Ch. 14: Nutrition for Childbearing (6%)

A patient has the nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy. What goal is most appropriate for this diagnosis? a. Weight change from 135 pounds to 165 pounds at delivery. b. Take daily supplements consistently. c. Decrease intake of snack foods. d. Increase intake of complex carbohydrates.

ANS: A A weight gain of 30 lb is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring nutritional intake for this pregnancy. Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal.

A pregnant patient would like to know a good food source of calcium other than dairy products. Which answer by the nurse is best? a. Legumes b. Yellow vegetables c. Lean meat d. Whole grains

ANS: A Although dairy products contain the greatest amount of calcium, it also is found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Yellow vegetables are rich in vitamin A. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium.

Which statement by a patient indicates that she understands the role of protein in her pregnancy? a. ―Protein will help my baby grow.‖ b. ―Eating protein will prevent me from becoming anemic.‖ c. ―Eating protein will make my baby have strong teeth after he is born.‖ d. ―Eating protein will prevent me from being diabetic.‖

ANS: A Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Eating protein will not prevent diabetes.

The nurse has taught a pregnant woman, who is a vegetarian, about foods that are high in iron. Which menu selections demonstrate good understanding of the material? (Select all that apply.) a. Cooked soybeans b. Canned stewed tomatoes c. Raisin bran cereal d. White bread e. Peaches

ANS: A, B, C Cooked soybeans, canned stewed tomatoes, and raisin bran cereal are all high in iron. White bread and peaches are not.

When assessing cultural influences on a pregnant woman's diet, which actions by the nurse are best? (Select all that apply.) a. Learn about traditional foods in that culture. b. Ask the woman how she prepares food. c. Determine if there are specific ―pregnancy‖ foods. d. Assess how traditional the woman is. e. Find out what support she has locally.

ANS: A, B, C The nurse should ask about traditional foods in her culture and how she (or others) prepare the food. In some cultures, specific foods are eaten during pregnancy, and the nurse should determine this as well. Assessing how traditional the woman is may or may not be helpful; some women who are not traditional at all return to their cultural practices during pregnancy for a number of reasons. Support systems are not related to food.

The nurse is teaching a pregnant woman to reduce her intake of sodium. What products does the nurse teach the woman to avoid? (Select all that apply.) a. Products with the word ―soda‖ in the ingredients b. Packaged gravy mixes c. Mayonnaise d. Cake mixes e. Fruit juices

ANS: A, B, D Products with the word ―soda‖ in the ingredient list are high in sodium, as are packaged gravy mixes and cake mixes. Mayonnaise and fruit juice are lower in sodium and acceptable.

A lactating woman tells the nurse she is glad to no longer have to follow specific dietary recommendations, now that her baby has been born. The nurse responds by teaching her that lactating women have an even greater need for which nutrients? (Select all that apply.) a. Vitamin A b. Vitamin D c. Folic acid d. Iron e. Iodine

ANS: A, E The lactating woman needs more vitamin A and iodine than the pregnant woman. The requirements for vitamin D are the same in both groups. The lactating woman needs less folic acid and iron than a pregnant woman.

In teaching the pregnant adolescent about nutrition, what suggestion by the nurse is best? a. Eliminate common teen snack foods, because they are too high in fat and sodium. b. Work with the teen to include some fast food in a healthy prenatal diet. c. Suggest that she not eat at fast-food restaurants where the foods are of poor nutritional value. d. Realize that most adolescents are unwilling to make dietary changes during pregnancy.

ANS: B Adolescents have some special nutritional needs during pregnancy, but they also need to feel that they fit in with their peers. Working with the teen to develop a healthy diet while including some snack and fast foods has the best chance of providing good nutrition. Telling the teen to eliminate certain foods or restaurants is likely not to work. Including the teen will make her more willing to make dietary changes.

Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy? a. A 15-year-old of normal height and weight b. A 17-year-old who is 10 pounds underweight c. A 16-year-old who is 10 pounds overweight d. A 16-year-old of normal height and weight

ANS: B All adolescents are at nutritional risk during pregnancy, but the adolescent who is pregnant and underweight is most at risk, because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus.

A nurse teaching a prenatal class is discussing nutrition. What foods does the nurse advise pregnant women to avoid? a. Canned white tuna as a preferred choice b. Shark, swordfish, and mackerel c. Treating fish caught in local waterways as the safest d. High levels of mercury in salmon and shrimp

ANS: B As a precaution against ingesting too much mercury, the pregnant patient should avoid eating all of these as well as the less common tilefish. Six ounces a week of canned albacore tuna is acceptable. Pregnant women should check with local authorities on the safety of eating locally caught fish, but if no advisories are in effect, eating them is fine. Salmon and shrimp are fine too up to 12 ounces a week.

A patient who is in week 28 of gestation is concerned about her weight gain of 1 pound in 1 week. Which response by the nurse is best? a. ―You should try to decrease your amount of weight gain for the next 12 weeks.‖ b. ―You have gained an appropriate amount for the number of weeks of your pregnancy.‖ c. ―You should not gain any more weight until you reach the third trimester.‖ d. ―You have not gained enough weight for the number of weeks of your pregnancy.‖

ANS: B At 28 weeks, a weight gain of 1 pound in 1 week is within the recommended range of 0.8 to 1 pound per week. The woman should be reassured that this is normal and healthy. The other responses are inaccurate.

A pregnant woman in the perinatal clinic is a recovering anorexic. She is distressed at the emphasis on weight gain. The nurse explains that the most important reason for evaluating the pattern of weight gain in pregnancy is to a. prevent excessive adipose tissue deposits. b. identify potential nutritional problems or complications of pregnancy. c. assess if this woman has relapsed. d. determine cultural influences on the woman's diet.

ANS: B Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. The nurse should assure this patient that monitoring weight gain is a routine part of prenatal care to ensure the baby's well-being. Preventing adipose tissue deposits is not the reason for monitoring weight gain. Determining cultural influences on diet and weight gain is important but not the most important reason.

Which statement made by a lactating woman leads the nurse to believe that the woman might have lactose intolerance? a. ―I always have heartburn after I drink milk.‖ b. ―If I drink more than a cup of milk, I get abdominal cramps and bloating.‖ c. ―Drinking milk usually makes me break out in hives.‖ d. ―Sometimes I notice that I have bad breath after I drink a cup of milk.‖

ANS: B One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. The woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn. A woman who breaks out in hives after consuming milk is more likely to have a milk allergy. Bad breath is not a sign of lactose intolerance.

The nurse working with pregnant women understands that anorexia and bulimia are associated with which conditions in the newborn? (Select all that apply.) a. Food cravings b. Low birth weight c. Food aversions d. Electrolyte imbalance e. Small for gestational age infants

ANS: B, D, E These conditions are associated with electrolyte imbalance, low birth weight, and small for gestational age infants. All women should be asked about eating disorders, and nurses should watch for behaviors that may indicate disordered eating. Some women eat normally during pregnancy for the sake of the fetus, but others continue their previous dysfunctional eating patterns during pregnancy or in the early postpartum period. Food cravings and aversions are normal for most women during pregnancy. Women may have a strong preference or strong dislike for certain foods. They're generally not harmful, and some, like aversion to alcohol, may be beneficial.

The nurse is counseling a woman in her third trimester about eating enough protein. If the woman already gets her non-pregnant RDA of protein, how much more does she need in her diet? a. 5 grams/day b. 10 grams/day c. 25 grams/day d. 30 grams/day

ANS: C The current RDA for protein in the non-pregnant woman is 46 grams. To reach the recommendation for protein in the second half of pregnancy (71 grams), the patient needs to add 25 more grams of protein to her diet daily.

A student nurse in the perinatal clinic sees the term ―pica‖ on a woman's chart and asks the registered nurse what this means. What definition is most accurate? a. Intolerance of milk products b. Iron deficiency anemia c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

ANS: C The practice of eating substances not normally thought of as food is called pica. Clay or dirt and solid laundry starch are the substances most commonly ingested. It is not intolerance of milk products, iron deficiency anemia, or episodes of anorexia and vomiting.

A pregnant woman's diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse should be most concerned about this woman's intake of which nutrient? a. Calcium b. Protein c. Vitamin B12 d. Folic acid

ANS: C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12. Depending upon the woman's food choices this diet may be adequate in calcium, protein, and folic acid.

A pregnant woman's diet may not meet her need for folate. The nurse teaches the woman to take how much folate as a supplement each day? a. 100 to 200 mcg b. 200 to 400 mcg c. 400 to 600 mcg d. 400 to 800 mcg

ANS: D The current recommendation for folate (folic acid) is 400 to 800 mcg (0.4 to 0.8 mg) per day.

The nurse teaches a pregnant woman that one danger in using nonfood supplementation of nutrients is a. increased absorption of all vitamins. b. development of pregnancy-induced hypertension (PIH). c. increased caloric intake. d. toxic effects on the fetus.

ANS: D The use of supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some nutrients have been shown to cause fetal defects. Supplements do not have better absorption than natural vitamins and minerals. There is no relationship between supplements and PIH. Supplements do not contain significant calories.

The nurse is teaching a young adolescent pregnant woman about proper diet. The nurse starts by collecting a 24-hour dietary recall. Which statement by the nurse would increase the likelihood of compliance to dietary changes by the woman? "This diet looks good but is low in calcium. Which of these high-calcium foods do you think you could include in your diet?" "This diet is low in calcium and you need to drink more milk. How about one glass for breakfast and one for lunch?" "You must drink more milk. The baby's health may be jeopardized if you don't start taking in more calcium now." "You must not like milk. Let's try eating cheese instead."

CORRECT "This diet looks good but is low in calcium. Which of these high-calcium foods do you think you could include in your diet?" This statement allows the woman to have control over the changes necessary. When she is in control, compliance increases. Statements that belittle the woman or place blame will decrease the likelihood of compliance.

A 27-year-old is in her third trimester. She gives the nurse the following 24-hour dietary recall: Breakfast: 1 cup cereal with 1 cup skim milk, ½ cup orange juice Lunch: 1 ounce ham and 2 slices whole wheat bread and 1 cup yogurt Supper: 3 ounces broiled chicken breast, ½ cup green beans, whole wheat roll Snack: 2 ounces cheese with 8 crackers When comparing this dietary recall with MyPlate, which snacks should the nurse suggest to the woman to meet her dietary deficits? 1 cup cottage cheese with fresh fruit Grilled cheese sandwich Yogurt with walnuts, crackers 2 cups salad greens with 3 ounces lean turkey, broccoli, and kidney beans

CORRECT 2 cups salad greens with 3 ounces lean turkey, broccoli, and kidney beans The woman is low on protein, vitamin A source, and vegetables. The broccoli and dark green salad greens are a good vitamin A source, plus they satisfy the need for vegetables. The turkey and kidney beans satisfy the protein needs. She has taken in more than the three servings of dairy products and whole grains that she needs. She is lacking in fruits and vegetables.

A Native American woman has lactose intolerance. In doing patient teaching, the nurse should instruct the woman to include what foods in her diet to increase calcium intake? She needs to get her calcium requirements through supplementation. Dried pinto beans, dark-green leafy vegetables, nuts Meat, legumes, fresh fruit Milk, yogurt, cheeses

CORRECT Dried pinto beans, dark-green leafy vegetables, nuts Dried pinto beans, dark-green leafy vegetables, and nuts are substitutes for dairy products. The woman will not be able to tolerate milk and dairy products due to her lactose intolerance. Legumes can be used to increase calcium intake, but meat and fresh fruit are poor choices. Calcium supplementation may be necessary, but it is best to first attempt to obtain the woman's needs through dietary intake.

A woman who is 8 weeks' pregnant calls the physician's office complaining of nausea and vomiting in the mornings. Which suggestions by the nurse would be helpful to decrease the nausea and vomiting? (Select all that apply.) Select all that apply. Eat some cheese before bedtime. Drink fluids between meals instead of with meals. Increase the intake of fats in her diet. Eat dry crackers before getting up in the morning.

CORRECT Eat some cheese before bedtime. CORRECT Drink fluids between meals instead of with meals. CORRECT Eat dry crackers before getting up in the morning. Drinking fluids between meals, eating dry carbohydrates before getting up in the morning, and eating a protein snack before bed may help to decrease nausea in the morning. High-fat foods will increase nausea and should be avoided.

A woman from Southeast Asia has been in the United States for 6 months. She just delivered her first child. The nurse notices that the woman does not drink any of the fluids that are offered (ice water, iced tea, and juices) and mentions this concern at the team meeting. The nurse manager states the problem may be cultural and that the woman may consider the postpartum period to be "cold." If this is correct, which fluids may be acceptable to the woman? Sweet tea or sweet juices (such as apple) Sour juices (such as grapefruit) Hot tea, lukewarm or hot water She will not drink any fluids during this time and will need to meet her fluid needs through foods with high water content.

CORRECT Hot tea, lukewarm or hot water Because the postpartum period is "cold," the woman will not drink cold fluids. She may feel this would cause the loss of more heat and would have ill effects on her health. Drinking sour juice or sweet tea does not prevent the loss of heat, which the woman is trying to prevent. Fluids are important during the early postpartum period to prevent or correct dehydration from the labor process. It is important for the nurse to assist the woman to meet her fluid needs without interfering with her cultural beliefs.

To increase her folic acid intake, what snack would be most beneficial for a pregnant woman? Orange juice and fortified cereal Strawberries with bananas Tuna fish salad and tomato Ham sandwich with mustard

CORRECT Orange juice and fortified cereal Both orange juice and fortified cereal are excellent sources of folic acid. Most meats and condiments are not high in folic acid. The bread may have folic acid added if it is enriched. Strawberries, bananas, most meats and tomatoes are not high in folic acid.

A woman has just decided to become a vegetarian and is 7 months' pregnant. The nurse knows that her patient teaching concerning protein foods has been successful when the woman chooses which foods to help satisfy her protein needs? Chicken with rice Green salad with walnuts Fresh fruit salad with almonds Pinto beans with cornbread

CORRECT Pinto beans with cornbread The combination of legumes and grains will give a complete protein that contains all of the essential amino acids. The walnuts are an incomplete protein, and the combination of vegetables will not make them complete. The almonds are an incomplete protein, and the combination of fruits will not make them complete. The chicken is a complete protein but is not included on a vegetarian diet.

In teaching about weight gain during pregnancy, the nurse should include during the third trimester, the pregnant woman should gain about 1 pound of weight per week. a young adolescent pregnant woman should gain less than the recommended weight gain. the woman who is overweight prior to pregnancy should not gain any weight during the pregnancy. the pregnant woman should gain a total of 25 pounds regardless of her beginning weight.

CORRECT during the third trimester, the pregnant woman should gain about 1 pound of weight per week. The pattern of weight gain is as important as the total increase. The general recommendation for the third trimester is 1 pound per week. Weight gain during pregnancy differs according to the beginning weight. A woman who is overweight should gain 15 to 25 pounds; a woman who is underweight should gain 28 to 40 pounds. Weight gain is important during pregnancy even for a woman who is overweight. An adolescent pregnant woman needs to gain weight toward the top end of the recommended weight gains. She needs to provide not only for the fetus but also for her own growth.

A woman has been diagnosed with iron deficiency anemia. The nurse knows that patient teaching about increasing iron intake has been effective if the woman chooses green salad with broccoli, black beans, and strawberries. broiled fish, fried potatoes, and green beans. baked chicken, pinto beans, and iced tea. boiled eggs, whole grain toast, and milk.

CORRECT green salad with broccoli, black beans, and strawberries. Green leafy vegetables and legumes are rich in iron. The strawberries are rich in vitamin C, which increases the absorption of iron. Boiled eggs and whole grain bread are rich in iron, but milk will decrease the absorption of iron and should not be taken at the same time. Meats and legumes are rich in iron; tea will decrease the absorption of iron and should not be taken at the same time. Broiled fish, fried potatoes, and green beans are not rich in iron.

The nurse is admitting a woman to the labor unit. When reviewing the prenatal record, the nurse notices that the woman did not gain the adequate amount of weight that was recommended for her pregnancy. The nurse is aware that the neonate will be at risk for high birth weight. cardiovascular problems. low birth weight. respiratory problems.

CORRECT low birth weight. Low birth weights for the neonate are associated with insufficient weight gain during pregnancy. Respiratory and cardiovascular problems are not associated with insufficient weight gain during pregnancy.