary intake, which information would the nurse include?

A woman with twins should gain approximately 1 pound a week for a total of 40 to 45 lbs. Explanation: 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.

When developing a plan of care, the nurse needs to make which assessments for a pregnant client with a BMI of 18.3? Select all that apply.

assess for maternal fatigue assess for poor fetal growth assess for preterm labor Explanation: With a low prepregnancy BMI of 18.3, this client needs to be monitored for complications related to deficient nutrient stores such as fatigue, poor fetal growth, and preterm labor. A low BMI does not place this client at high risk for gestational diabetes or eclampsia.

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?

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?

A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend?

Eat fiber rich foods. Explanation: Increasing dietary fiber is the best way to address constipation. Laxatives, suppositories, and enemas only provide temporary relief and may stimulate labor.

A woman who is obese comes to the clinic because she thinks that she is pregnant. The pregnancy is confirmed. The nurse is developing a teaching plan for this woman about pregnancy and challenges associated with it related to obesity. The nurse would most likely plan to address which condition(s) as being an increased risk? Select all that apply.

Gestational diabetes Large for gestational age (LGA) neonate Difficult vaginal birth Explanation: Obesity increases the risk for gestational diabetes, LGA and postmature neonates, more difficult vaginal briths due to possible macrosomia, and complications should a cesarean birth be necessary.

During pregnancy most nutritional needs can be consumed in adequate amounts through the diet. What nutrient is the exception to this statement?

Iron Explanation: Although most nutrients are needed in greater amounts during pregnancy, most women who are at low nutritional risk can meet their nutrient needs throughout pregnancy from food alone. A notable exception is iron. Folic acid is another possible exception: as previously noted, fortified foods or supplements containing 600 micrograms of folic acid are recommended during pregnancy. A woman at low nutritional risk can meet the needs for calcium, sodium, and vitamin D in her diet.

The nutritional needs of an adolescent pregnant patient are unique because

Owing to typical food choices, an adolescent is often lacking calcium, iron, and folic acid in the diet Explanation: A pregnant adolescent has the same caloric requirements as an older pregnant woman of the same BMI (2500 calories a day for normal weight BMI). Often adolescents are already deficient in their caloric intake and therefore have to increase their daily calorie consumption by more than the recommended 300 calories a day to meet a diet of 2500 calories. Adolescents snack frequently but do not typically eat three meals a day. Parents may be very involved in the diets of these patients in that they often buy and cook the food that they consume.

A patient is concerned about the mercury levels in fish and asks the nurse which fish are safe to eat. The best response is

Shrimp, canned tuna, pollack, and catfish Explanation: 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.

You are doing client education with an obese woman who is trying to get pregnant. She confides in you that she is on a diet and trying to lose weight. Which of the following would you teach her?

Weight reduction should not be undertaken during pregnancy. Explanation: Once a woman becomes pregnant, weight reduction should never be undertaken. A pregnant woman should not stay on a weight reduction diet during her pregnancy. Pregnancy is not a safe time to lose weight. Obesity impacts the pregnancy by making it high risk.

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.

developing healthy patterns for a lifetime identifying foods to build iron stores incorporating foods to build bone mass designing a diet consistent with cultural factors Explanation: 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, which 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.

The nurse is discussing nutritional supplementation with a 27-year-old pregnant client. Which element would the nurse encourage as essential in preventing neural tube defects?

folic acid Explanation: Folic acid supplementation is essential during the first trimester to prevent neural tube defects. Iron deficiency leads to anemia, which causes preterm birth and low birth weight infants. Iron, calcium and iodine supplementation are necessary during pregnancy, but the lack of these does not cause neural tube defects in the fetus.

When caring for a client with lactose intolerance, the nurse would be aware of which potential problem during pregnancy?

inadequate calcium for skeletal growth Explanation: Lactose intolerance can lead to inadequate calcium intake, which can impact fetal skeletal growth. There are many nondairy sources of protein. Iron and folate intake are not altered by lactose intolerance.

During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy?

prepregnancy BMI Explanation: 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.

The nurse educates the vegetarian client about which nutritional need during pregnancy?

taking a B12 supplement Explanation: 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.