OB Exam #1, Part 4: Ch. 8 (34 questions)

Which guidance related to a healthy diet during pregnancy will the nurse provide to a patient in her 1st trimester? a. "Every day you need to have at least 6 ounces of protein from sources such as meat, fish, eggs, beans, nuts, soybean products, and tofu." b. "High-dose vitamin A supplements will promote optimal vision while preventing a common cause of blindness in neonates." c. "Meals such as sushi with a cold deli salad made with raw sprouts combine high-fiber foods with protein sources to meet multiple nutritional needs." d. "Vitamin and mineral supplements can meet your nutrient needs if you have inadequate intake because of nausea or a sensation of fullness."

a. "Every day you need to have at least 6 ounces of protein from sources such as meat, fish, eggs, beans, nuts, soybean products, and tofu." Protein sources include meat, poultry, fish, eggs, legumes (e.g., beans, peas, lentils), nuts, and soybean products such as tofu. Pregnant women need 6 to 6.5 oz of protein daily. Vitamin A can cause fetal anomalies of the bones, urinary tract, and central nervous system when taken in high doses. Pregnant women should avoid raw fish and foods such as cold deli salads and raw sprouts. Supplements do not generally contain protein and calories and may lack many necessary nutrients; therefore they cannot serve as food substitutes.

The nurse is teaching a pregnant patient about food safety during pregnancy and lactation. Which statements by the patient indicate she understood the teaching? (Select all that apply.) a. "I will limit my intake of shrimp to 12 oz a week." b. "I will avoid the soft cheeses made with unpasteurized milk." c. "I plan to continue to pack my bologna sandwich for lunch." d. "I am glad I can still go to the sushi bar during my pregnancy." e. "I will not eat any swordfish or shark while I am pregnant or nursing."

a. "I will limit my intake of shrimp to 12 oz a week." b. "I will avoid the soft cheeses made with unpasteurized milk." e. "I will not eat any swordfish or shark while I am pregnant or nursing." Statements that indicate the patient understood the teaching are limiting shrimp to 12 oz a week, avoiding soft cheeses, and not eating any swordfish. A bologna sandwich should be avoided unless it is reheated until steaming hot. Raw or undercooked fish should be avoided.

A patient with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the patient gain during the pregnancy? a. 20 lb b. 25 lb c. 28 lb d. 40 lb

a. 20 lb The weight gain for obese women is 5 to 9 kg (11 to 20 lb). A BMI of 30 or higher categorizes the patient as obese. The other options refer to minimal or maximal weight gain for patients in other BMI categories.

A pregnant patient has lactose intolerance. Which recommendation will the nurse provide to best help the patient meet dietary needs for calcium? a. Add foods such as nuts, dried fruit, and broccoli to the diet. b. Consume dairy products but take an over-the-counter anti-gas product. c. Increase the intake of dark leafy vegetables, such as spinach and chard. d. Use powdered milk instead of liquid forms of milk.

a. Add foods such as nuts, dried fruit, and broccoli to the diet. Calcium is present in legumes, nuts, dried fruits, and broccoli, so these foods can be added to increase calcium intake. Although dark leafy vegetables contain calcium, they also contain oxalates that decrease the availability of calcium. Powdered milk contains lactase, similar to the nondehydrated varieties. Milk products should be avoided by patients with lactose intolerance. Adequate calcium may be obtained from food and supplements. Some patients may be able to tolerate lactose free dairy products.

The nurse is teaching a breastfeeding patient about substances to avoid while she is breastfeeding. Which substances should the nurse include in the teaching session? (Select all that apply.) a. Caffeine b. Alcohol c. Omega-6 fatty acids d. Appetite suppressants e. Polyunsaturated omega-3 fatty acids

a. Caffeine b. Alcohol d. Appetite suppressants Foods high in caffeine should be limited. Infants of mothers who drink more than two or three cups of caffeinated coffee or the equivalent each day may be irritable or have trouble sleeping. Although the relaxing effect of alcohol was once thought to be helpful to the nursing mother, the deleterious effects of alcohol are too important to consider this suggestion appropriate today. An occasional single glass of an alcoholic beverage may not be harmful, but larger amounts may interfere with the milk-ejection reflex and may be harmful to the infant. Nursing mothers should avoid appetite suppressants, which may pass into the milk and harm the infant. The long-chain polyunsaturated omega-3 and omega-6 fatty acids are present in human milk. Therefore they should be included in the mother's diet during lactation.

A pregnant woman of normal weight enters her 13th week of pregnancy. If the patient eats and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the remaining trimesters? a. 0.3 lb every week b. 1 lb every week c. 1.8 lb every week d. 2 lb every week

b. 1 lb every week After the first 12 weeks (first trimester), the pregnant woman should gain 0.35 to 0.5 kg (0.8 to 1 lb) per week for the remainder of the pregnancy.

In teaching a pregnant adolescent about nutrition, what should the nurse include in the care plan? a. Determine the weight gain needed to meet adolescent growth and add 35 lb. b. Suggest that she does not eat at fast food restaurants to avoid foods of poor nutritional value. c. Realize that most adolescents are unwilling to make dietary changes during pregnancy. d. Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium.

a. Determine the weight gain needed to meet adolescent growth and add 35 lb. 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. Adolescents are willing to make changes; however, they still need to be like their peers. Eliminating fast foods will make her appear different from her peers. She should be taught to choose foods that add needed nutrients. Changes in the diet should be kept at a minimum and snacks should be included. Snack foods can be included in moderation and other foods added to make up for the lost nutrients.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. Adolescents are willing to make changes; however, they still need to be like their peers. Eliminating fast foods will make her appear different from her peers. She should be taught to choose foods that add needed nutrients. Changes in the diet should be kept at a minimum and snacks should be included. Snack foods can be included in moderation and other foods added to make up for the lost nutrients.

A pregnant patient would like to know which foods, other than dairy products, contain the most calcium. Which food group would the nurse recommend? a. Legumes b. Lean meat c. Whole grains d. Yellow vegetables

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

A patient postdelivery is concerned about getting back to her prepregnancy weight as soon as possible. She had only gained 15 lb during her pregnancy. Which assessment factor would be of concern at her 6-week postpartum checkup? a. Patient has lost 30 lb during the 6-week period prior to her scheduled checkup. b. Patient states that she is eating healthy and limiting intake of processed foods. c. Patient relates increased consumption of fruits and vegetables in her diet postbirth. d. Patient has resumed her usual exercise pattern of walking around the neighborhood for 10 minutes each night.

a. Patient has lost 30 lb during the 6-week period prior to her scheduled checkup. Although a certain amount of weight loss is expected in the postpartum period, the fact that the reported weight loss is double the amount of weight gained during the pregnancy places the patient at risk for malnutrition. Further inquiry is needed. Limiting the intake of processed foods is a healthy dietary alternative to decreasing sodium intake. Increases in fruits and vegetables are a healthy dietary alternative to decrease possible occurrence of hypertension. An exercise program is part of a healthy nutrition approach.

The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can assist a patient increase her intake of these foods by which action? a. Suggest that she eat more tofu, bok choy, and broccoli. b. Suggest that she eat more hot foods during pregnancy. c. Emphasize the need for increased milk intake during pregnancy. d. Tell her husband that she must increase her intake of fruits and vegetables for the baby's sake.

a. Suggest that she eat more tofu, bok choy, and broccoli. The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron. Pregnancy is considered hot; therefore the woman would eat cold foods. Because milk products are not part of this woman's diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. Fruits and vegetables are cold foods and should be included in the diet. In regard to the family dynamics, however, the husband does not dictate to the wife in this culture

Which effect is a common response to both smoking and cocaine use in the pregnant patient? a. Vasoconstriction b. Increased appetite c. Increased metabolism d. Changes in insulin metabolism

a. Vasoconstriction Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism.

The nurse is advising a lactose-intolerant pregnant patient about calcium intake. Which calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.) a. cup yogurt b. 1 cup of sherbet c. oz of hard cheese d. cups of ice cream e. cup of low-fat cottage cheese

a. cup yogurt c. oz of hard cheese d. cups of ice cream Calcium sources approximately equivalent to 1 cup of milk include cup yogurt, ounce of hard cheese, and cups of ice cream. It takes 3 cups of sherbet and cups of low-fat cottage cheese to equal the calcium equivalent of 1 cup of milk.

Which patient is most at risk for a low-birth-weight infant? a. 22-year-old, 60 inches tall, normal prepregnant weight b. 18-year-old, 64 inches tall, body mass index is <18.5 c. 30-year-old, 78 inches tall, prepregnant weight is 15 lb above the norm d. 35-year-old, 75 inches tall, total weight gain in previous pregnancies was 33 lb

b. 18-year-old, 64 inches tall, body mass index is <18.5 The patient who has a low prepregnancy weight is associated with preterm labor and low-birth-weight infants. Women who are underweight should gain more during pregnancy to meet the needs of pregnancy as well as their own need to gain weight; patients who have a normal prepregnancy weight, who start pregnancy overweight, or who have a history of excessive weight gain in pregnancy are not at risk for low-birth-weight infants.

A patient in her fifth month of pregnancy asks the nurse, "How many more calories should I be eating daily?" What is the correct response by the nurse? a. 180 more calories a day b. 340 more calories a day c. 452 more calories a day d. 500 more calories a day

b. 340 more calories a day The increased nutritional needs of pregnancy can be met with an additional 340 calories per day. 180 calories are not enough to meet the increased nutritional needs of pregnancy. 452 calories are more than the recommended calories for pregnancy at this gestation. A patient in her third trimester would increase her energy intake by 452 calories per day. 500 calories are more than the recommended calories for pregnancy.

A pregnant patient asks the nurse if she can double her prenatal vitamin dose because she does not like to eat vegetables. What is the nurse's response regarding the danger of taking excessive vitamins? a. Increases caloric intake b. Has toxic effects on the fetus c. Increases absorption of all vitamins d. Promotes development of pregnancy-induced hypertension (PIH)

b. Has toxic effects on the fetus The use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been linked to fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH.

The nurse is teaching a patient taking prenatal vitamins how to avoid constipation. Which should the nurse plan to include in the teaching session? (Select all that apply.) a. Advise taking a daily laxative for constipation. b. Recommend a diet high in fruits and vegetables. c. Encourage an increase in fluid consumption during the day. d. Increase the intake of whole grains and whole grain products. e. Suggest increasing the intake of dairy products, especially cheeses.

b. Recommend a diet high in fruits and vegetables. c. Encourage an increase in fluid consumption during the day. d. Increase the intake of whole grains and whole grain products. Common sources of dietary fiber include fruits and vegetables (with skins when possible—apples, strawberries, pears, carrots, corn, potatoes with skins, and broccoli), whole grains, and whole grain products—whole wheat bread, bran muffins, bran cereals, oatmeal, brown rice, and whole wheat pasta. Increased intake of fluids can help prevent constipation. A pregnant patient should not take a daily laxative unless prescribed by her health care provider. Increased intake of dairy products, especially cheese, may increase constipation.

When planning a healthy diet with a pregnant patient, what should the nurse's first action be? a. Teach the patient about MyPlate. b. Review the patient's current dietary intake. c. Instruct the patient to limit the intake of fatty foods. d. Caution the patient to avoid large doses of vitamins, especially those that are fat-soluble.

b. Review the patient's current dietary intake. The first action should be to assess the patient's current dietary pattern and practices because instruction should be geared to what she already knows and does. Teaching the food guide MyPlate is important but not the first action when planning a diet with a pregnant patient. Limiting intake of fatty foods is important in a pregnant patient's diet; however, not the first action. Caution regarding about excessive fat-soluble vitamins is important; however, not the first action.

A pregnant patient arrives for her first prenatal visit at the clinic. She informs the nurse that she has been taking an additional 400 mcg of folic acid prior to becoming pregnant. Based on the patient's history, she has reached 8 weeks' gestation. Which recommendation would the nurse provide regarding folic acid supplementation? a. Have the patient continue to take 400 mcg folic acid throughout her pregnancy. b. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins. c. Have the patient increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy. d. Schedule the patient to go for an AFP (alpha-fetoprotein) test.

b. Tell the patient that she no longer has to take additional folic acid because it will be included in her prenatal vitamins. Prenatal vitamins include adequate folic acid supplementation, so patients should not take additional supplementation as long as they continue their prenatal vitamins. During pregnancy, the recommendation is to increase the folic acid intake to 600 mcg. 1000 mcg of folic acid would be an excessive dose. The AFP test should be done at 15 to 18 weeks' gestation. This is not clinically indicated because the patient is at 8 weeks' gestation.

Changes in the diet of the pregnant patient who has phenylketonuria would include a. adding foods high in vitamin C. b. eliminating drinks containing aspartame. c. restricting protein intake to <20 g a day. d. increasing caloric intake to at least 1800 cal/day.

b. eliminating drinks containing aspartame. Use of aspartame by women with phenylketonuria can result in fetal brain damage because these women lack the enzyme to metabolize aspartame. Adding vitamin C, restricting protein, and increasing caloric intake are not necessary for the pregnant patient with phenylketonuria.

A patient at 8 weeks' gestation complains to the nurse, "I feel sick almost every morning. And I throw up at least two or three times a week." What is the nurse's best guidance for this patient? a. "Do you like cheese?" b. "Try eating four meals a day instead of three meals a day." c. "Try eating peanut butter on whole wheat bread right before going to bed." d. "If you can eat enough throughout the day, you don't have to worry about being sick."

c. "Try eating peanut butter on whole wheat bread right before going to bed." Eating a bedtime protein snack helps maintain glucose levels throughout the night. Cheese is high in fat and can aggravate nausea. Small and frequent meals is the optimal recommendation. Four meals a day would not be ideal for a patient experiencing nausea, she needs to eat more frequently. Consumption is not the patient's stated concern—it is the nausea and vomiting.

When explaining the recommended weight gain to your patient, the nurse's teaching should include which statement? a. "All pregnant women need to gain a minimum of 25 to 35 lb." b. "The fetus, amniotic fluid, and placenta require 15 lb of weight gain." c. "Weight gain in pregnancy is based on the patient's prepregnant body mass index." d. "More weight should be gained in the first and second trimesters and less in the third."

c. "Weight gain in pregnancy is based on the patient's prepregnant body mass index." Recommendations for weight gain in pregnancy are based on the woman's prepregnancy weight for her height (body mass index). Depending on the prepregnant weight, recommendation for weight gain may be more or less than 25 to 35 lb. The combination of the fetus, amniotic fluid, and placenta averages about 11 lb in the patient who has a normal BMI. Less weight should be gained in the first trimester, when the fetus needs fewer nutrients for growth, and more in the third trimester, when fetal growth is accelerated.

Which patient has correctly increased her caloric intake from her recommended pregnancy intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months? a. From 1800 to 2200 calories per day b. From 2000 to 2500 calories per day c. From 2200 to 2530 calories per day d. From 2500 to 2730 calories per day

c. From 2200 to 2530 calories per day The increased calories necessary for breastfeeding are 500, with 330 calories coming from increased caloric intake and 170 calories from maternal stores. An increase of 230 calories is insufficient for breastfeeding. An increase of 400 and 500 calories is above the recommended amount.

For the pregnant patient who is a vegan, what combination of foods will the nurse advise to meet the nutritional needs for all essential amino acids? a. Eggs and beans b. Fruits and vegetables c. Grains and legumes d. Vitamin and mineral supplements

c. Grains and legumes Combining incomplete plant proteins with other plant foods that have complementary amino acids allows intake of all essential amino acids. Dishes that contain grains (e.g., wheat, rice, corn) and legumes (e.g., garbanzo, navy, kidney, or pinto beans, peas, peanuts) are combinations that provide complete proteins. Eggs are not consumed by vegans. Fruits and vegetables alone will not provide the essential amino acids. Vitamin and mineral supplements do not provide amino acids.

The nurse is conducting a prenatal nutrition education class for a group of nursing students. Which statement best describes the condition known as pica? a. Iron-deficiency anemia b. Intolerance to milk products c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

c. Ingestion of nonfood substances The practice of eating substances not normally thought of as food is called pica. Clay, dirt, and solid laundry starch are the substances most commonly ingested. Pica may produce iron-deficiency anemia if proper nutrition is decreased. Intolerance to milk products is termed lactose intolerance. Pica is not related to anorexia and vomiting.

A pregnant patient with significant iron-deficiency anemia is prescribed iron supplements. The patient explains to the nurse that she cannot take iron because it makes her nauseous. What is the best response by the nurse? a. "Iron will be absorbed more readily if taken with orange juice." b. "It is important to take this drug regardless of this side effect." c. "Taking the drug with milk may decrease your symptoms." d. "Try taking the iron at bedtime on an empty stomach."

d. "Try taking the iron at bedtime on an empty stomach." Iron taken at bedtime may be easier to tolerate. All the answers are true statements; however, only the option that states that iron taken at bedtime may be easier to tolerate addresses both optimal absorption of iron and alleviation of nausea, which will not be noticeable during sleep. It is true that taking iron with milk will decrease the symptoms; however, it will also decrease absorption.

Which patient would require additional calories and nutrients? a. A 36-year-old female gravida 2, para 1, in her first trimester of pregnancy b. An 18-year-old female who delivered a 7-lb baby and is bottle feeding c. A 23-year-old female who had a cesarean birth and is bottle feeding d. A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding

d. A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding A patient who is breastfeeding will require more calories and nutrients than women who are pregnant. The type of birth has no impact on nutrient intake. A patient who is bottle-feeding does not require additional calories.

The nurse is meeting with a patient with an elevated BMI regarding an optimal diet for pregnancy. Which major source of nutrients should be a significant component of this patient's diet? a. Fats b. Fiber c. Simple sugars d. Complex carbohydrates

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

A pregnant patient's diet may not meet her need for folate. Which food choice is an excellent source of this nutrient? a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables

d. Green leafy vegetables Sources of folate include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken is a good source of protein, but poor in folate. Cheese is an excellent source of calcium, but poor in folate. Potatoes contain carbohydrates and vitamins but are poor in folate.

Which is the most important reason for evaluating the pattern of weight gain in pregnancy? a. Prevents excessive adipose tissue deposits b. Determines cultural influences on the woman's diet c. Assesses the need to limit caloric intake in obese women d. Identifies potential nutritional problems or complications of pregnancy

d. Identifies potential nutritional problems or complications of pregnancy Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. Excessive adipose tissue may occur with excess weight gain but is not the reason for monitoring the weight gain pattern. The pattern of weight gain is not affected by cultural influences. It is important to monitor the pattern of weight gain for the developing complications.

To determine cultural influences on a patient's diet, what is the nurse's primary action? a. Evaluate the patient's weight gain during pregnancy. b. Assess the socioeconomic status of the patient. c. Discuss the four food groups with the patient. d. Identify the food preferences and methods of food preparation common to the patient's culture.

d. Identify the food preferences and methods of food preparation common to the patient's culture. Understanding the patient's food preferences and how she prepares food will assist the nurse in determining whether the patient's culture is adversely affecting her nutritional intake. Evaluating a patient's weight gain during pregnancy should be included for all patients, not just for those who are culturally different. The socioeconomic status of the patients may alter the nutritional intake, but not the cultural influence. Teaching the food groups to the patient should come after assessing food preferences.

When should iron supplementation during a normal pregnancy begin? a. Before pregnancy b. In the first trimester c. In the third trimester d. In the second trimester

d. In the second trimester Vitamin supplements should be prescribed in the second trimester, when the need for iron is increased. Healthy young women do not usually need iron supplementation for their diets. Morning sickness in the first trimester increases the routine side effects of iron supplements. The iron supplements may continue to be prescribed in the third trimester and during the postpartum period.

Which clinical finding is associated with inadequate maternal weight gain during pregnancy? a. Prolonged labor b. Preeclampsia c. Gestational diabetes d. Low-birth-weight infant

d. Low-birth-weight infant Inadequate maternal weight gain during pregnancy can manifest in the birth of a low-birth-weight infant. Prolonged labor and gestational diabetes are associated with excess weight gain during pregnancy. Preeclampsia is based on maternal hypertension, proteinuria, and edema states.

In order to increase the absorption of iron by a pregnant patient, which beverage should an iron preparation be given with? a. Tea b. Milk c. Coffee d. Orange juice

d. Orange juice Vitamin C source may increase the absorption of iron and would be the optimal choice. Tannin in the tea reduces the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Decreased intake of caffeine is recommended during pregnancy.

The nurse is reviewing a list of foods high in folic acid with a patient who is considering becoming pregnant. The nurse determines that the patient understands the teaching when the patient states she will include which list of foods in her diet? a. Peaches, yogurt, and tofu b. Strawberries, milk, and tuna c. Asparagus, lemonade, and chicken breast d. Spinach, orange juice, and fortified bran flakes

d. Spinach, orange juice, and fortified bran flakes Prepregnant, the recommendation for folic acid is 800 mcg. Foods high in folic acid are dark green leafy vegetables, legumes (beans, peanuts), orange juice, asparagus, spinach, and fortified cereal and pasta. In the United States, folic acid is added to orange juice and wheat-based products.