olds Maternity Ch. 11 13,14,

7) In early-pregnancy class, the nurse emphasizes the importance of 8-10 glasses of fluid per day. How many of these should be water? A) 1 to 2 B) 2 to 4 C) 4 to 6 D) 3 to 5

A) Answer: C Explanation: A) One to two glasses of water is not an adequate intake. B) Two to four glasses of water is not an adequate intake. C) A pregnant woman should consume at least 8 to 12 (8 oz) glasses of fluid each day, of which 4 to 6 glasses should be water. D) Three to five glasses of water is not an adequate intake.

19) The kosher diet followed by many Jewish people forbids the eating of what foods? A) Pig products and shellfish B) Dairy products C) All animal products D) Dairy products and eggs

A) The kosher diet followed by many Jewish people forbids the eating of pig products and shellfish. Certain cuts of meat from sheep and cattle are allowed, as are fish with fins and scales. In addition, many Jews believe that meat and dairy products should not be mixed or eaten at the same meal. B) Lacto-vegetarian diets include dairy products but no eggs. C) Vegans are strict vegetarians who will not eat any food from animal sources. Lacto-ovo-vegetarians include milk, dairy products, and eggs in their diet, but no meat

1) The nurse is preparing material to present to a group of patients in the second trimester of their pregnancies. Which topics should the nurse include in this presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Clothing 2. Infant feeding 3. Fetal movement 4. Exercise and rest 5. Skin and breast care

Answer: 1, 2, 3, 5 Explanation: Topics appropriate to teach patients in the second trimester of pregnancy include clothing, infant feeding, fetal movement, and skin and breast care. Exercise and rest are topics to be reviewed during the first and third trimesters

1) After teaching a pregnant client about the effects of smoking on pregnancy, the nurse knows that the client needs further education when she makes which statement? A) "I am at increased risk for preeclampsia." B) "I am at increased risk for preterm birth." C) "I am at increased risk for placenta previa." D) "I am at increased risk for abruptio placentae."

Answer: A Explanation: A) Smoking is not associated with increased risk for preeclampsia. B) Smoking is associated with increased risk for preterm birth. C) Smoking is associated with increased risk for placenta previa. D) Smoking is associated with increased risk for abruptio placentae.

31) A patient asks if seafood is permitted during pregnancy. Which foods should the nurse encourage the patient to consume during this time? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Shrimp 2. Catfish 3. Salmon 4. Swordfish 5. Canned light tuna

Answer: 1, 2, 3, 5 Explanation: Women who are pregnant or who may become pregnant, breastfeeding mothers, and young children should not eat swordfish, shark, tilefish, or king mackerel because these fish contain high levels of methyl mercury. Commonly eaten fish that are low in mercury include canned light tuna, shrimp, salmon, catfish, and pollack. Albacore (white) tuna has more mercury than canned light tuna; therefore, only 6 oz. / week of albacore tuna is recommended.

1) A patient in the first trimester of pregnancy is experiencing ptyalism. What should the nurse suggest to help this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Use chewing gum 2. Suck on hard candy 3. Snack on soda crackers 4. Use an astringent mouthwash 5. Brush the teeth with baking soda

Answer: 1, 2, 4 Explanation: Ptyalism is a rare discomfort of pregnancy in which excessive, often bitter, saliva is produced. Its cause has not been established. Effective treatments are limited, however using astringent mouthwashes, chewing gum, or sucking on hard candy may minimize the problem. Many women also choose to carry tissues or a small towel to spit into when necessary. Soda crackers and brushing the teeth with baking soda are not identified as helpful with ptyalism.

1) A pregnant patient in the early stages of labor asks for assistance to sit in the whirlpool tub. What are the advantages of using this intervention for the laboring patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Increases relaxation 2. Increases pain threshold 3. Reduces postural hypotension 4. Promotes maternal-infant bonding 5. Reduces the need for pain medication

Answer: 1, 2, 5 Explanation: The benefits of using a whirlpool tub during labor include increased relaxation, increased pain threshold, and reduced need for pain medication. The whirlpool tub will not reduce postural hypotension. Breastfeeding promotes maternal-infant bonding.

1) The nurse learns that a patient who is 8 weeks pregnant continues to smoke 10 cigarettes a day. In which order should the nurse provide a 5 to 15 minute intervention about smoking with this patient? 1. Ask about tobacco use 2. Advise to quit smoking 3. Assist in attempt to quit 4. Arrange for follow-up care 5. Assess willingness to quit

Answer: 1, 2, 5, 3, 4 Explanation: A C O G suggests that a 5- to 15-minute intervention with women who smoke fewer than 20 cigarettes a day is most effective. This program and other programs encourage healthcare providers to use the five As: ask about tobacco use; advise to quit smoking; assess willingness to quit; assist in attempt to quit; and arrange for follow-up care.

28) A patient who is 12 weeks pregnant is counseled to increase her protein intake by an additional 40 grams per day. If each gram of protein is 4 calories, how many additional calories per day should this patient ingest to reach the recommended 300 calories more per day during the pregnancy?

Answer: 140 calories Explanation: The additional protein provides 160 calories (40 grams × 4 = 160). If the total increase in daily calories is to be 300 calories, then subtract 160 calories for the extra protein from 300 or 300 — 160 = 140 calories.

28) Before becoming pregnant, a patient had a B M I of 28.5 and weighed 150 l b s. What should be the minimum weight of this patient upon delivery?

Answer: 165 l b s. Explanation: For a patient who is overweight, the total weight gain during pregnancy should be between 15 and 25 l b s. The minimum weight of this patient upon delivery should be 165 l b s.

30) The nurse is instructing a pregnant patient on the importance of increasing her dietary intake of vitamin E. Which foods should the nurse recommend to meet this dietary need? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Milk 2. Eggs 3. Liver 4. Green salads 5. Whole grain bread

Answer: 2, 4, 5 Explanation: Vitamin E is widely distributed in foodstuffs, especially vegetable fats and oils, whole grains, greens, and eggs. Milk and liver are good sources of vitamin A.

32) A breastfeeding mother is instructed to increase her daily caloric intake an additional 500 calories each day. If her daily intake of protein is 65 grams at 4 calories per gram, how many calories will this patient need to ingest to reach the recommended daily intake?

Answer: 240 calories Explanation: The amount of calories ingested with the protein is 65 grams × 4 calories or 260 calories. To reach the recommended daily caloric increase of 500 calories, subtract 260 from 500 or 500 — 260 = 240 calories.

16) The nurse is planning an educational session for pregnant vegans. What information should the nurse include? A) Eating beans and rice provides complete protein needs. B) Soy is not a good source of protein for vegans. C) Rice contains a high level of vitamin B12. D) Vegan diets are excessively high in iron.

Answer: A Explanation: A) Adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. Consuming an assortment of plant proteins throughout the day such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk ensures that the expectant mother obtains all essential amino acids. B) Good sources of plant proteins include beans, soy products, lentils, nuts, and nut butters. C) Vitamin B12 is the cobalt-containing vitamin found only in animal sources. D) Supplementation may be recommended for vegans who have difficulty meeting the recommended amounts of iron through food sources.

13) A pregnant client who was of normal pre-pregnancy weight is now 30 weeks pregnant. She asks the nurse what appropriate weight gain for her should be. What is the nurse's best response? A) "25-35 pounds" B) "30-40 pounds" C) "17-18 pounds" D) "Less than 15 pounds"

Answer: A Explanation: A) An appropriate weight gain for a woman of normal weight before pregnancy would be 25-35 pounds. B) This is not the correct range for woman of normal weight before pregnancy. C) This is not the correct range for woman of normal weight before pregnancy. D) A woman of normal weight before pregnancy should gain more than 15 pounds by 30 weeks.

22) Which statement is best to include when teaching a pregnant adolescent about her nutritional needs in pregnancy? A) "It is important to eat iron-rich foods like meat every day." B) "Calcium and milk aren't needed until the third trimester." C) "Folic acid intake is the key to having a healthy baby." D) "You just need to pay attention to what you eat now."

Answer: A Explanation: A) An inadequate iron intake is a major concern with the adolescent diet. Iron needs are high for the pregnant teen because of the requirement for iron by the enlarging maternal muscle mass and blood volume. Giving specific examples is helpful when giving nutritional information. B) Calcium is needed throughout pregnancy, and should be consumed daily. C) Although folic acid is important during pregnancy to prevent neural tube defects, and for lactation, there is no single nutritional element responsible for having a healthy baby. D) This response is too vague to be helpful. Adolescents will need specific information to improve nutrition during pregnancy.

5) The nurse is presenting a preconception counseling class. The nurse instructs the participants that niacin intake should increase during pregnancy to promote metabolic coenzyme activity. The nurse will know that teaching has been effective if a client suggests which food as a source of niacin? A) Fish B) Apples C) Broccoli D) Milk

Answer: A Explanation: A) Dietary sources of niacin include meats, fish, and whole grains. B) Apples are a source of other vitamins; however, they do not contain significant niacin. C) Broccoli is a source of other vitamins; however, it does not contain significant niacin. D) Milk is a source of other vitamins; however, it does not contain significant niacin.

1) A 38-year-old client in her second trimester states a desire to begin an exercise program to decrease her fatigue. What is the most appropriate nursing response? A) "Fatigue should resolve in the second trimester, but walking daily might help." B) "Avoid a strenuous exercise regimen at your age. Drink coffee to combat fatigue." C) "Avoid an exercise regimen due to your pregnancy. Try to nap daily." D) "Fatigue will increase as pregnancy progresses, but running daily might help."

Answer: A Explanation: A) Even mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred. B) The age of 38 is not too old to begin an exercise routine. Nurses should advise women of common sources of caffeine, including coffee, tea, colas, and chocolate and suggest they limit their caffeine intake to about 300 m g/day. C) Mild to moderate exercise is beneficial during pregnancy. Scheduling activities to allow for napping is helpful. D) Jogging or running is acceptable for women already conditioned to these activities, as long as they avoid exercising at maximum effort and overheating.

15) The prenatal clinic nurse is caring for a 15-year-old client who is at 8 weeks' gestation. The client asks the nurse why she is supposed to gain so much weight. What is the best response by the nurse? A) "Gaining 25-35 pounds is recommended for healthy fetal growth." B) "It's what your certified nurse-midwife recommended for you." C) "Inadequate weight gain delays lactation after delivery." D) "Weight gain is important to ensure that you get enough vitamins."

Answer: A Explanation: A) For an appropriate-weight woman, 25-35 pounds of weight gain is recommended for optimal fetal growth and development. B) Although this statement might be true, the client has asked a "why" question that should be directly answered. C) Inadequate weight gain can lead to decreased fetal growth and development. D) Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet may not be optimal from a nutritional standpoint.

25) The nurse is preparing a prenatal class about infant feeding methods. The maternal nutritional requirements for breastfeeding and formula-feeding will be discussed. What statement should the nurse include? A) "Breastfeeding requires a continued high intake of protein and calcium." B) "Formula-feeding mothers should protect their health with a lot of calcium." C) "Producing breast milk requires calories, but any source of food is fine." D) "Formula-feeding mothers need a high protein intake to avoid fatigue."

Answer: A Explanation: A) Lactation requires calories, along with increased protein and calcium intake. B) Formula-feeding mothers do not need additional nutrients. C) Although any food source would provide the additional calories, an adequate protein intake is essential while breastfeeding because protein is an important component of breast milk and calcium is an important nutrient in milk production, and increases over non-pregnancy needs are expected. D) Formula-feeding moms do not need additional nutrients.

1) The primiparous client has told the nurse that she is afraid she will develop hemorrhoids during pregnancy because her mother did. Which statement would be best for the nurse to make? A) "It is not unusual for women to develop hemorrhoids during pregnancy." B) "Most women don't have any problem until after they've delivered." C) "If your mother had hemorrhoids, you will get them, too." D) "If you get hemorrhoids, you probably will need surgery to get rid of them."

Answer: A Explanation: A) Many pregnant women will develop hemorrhoids. Hemorrhoids are varicosities of the veins in the lower end of the rectum and anus. During pregnancy, the gravid uterus presses on the veins and interferes with venous circulation. As the pregnancy progresses, the straining that accompanies constipation can contribute to the development of hemorrhoids. B) It is not true that most women have no hemorrhoids until after the birth. Many women develop hemorrhoids during pregnancy. C) A family history does not automatically mean that a client will develop the condition. D) Hemorrhoids that occur in pregnancy or at birth usually become asymptomatic after the early postpartum period.

1) A Navajo client who is 36 weeks pregnant meets with a traditional healer as well as her physician. What does the nurse understand this to mean? A) The client is seeking spiritual direction. B) The client does not trust her physician. C) The client will not adapt well to mothering. D) The client is experiencing complications of pregnancy.

Answer: A Explanation: A) Navajo clients are aware of the mind-soul connection, and might try to follow certain practices to have a healthy pregnancy and birth. Practices could include focus on peace and positive thoughts as well as certain types of prayers and ceremonies. A traditional healer may assist them. B) Seeing a traditional healer does not indicate mistrust of the provider. C) Seeking a spiritual healer does not indicate the client's lack of parenting ability. D) Seeking a spiritual healer does not indicate any type of pathology or complications.

11) The nurse is preparing for a postpartum home visit. The client has been home for a week, is breastfeeding, and experienced a third-degree perineal tear after vaginal delivery. The nurse should assess the client for which of the following? A) Dietary intake of fiber and fluids B) Dietary intake of folic acid and prenatal vitamins C) Return of hemoglobin and hematocrit levels to baseline D) Return of protein and albumin to predelivery levels

Answer: A Explanation: A) This mother needs to avoid the risk of constipation. She might be hesitant to have a bowel movement due to anticipated pain from the perineal tear, and constipation will decrease the healing of the laceration. B) Dietary intake of prenatal vitamins is important while breastfeeding, but folic acid is more important prior to conception and in the first weeks of pregnancy to prevent neural tube defects. C) It will take several months for the laboratory levels to return to normal. It will take several months for the laboratory levels to return to normal

5) The nurse evaluates the diet of a pregnant client and finds that it is low in zinc. The nurse knows that zinc intake should increase during pregnancy to promote protein metabolism. Which food should the nurse suggest in order to increase intake of zinc? A) Shellfish B) Bananas C) Yogurt D) Cabbage

Answer: A Explanation: A) Zinc is found in greatest concentration in meats, shellfish, and poultry. Other good sources include whole grains and legumes. B) Bananas are high in other nutrients, but do not have significant levels of zinc. C) Yogurt is high in other nutrients, but does not have significant levels of zinc. D) Cabbage is high in other nutrients, but does not have significant levels of zinc.

1) What self-care measures would a nurse recommend for a client in her first trimester to reduce the discomfort of nausea and vomiting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Avoid odors or causative factors. B) Have small but frequent meals. C) Drink carbonated beverages. D) Drink milk before arising in the morning. E) Eat highly seasoned food.

Answer: A, B, C Explanation: A) The nurse would recommend for a client in her first trimester to avoid odors and causative factors to reduce the discomfort of nausea and vomiting. B) The nurse would recommend for a client in her first trimester to have small but frequent meals to reduce the discomfort of nausea and vomiting. C) The nurse would recommend for a client in her first trimester to drink carbonated beverages to reduce the discomfort of nausea and vomiting. D) The nurse would recommend for a client in her first trimester to eat dry crackers or toast before arising in the morning to reduce the discomfort of nausea and vomiting. E) The nurse would recommend for a client in her first trimester to avoid greasy or highly seasoned foods to reduce the discomfort of nausea and vomiting.

1) The prenatal period should be used to expose the prospective parents to up-to-date, evidence-based information about which of the following topics? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Breastfeeding B) Pain relief C) Obstetric complications and procedures D) Toddler care E) Antepartum adjustment

Answer: A, B, C Explanation: A) The prenatal period should expose prospective parents to up-to-date, evidence-based information about breastfeeding. B) The prenatal period should expose prospective parents to up-to-date, evidence-based information about pain relief. C) The prenatal period should expose prospective parents to up-to-date, evidence-based information about obstetric complications and procedures. D) The prenatal period should expose prospective parents to up-to-date, evidence-based information about normal newborn care. E) The prenatal period should expose prospective parents to up-to-date, evidence-based information about postpartum adjustment.

4) The nurse is planning an early-pregnancy class session on nutrition. Which information should the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Protein is important for fetal development. B) Iron helps both mother and baby maintain the oxygen-carrying capacity of the blood. C) Calcium prevents constipation at the end of pregnancy. D) Zinc facilitates synthesis of R N A and D N A. E) Vitamin A promotes development of the baby's eyes.

Answer: A, B, D, E Explanation: A) During pregnancy, the woman needs increased amounts of protein to provide amino acids for fetal development. B) Iron deficiency anemia is associated with an increased incidence of preterm birth, low-birth-weight infants, and maternal and infant mortality. C) Calcium is not related to constipation. Calcium is involved in the mineralization of fetal bones and teeth, energy and cell production, and acid-base buffering. D) Zinc is involved in R N A and D N A synthesis, and milk production during lactation. E) Vitamin A promotes healthy formation and development of the fetal eyes.

1) Remedies for back pain in pregnancy that are supported by research evidence and may safely be taught to any pregnant woman by the nurse include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Pelvic tilt B) Water aerobics C) Sit-ups D) Proper body mechanics E) Good posture is important because it allows more room for the stomach to function.

Answer: A, B, D, E Explanation: A) The pelvic tilt can help restore proper body alignment and relieve back pain. B) Exercise is an effective treatment for lower back pain. Exercise in water seems to provide benefits while being physically comfortable for expectant mothers. C) Sit-ups require back-lying. Because of the pressure of the enlarging uterus on the vena cava, the woman should not lie flat on her back after about the fourth month. D) The use of proper posture and good body mechanics throughout pregnancy is important. E) Good posture is important because it allows more room for the stomach to function.

3) The pregnant client states she does not want "to take all these supplements." What recommendations could the nurse make for the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Folic acid has been found to be essential for minimizing the risk of neural tube defects." B) "You do not have to take these supplements if you think you are healthy enough." C) "Most women do not have adequate intake of iron pre-pregnancy, and iron needs increase with pregnancy." D) "These medications do the same thing. I will call your physician to cancel one of your medications." E) "You should take the folic acid, but the vitamins are not that important."

Answer: A, C Explanation: A) An inadequate intake of folic acid has been associated with neural tube defects (N T Ds) (e.g., spina bifida, anencephaly). B) This answer is incorrect because prenatal vitamins with iron and folic acid are necessary. C) Iron is essential because many pregnant women do not have adequate intake of iron before pregnancy. D) It is not the nurse's role to tell the physician to cancel any prescribed medication. E) Both folic acid and other vitamins and minerals are necessary for a successful pregnancy and a healthy baby.

9) Postpartum nutritional status is determined primarily by assessing which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Dietary history B) Menstrual history C) Mother's weight D) Hemoglobin levels E) Mother's height

Answer: A, C, D Explanation: A) Postpartum nutritional status is determined by assessing the new mother's dietary history. B) Postpartum nutritional status is not determined by assessing the new mother's menstrual history. C) Postpartum nutritional status is determined by assessing the new mother's weight. D) Postpartum nutritional status is determined by assessing the new mother's hemoglobin levels. E) Postpartum nutritional status is not determined by assessing the new mother's height.

26) Women with eating disorders who become pregnant are at risk for a variety of complications including which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Premature birth B) Too many nutrients available for the fetus C) Miscarriage D) High birth weight E) Perinatal mortality

Answer: A, C, E Explanation: A) Risks to the mother and baby include premature birth. B) Risks to the mother and baby include lack of nutrients available for the fetus. C) Risks to the mother and baby include miscarriage. D) Risks to the mother and baby include low birth weight. E) Risks to the mother and baby include perinatal mortality.

24) The pregnant teen who was prescribed prenatal vitamins at her initial prenatal visit states that she does not like to take them. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Folic acid has been found to be essential for minimizing the risk of neural tube defects." B) "You do not have to take these supplements if you think you are healthy enough." C) "These medications do the same thing. I will call your doctor to cancel one of your medications." D) "You can trust your doctor to know what you need." E) "You need the supplements because your dietary intake may not be adequate for fetal development."

Answer: A, E Explanation: A) The C D C estimates that most neural tube defects could be prevented if women followed folic acid supplementation recommendations before they became pregnant. B) One role of the nurse is educator, and this client needs additional information on why she needs the supplements. C) One role of the nurse is educator, and this client needs additional information on why she needs the supplements. D) Therapeutic communication requires addressing the client's concern. One role of the nurse is educator, and this client needs additional information on why she needs the supplements. E) One role of the nurse is educator, and this client needs additional information on why she needs the supplements. This response answers the client's concerns.

12) Which of the following is important for the development of the central nervous system of the fetus? A) Calcium and phosphorus B) Essential fatty acids C) Iron D) Vitamin D

Answer: B Explanation: A) Calcium and phosphorus are involved in the mineralization of fetal bones and teeth, energy and cell production, and acid-base buffering. B) Essential fatty acids are important for the development of the central nervous system of the fetus. Of particular interest are the omega-3 fatty acids and their derivatives. C) Iron requirements increase during pregnancy because of the growth of the fetus and placenta and the expansion of maternal blood volume. D) Vitamin D is known for its role in the absorption and utilization of calcium and phosphorus in skeletal development.

23) The school nurse is planning a class about nutrition for pregnant teens, several of whom have been diagnosed with iron-deficiency anemia. In order to increase iron absorption, the nurse would encourage the teens to consume more of what beverage? A) Gatorade B) Orange juice C) Milk D) Green tea

Answer: B Explanation: A) Gatorade does not contain vitamin C, which increases iron absorption. B) Vitamin C is found in citrus fruits and juices, and is known to enhance the absorption of iron from meat and non-meat sources. C) Milk does not contain vitamin C, which increases iron absorption. D) Green tea does not contain vitamin C, which increases iron absorption.

8) What would the nurse do to accurately assess a pregnant client's food intake? A) Assess her most recent laboratory values. B) Ask her to complete a nutritional questionnaire. C) Observe for signs of hunger. D) Ask about her cooking facilities.

Answer: B Explanation: A) Laboratory values may provide information on the nutritional status of the client, but do not indicate what foods she has eaten. B) Diet may be evaluated using a food frequency questionnaire, which lists common categories of foods and asks the woman how frequently in a day (or week) she consumes foods from the list. C) Hunger alone is not an adequate indicator of nutritional status. D) Cooking facilities are not related to food intake.

1) The nurse is preparing a class for expectant fathers. Which information should the nurse include? A) Siblings adjust readily to the new baby. B) Sexual activity is safe for normal pregnancy. C) The expectant mother decides the feeding method. D) Fathers are expected to be involved in labor and birth.

Answer: B Explanation: A) Siblings often have difficulty adapting to the arrival of a new baby. Parents who are unprepared for the older child's feelings of anger, jealousy, and rejection may respond inappropriately in their confusion and surprise. B) In a healthy pregnancy, there is no medical reason to limit sexual activity. C) Often, the father wants input in deciding on the feeding method. D) In some cultures, the father is not present at birth. The nurse should recognize the importance of birth practices that are part of a family's tradition and honor these practices when possible.

14) A client presents to the antepartum clinic with a history of a 20-pound weight loss. Her pregnancy test is positive. She is concerned about gaining the weight back, and asks the nurse if she can remain on her diet. What is the nurse's best response? A) "As long as you supplement your diet with the prenatal vitamin, the amount of weight you gain in pregnancy is not significant." B) "I understand that gaining weight after such an accomplishment might not appeal to you but weight gain during pregnancy is important for proper fetal growth." C) "Dieting during pregnancy is considered child neglect." D) "Excessive weight gain in pregnancy is due to water retention, so weight loss following birth will not be an issue."

Answer: B Explanation: A) Supplementation with vitamins is important, but so is maintaining weight gain within the expected parameters. B) Maternal weight gain is an important factor in fetal growth and in infant birth weight. An adequate weight gain over time indicates an adequate caloric intake. Child neglect can apply only after the child is born D) Weight gain during pregnancy typically is not water-related. Excess weight gain can be difficult to lose.

27) Carbohydrates provide the body's primary source of energy as well as fiber necessary for proper bowel functioning. If the carbohydrate intake is not adequate, the body will use which of the following for energy? A) Iron B) Protein C) Vitamin C D) Vitamin D

Answer: B Explanation: A) The body would not use iron as a source of energy. B) If the carbohydrate intake is not adequate, the body uses protein for energy. Protein then becomes unavailable for growth needs. C) A major function of vitamin C is to aid the formation and development of connective tissue and the vascular system. D) Vitamin D is best known for its role in the absorption and utilization of calcium and phosphorus in skeletal development.

10) The breastfeeding mother is concerned that her milk production has decreased. The nurse knows that further client teaching is needed based on which statement? A) "I am drinking a minimum of 8 to 10 glasses of liquid a day." B) "I have started cutting back on my protein intake." C) "At least three times a day, I drink a glass of milk." D) "My calorie intake is higher than during the pregnancy."

Answer: B Explanation: A) The breastfeeding mother must consume a minimum of 8 to 10 glasses of liquid per day. B) An adequate protein intake is essential while breastfeeding because protein is an important component of breast milk. C) The breastfeeding mother must increase her protein and calcium intake. D) An inadequate caloric intake can reduce milk volume. Breastfeeding mothers should increase their caloric intake by 200 kcal over the pregnancy requirements.

1) The pregnant client has asked the nurse what kinds of medications cause birth defects. Which statement would best answer this question? A) "Birth defects are very rare. Don't worry; your doctor will watch for problems." B) "To be safe, don't take any medication without talking to your doctor." C) "Too much vitamin C is one of the most common issues." D) "Almost all medications will cause birth defects in the first trimester."

Answer: B Explanation: A) The nurse should avoid giving a "don't worry" answer to ensure therapeutic communication, but it is appropriate to instruct the client to check with her caregiver about medications. B) The nurse should remind the client of the need to check with her caregiver about medications. If a woman has taken a drug in category D or X, she should be informed of the risks associated with that drug and of alternatives. C) Vitamin C is cited as a category A drug, as long as its use does not exceed the recommended dietary allowance. It has demonstrated no associated fetal risk. D) Not all medications are teratogenic.

1) A Chinese woman who is 12 weeks pregnant reports to the nurse that ginseng and bamboo leaves help reduce her anxiety. How should the nurse respond to this client? A) Advise the client to give up the bamboo leaves but to continue taking ginseng. B) Advise the client to discuss all herbal remedies with the provider. C) Tell the client that the provider thinks the remedies have no scientific foundation. D) Assess where the client obtains her remedy, and investigate the source.

Answer: B Explanation: A) The nurse should find out what medications and home remedies the client is using, and counsel the client regarding overall effects. B) The nurse should advise the client to discuss all medications (including herbal supplements) with the health care provider. C) It is not appropriate to tell the client that the provider thinks the remedies have no scientific foundation. D) It is outside the nurse's scope to assess the source of the herbs.

1) A pregnant client who swims 3-5 times per week asks the nurse whether she should stop this activity. What is the appropriate nursing response? A) "You should decrease the number of times you swim per week." B) "Continuing your exercise program would be beneficial." C) "You should discontinue your exercise program immediately." D) "You should consider a less strenuous type of exercise."

Answer: B Explanation: A) There is no need to decrease the number of times the client swims per week, because mild to moderate exercise is beneficial during pregnancy. B) Mild to moderate exercise is beneficial during pregnancy. Regular exercise-at least 30 minutes of moderate exercise daily or at least most days of the week-is preferred. C) Non-weight-bearing exercises, such as swimming or cycling, are recommended because they decrease the risk of injury and provide fitness with comfort. D) A moderate, rhythmic exercise routine involving large muscle groups such as swimming, cycling, or brisk walking is best.

1) A pregnant teenage client is diagnosed with iron-deficiency anemia. Which nutrient should the nurse encourage her to take to increase iron absorption? A) Vitamin A B) Vitamin C C) Vitamin D D) Vitamin E

Answer: B Explanation: A) While vitamin A is good for the body, it does not promote the absorption of iron. B) Vitamin C is known to enhance the absorption of iron from meat and nonmeat sources. C) While vitamin D is good for the body, it does not promote the absorption of iron. D) While vitamin E is good for the body, it does not promote the absorption of iron.

1) Absolute contraindications to exercise while pregnant include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Abruptio placentae B) Placenta previa after 26 weeks' gestation C) Preeclampsia-eclampsia D) Cervical insufficiency (cerclage) E) Intrauterine growth restriction (I U G R)

Answer: B, C, D Explanation: A) Abruptio placentae is not an absolute contraindication to exercise. B) Placenta previa after 26 weeks' gestation is an absolute contraindication to exercise. C) Preeclampsia-eclampsia is an absolute contraindication to exercise. D) Cervical insufficiency (cerclage) is an absolute contraindication to exercise. E) Intrauterine growth restriction (I U G R) is not an absolute contraindication to exercise.

17) A pregnant client who is a lacto-vegetarian asks the nurse for assistance with her diet. What instruction should the nurse give? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "Protein is important; therefore, the addition of one serving of meat a day is necessary." B) "A daily supplement of vitamin B12 is important." C) "The high fiber in a vegetarian diet is dangerous for pregnant women." D) "Eggs are important to add to your diet. Eat six eggs per week." E) "Milk products contain protein, but they are very low in iron."

Answer: B, E Explanation: A) Lacto-vegetarians do not eat meat, meat by-products, or eggs, and the nurse should not force this issue. Most vegetables must be combined with another food to form complete proteins. B) Supplementation may be recommended for vegans who have difficulty meeting the recommended amounts of vitamin B12 through food sources. C) The high fiber found in vegetarian diets actually is good for the pregnant woman who may be suffering from constipation. D) Lacto-vegetarians do not eat meat, meat by-products, or eggs, and the nurse should not force this issue. Most vegetables must be combined with another food to form complete proteins. E) Milk products will provide needed protein, but are not significant sources of iron.

18) A pregnant client confides to the nurse that she is eating laundry starch daily. The nurse should assess the client for which of the following? A) Alopecia B) Weight loss C) Iron deficiency anemia D) Fecal impaction

Answer: C Explanation: A) Alopecia, a condition that causes hair loss, is not associated with eating laundry starch. B) Weight gain is related to the client's eating laundry starch. C) Iron deficiency anemia is the most common concern with pica. The ingestion of laundry starch or certain types of clay may contribute to iron deficiency by replacing iron-containing foods from the diet or by interfering with iron absorption. D) Fecal impaction is associated with the eating of clay, not laundry starch.

1) The pregnant client in her second trimester states, "I didn't know my breasts would become so large. How do I find a good bra?" The best answer for the nurse to give would be which of the following? A) "Avoid cotton fabrics and get an underwire bra; they fit everyone best." B) "Just buy a bra one cup size bigger than usual, and it will fit." C) "Look for wide straps and cups big enough for all of your breast tissue." D) "There isn't much you can do for comfort. Try not wearing a bra at all."

Answer: C Explanation: A) Cotton is comfortable during pregnancy when perspiration increases, because it does not retain heat and moisture. B) The client should be fitted for a well-fitting, supportive bra of an appropriate size. C) The nurse should instruct the client to get a bra that fits with straps that are wide and do not stretch, and a cup that holds all breast tissue comfortably. D) One can obtain a bra that fits and is comfortable. It is not necessary to be uncomfortable.

1) The nurse is teaching an early pregnancy class for clients in the first trimester of pregnancy. Which statement by a client requires immediate intervention by the nurse? A) "When my nausea is bad, I will drink some ginger tea." B) "The fatigue I am experiencing will improve in the second trimester." C) "It is normal for my vaginal discharge to be green." D) "I will urinate less often during the middle of my pregnancy."

Answer: C Explanation: A) Ginger helps nausea, and is safe for use during pregnancy. B) First-trimester fatigue is common; fatigue usually improves during the second trimester. C) Increased whitish vaginal discharge, called leukorrhea, is common in pregnancy. Green discharge is not a normal finding, and indicates a vaginal infection. D) Urinary frequency, a common discomfort of pregnancy, occurs early in pregnancy and again during the third trimester because of the pressure of the enlarging uterus on the bladder.

1) Which statement, if made by a pregnant client, would indicate that she understands health promotion during pregnancy? A) "I lie down after eating to relieve heartburn." B) "I try to limit my fluid intake to 3 or 4 glasses each day." C) "I elevate my legs while sitting at my desk." D) "I am avoiding exercise to stay well rested."

Answer: C Explanation: A) Heartburn is gastroesophageal reflux, and will be exacerbated by lying down. B) At least 8-10 glasses of fluids should be consumed each day to maintain the increased blood volume of pregnancy. C) Elevating the legs can help decrease lower leg edema. D) Regular mild to moderate exercise has many benefits for pregnant women.

1) The nurse in a prenatal clinic finds that four clients have called with complaints related to their pregnancies. Which call should the nurse return first? A) Pregnant woman at 7 weeks' gestation reporting nasal stuffiness B) Pregnant woman at 38 weeks' gestation experiencing rectal itching and hemorrhoids C) Pregnant woman at 15 weeks' gestation with nausea and vomiting and a 15-pound weight loss D) Pregnant woman at 32 weeks' gestation treating constipation with prune juice

Answer: C Explanation: A) Nasal stuffiness is common in the first trimester as a result of increased estrogen. B) Hemorrhoids are common during pregnancy and often cause itching. C) The nurse should return this call first because this patient is the highest priority. A 15-pound weight loss is not an expected finding. Although some nausea is common, the woman who suffers from extreme nausea coupled with vomiting requires further assessment. D) Constipation during the third trimester is a common finding. Increased fluid and fiber from food sources are most effective in relieving constipation.

1) The prenatal client in her third trimester tells the clinic nurse that she works 8 hours a day as a cashier and stands when at work. What response by the nurse is best? A) "No problem. Your baby will be fine." B) "Do you get regular breaks for eating?" C) "Your risk of poor pregnancy outcomes may be higher." D) "Standing might increase ankle swelling."

Answer: C Explanation: A) Standing more than 3 hours a day increases the risk of preterm labor. To be therapeutic in communication, avoid false reassurance. B) Although breaks for eating are important for pregnant employees, it is more important to tell the client about the increased risks associated with standing more than 3 hours a day. C) Pregnant women who are employed in jobs that require prolonged standing (more than 3 hours) may be at risk for poor pregnancy outcomes. D) Although this is true, it is less important than teaching the client about the risks of preterm labor from standing more than 3 hours a day.

1) The nurse is presenting a class of important "dos and don'ts" during pregnancy, including travel considerations. What method of travel does the nurse recommend as most appropriate for a client in her 25th week of pregnancy? A) Automobile B) Airplane C) Train D) None; this client should not travel

Answer: C Explanation: A) Travel by automobile can be especially fatiguing, aggravating many of the discomforts of pregnancy. The pregnant woman needs frequent opportunities to get out of the car and walk. B) Occasional flying is considered safe in the absence of any obstetric or medical complications. However, those women who have medical or obstetric complications, such as poorly controlled diabetes, sickle cell disease, or preeclampsia, and those women with placental abnormalities or who are at risk for preterm birth are advised to avoid flying during pregnancy. Before flying, the pregnant woman should check with her particular airline to see if it has any travel restrictions. C) As pregnancy progresses, travel by train is generally recommended for long distances. D) If medical or pregnancy complications are not present, there are no restrictions on travel. Pregnant women should avoid travel if there is a history of bleeding or preeclampsia, or if multiple births are anticipated.

1) The nurse assessing a pregnant African American woman in the first trimester understands that a cultural practice is which of the following? A) Use of herbs like dandelion during pregnancy to increase lactation B) Drinking ginseng tea for faintness C) Eating clay to supply dietary minerals D) Consulting a spiritual advisor to ensure a healthy pregnancy and birth

Answer: C Explanation: A) Use of dandelion is a practice of American Indians. B) Asian women who are pregnant often drink ginseng tea. C) African American pregnant women may be guided by their extended family into common practices such as geophagia, the ingestion of dirt or clay, which is believed to alleviate mineral deficiencies. D) Consulting a spiritual advisor is common among Navajo and many other Native American cultures.

2) The pregnant client cannot tolerate milk or meat. What would the nurse recommend to the client to assist in meeting protein needs? A) Wheat bread and pasta B) Ice cream and peanut butter C) Eggs and tofu D) Beans and potatoes

Answer: C Explanation: A) Wheat bread and pasta are not sources of complete protein. B) Ice cream is a milk by-product, and would not be tolerated by this client. C) The best food choices that are nondairy and complete proteins alone are eggs and tofu. D) Beans and potatoes would not provide the client with adequate protein.

1) Which of the following drugs and drug categories can cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies? A) Category C: Zidovudine B) Category B: Penicillin C) Category X: Isotretinoin D) Category A: Vitamin C

Answer: C Explanation: A) Zidovudine does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. B) Penicillin does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies. C) Isotretinoin (Accutane), the acne medication, can cause multiple central nervous system (C N S), facial, and cardiovascular anomalies. D) Vitamin C does not cause multiple fetal central nervous system (C N S), facial, and cardiovascular anomalies.

20) e nurse is working with a pregnant 14-year-old. Which statement indicates that additional education is required? A) "Because I am still growing, I need more calories than a pregnant adult." B) "I need to eat fruit and vegetables every day to get enough vitamins." C) "My favorite food is pizza, and I eat it once a week." D) "Because I don't eat breakfast, I'll have to eat more at supper."

Answer: D Explanation: A) Caloric needs of pregnant adolescents vary widely. Figures as high as 50 kcal/kg have been suggested for young, growing teens who are very active physically. B) Eating a variety of fruits and vegetables helps ensure adequate intake of vitamins and some minerals. C) Pizza is not contraindicated during pregnancy. Eating a food once per week will not lead to nutritional imbalance. D) Pregnant young adolescents should eat breakfast to ensure that adequate calorie and protein intake is achieved. In assessing the diet of the pregnant adolescent, the nurse should consider the eating pattern over time, not simply a single day's intake.

1) Intercourse is contraindicated if the pregnancy is vulnerable because of which diagnosis? A) Gestational diabetes B) Cervical insufficiency (cerclage) C) Abruptio placentae D) Placenta previa

Answer: D Explanation: A) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of gestational diabetes. B) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of cervical insufficiency (cerclage). C) Intercourse is not contraindicated if the pregnancy is vulnerable because of the diagnosis of abruptio placentae. D) Intercourse is contraindicated if the pregnancy is vulnerable because of the diagnosis of threatened spontaneous abortion, placenta previa, or the risk of preterm labor.

1) A client in her third trimester of pregnancy reports frequent leg cramps. What strategy would be most appropriate for the nurse to suggest? A) Point the toes of the affected leg B) Increase intake of protein-rich foods C) Limit activity for several days D) Flex the foot to stretch the calf

Answer: D Explanation: A) Leg cramps are exacerbated by pointing the toes. B) Leg cramps often result from an imbalance in the calcium-phosphorus ratio, not from a lack of protein-rich foods. C) Leg cramps are not caused by excess activity. D) The nurse should advise the client to practice dorsiflexion of her feet to stretch the affected muscle.

21) When preparing nutritional instruction, which pregnant client would the nurse consider the highest priority? A) 40-year-old gravida 2 B) 22-year-old primigravida C) 35-year-old gravida 4 D) 15-year-old nulligravida

Answer: D Explanation: A) The 40-year-old woman has completed her growth cycle, and her body can focus on diverting nutrition to the fetus. B) The 22-year-old woman has completed her growth cycle, and her body can focus on diverting nutrition to the fetus. C) The 35-year-old woman has completed her growth cycle, and her body can focus on diverting nutrition to the fetus. D) An expectant adolescent must meet the nutritional needs for her own growth in addition to the nutritional needs of pregnancy.

1) The nurse is caring for a pregnant client. The client's husband has come to the prenatal visit. Which question is best for the nurse to use to assess the father's adaptation to the pregnancy? A) "What kind of work do you do?" B) "What furniture have you gotten for the baby?" C) "How moody has your wife been lately?" D) "How are you feeling about becoming a father?"

Answer: D Explanation: A) What kind of work the husband does is not an indicator of his adaptation to the pregnancy. B) What furniture has been obtained is not an indicator of the father's adaptation to the pregnancy. C) The husband's perceptions of his wife's moodiness are not an indicator of the father's adaptation to the pregnancy. D) A husband's adaptation to pregnancy includes his feelings about impending fatherhood.