The Nursing Role in Promoting Nutritional Health During Pregnancy. CH13

10. If constipation is a problem for a woman during pregnancy, which measure would be best to recommend? A) mineral oil B) increased fiber intake C) stopping prenatal vitamins temporarily D) eating more meat products

Ans: B Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 289 Feedback: Increasing fiber intake is helpful in relieving constipation because it increases peristalsis. Mineral oil is contraindicated because it prevents the absorption of fat-soluble vitamins.

19. The nurse is determining the effectiveness of nutritional teaching with a pregnant patient. Which food item that the patient selects indicates that additional teaching on good sources of iron is needed? A) Milk B) Beef C) Grains D) Legumes

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 284-285 Feedback: The foods richest in iron include organ meats; eggs; green, leafy vegetables; whole grains; enriched breads; or dried fruits. Milk is not a good source of iron and indicates that additional teaching is needed.

18. A pregnant patient asks if an over-the-counter vitamin can be taken during pregnancy instead of the prescribed prenatal vitamin. What should the nurse explain as the chief ingredient in prenatal vitamins that makes them important for pregnancy nutrition? A) Folic acid B) Vitamin C C) Potassium D) Vitamin B12

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 289 Feedback: Folic acid is added to maternal prenatal vitamins because of the threat of developing anemia. The pregnant patient should take a prenatal vitamin that contains a folic acid supplement of 0.4 to 0.6 mg, which may or may not be a part of an over-the-counter vitamin supplement. Vitamin C, potassium, and vitamin B12 are important; however, do not have the same risk of developing a health problem if not present in a prenatal vitamin supplement.

17. The nurse is instructing a pregnant patient to consume a diet high in complete proteins. Which food item should the nurse recommend as an example of a complete protein? A) A boiled or fried egg B) Green, leafy vegetables C) A slice of whole grain toast D) Applesauce or a whole apple

Ans: A Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 289 Feedback: The protein in meat, poultry, fish, yogurt, eggs, and milk contain all nine essential amino acids required and are considered complete proteins. The protein in nonanimal sources does not contain all essential amino acids and are considered incomplete proteins. Green, leafy vegetables; whole grain toast; and apples or applesauce are carbohydrate sources.

4. Which food below is not a good source of iron? A) Milk B) Legumes C) Grains D) Beef

Ans: A Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 295 Feedback: Although milk is sometimes advertised as a near-perfect food, it is not high in iron.

30. During a prenatal appointment, a patient who is 3 months pregnant states she ingests starch because of a craving. What should the nurse respond to this patient? A) Suggest a hemoglobin assessment be done. B) Kindly encourage the patient to discontinue the habit. C) Emphasize the protein, vitamin, and iron needs of pregnancy nutrition. D) Plan another appointment to discuss the hazards of ingesting nonfood substances.

Ans: A Client Needs: Physiological Integrity: Basic Care and Comfort Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Apply Page: 297 Feedback: Pica is a symptom that often accompanies iron-deficiency anemia, and the primary care provider might need to assess the patient's serum iron level because correcting this underlying problem with an iron supplement may correct the pica. Stopping eating the nonfood substance may be difficult because the habit may be deeply ingrained. Emphasizing the importance of other nutrients while pregnant will not correct the problem. The nurse does not need to make another appointment to discuss the hazards of ingesting nonfood substances. The teaching can be conducted during the current appointment.

3. A woman asks the nurse if she can take an over-the-counter vitamin during pregnancy rather than her prescription prenatal vitamin. A chief ingredient in prenatal vitamins that makes them important for pregnancy nutrition is: A) folic acid. B) vitamin B12. C) vitamin C. D) potassium.

Ans: A Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Page: 305 Feedback: Because folic acid is important during pregnancy to reduce the incidence of spinal cord lesions, prevent abortion, and prevent megaloblastic anemia, it is added at greater strengths to prenatal vitamins.

22. During a previous prenatal visit, the nurse focused on the importance of adequate nutritional intake with a pregnant patient. Which assessment findings indicate that this teaching has been effective? (Select all that apply.) A) Shiny hair B) Smooth tongue C) Conjunctiva pale D) Chipped finger nails E) Normal muscle reflexes

Ans: A, B, E Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Analyze Page: 294 Feedback: Evidence of an adequate nutritional intake while pregnant includes shiny hair, smooth tongue, and normal muscle reflexes. Pale conjunctiva could indicate iron deficiency. Chipped fingernails could indicate inadequate protein intake.

23. The nurse is planning care for several pregnant patients. Which patient is at the greatest risk for nutritional deficiency while pregnant? A) Patient who rarely eats fruit B) Patient with a 1-year-old son C) Patient with 10-year-old twins D) Patient who never follows a weight-reduction diet

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Analyze Page: 294 Feedback: A pregnant woman with high parity or a short interval between pregnancies such as having a 1-year-old son may enter pregnancy with depleted nutritional reserves that she has little to draw on during the first part of pregnancy. The other pregnant patients may have nutritional deficiencies that can be corrected with vitamin supplementation or adjustments in the diet.

28. The nurse is planning nutritional instructions for a pregnant patient who is a Mexican immigrant. On which areas should the nurse focus when preparing teaching for this patient? (Select all that apply.) A) Add fruits rich in vitamin C. B) Consume potatoes at every meal. C) Increase the intake of dairy products. D) Reduce the cooking time of vegetables. E) Limit the amount of added animal fat in foods.

Ans: A, C, D, E Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 296 Feedback: In the Mexican culture, most vegetables are cooked for a long time so they lose most of their nutritional value. Diet is high in fiber and starch. Animal fat is frequently added during food preparation. The diet may be inadequate in calcium, iron, vitamin A, and vitamin C. The nurse should instruct the patient to add fruits rich in vitamin C, increase dairy product intake, reduce cooking times of vegetables, and limit the amount of animal fat in the diet.

21. A pregnant patient tells the nurse that saturated fats are avoided by using vegetable oil. What additional information about vegetable oil can the nurse use to reinforce this patient's decision? A) Aids in fluid balance B) Contains linoleic acid C) Stimulates kidney function D) Has a high-potassium content

Ans: B Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 289 Feedback: Linoleic acid is a fat that is essential for new cell growth but cannot be manufactured by the body. Vegetable oils such as safflower, corn, olive, peanut, and cottonseed; fatty fish; omega-3-infused eggs; and omega-3-infused spreads are all good sources of linoleic acid. Vegetable oil does not aid in fluid balance, stimulate kidney function, or have high potassium content.

29. A patient who is 4 months pregnant is experiencing pyrosis. Which suggestion should the nurse make to the patient to help with this health problem? A) Try to include complex carbohydrates in meals. B) Eat small meals and do not lie down after meals. C) Increase vitamin intake by adding more citrus fruit. D) Take 30 ml of milk of magnesia after every meal.

Ans: B Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 298 Feedback: Pyrosis, or heartburn, occurs in pregnancy because the uterine pressure against the stomach causes regurgitation into the esophagus. Eating small meals and remaining upright limits the possibility of regurgitation. The patient should be instructed to avoid fatty and fried foods, coffee, carbonated beverages, tomato products, and citrus juices. Complex carbohydrates will not help with the problem. Milk of magnesia is not recommended to be taken for pyrosis.

7. A nurse is teaching a group of pregnant women about the importance of good nutrition during pregnancy. After describing the B vitamins, the nurse determines that the teaching was effective when the group states which food as the best source of vitamin B12? A) Carrots B) Beef C) Bread D) Lemons

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Page: 289 Feedback: B12 is found almost exclusively in animal sources; therefore beef would be the best choice. .

13. A woman who professes to be a strict vegetarian voices concerns about her ability to meet the nutritional needs of her fetus. Which concerns should be addressed in this session? A) Her diet will need to have an increase in fruits and vegetables to meet the nutritional requirements of her baby. B) The supplementation of Vitamin B12 should be addressed. C) There are not special concerns for vegans as they can easily meet the dietary requirements without violating their "no meat" rules. D) She should be advised to forgo her beliefs during the pregnancy to adequately provide the nutritional requirements for her pregnancy.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 302-303 Feedback: Vitamin B12 is almost exclusively met via animal sources.

12. Which of the following would you suggest to a pregnant woman who follows a vegetarian diet? A) Include at least one serving of meat daily. B) Anticipate needing a vitamin B12 supplement during pregnancy. C) Be careful not to eat more than four servings of fruit daily. D) Discontinue a vegetarian diet for the remainder of pregnancy.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 302-303 Feedback: Vitamin B12 is found almost solely in meat so it may need to be supplemented in a vegetarian diet.

11. A woman of normal weight asks you what an ideal weight gain is during pregnancy. Which of the following would be your best answer? A) She should not gain over 20 lb. B) Twenty-five to thirty-five pounds is ideal. C) The amount of weight gain is not important. D) Any gain over 30 lb is ideal.

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 285 Feedback: A weight gain of 25 to 35 lbs. encourages fetal growth yet does not lead to a maternal weight gain postpregnancy.

6. A pregnant woman tells you that she wants to avoid saturated fat by using vegetable oil. What is another advantage of vegetable oil? A) Aids fluid balance B) Contains linoleic acid C) Stimulates kidney function D) Has a high potassium level

Ans: B Client Needs: Health Promotion and Maintenance Cognitive Level: Understand Page: 289 Feedback: Linoleic acid is a fat important for skin integrity in the mother and for fetal growth.

14. A woman who is 4 months pregnant has pyrosis. Which suggestion would the nurse give her? A) Take 30 mL of milk of magnesia after every meal. B) Eat small meals and do not lie down after meals. C) Try to include complex carbohydrates in meals. D) Increase vitamin intake by adding more citrus fruit.

Ans: B Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 298 Feedback: Pyrosis, or heartburn, occurs in pregnancy because the uterine pressure against the stomach causes regurgitation into the esophagus. Eating small meals and remaining upright limits the possibility of regurgitation.

8. A nurse is reviewing the medical records of several pregnant women who come to the center for care. Which woman would the nurse most likely identify as being at greatest risk for nutritional deficiency during pregnancy? A) A woman who never worries about dieting B) A woman with a 1-year-old son C) A woman with 10-year-old twins D) A woman who rarely eats fruit

Ans: B Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 299-300 Feedback: Pregnancy depletes nutritional stores. A woman who enters a second pregnancy almost immediately after a first can enter the second pregnancy with nutritional shortages.

25. A pregnant patient asks the nurse what can be done for constipation. What should the nurse recommend to the patient? A) Mineral oil B) Increased fiber intake C) Eating more meat products D) Stopping prenatal vitamins temporarily

Ans: B Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 289-291 Feedback: Eating fiber-rich foods is a natural way to prevent constipation because the bulk of the fiber left in the intestine aids evacuation. Eating fiber-rich foods this way is a better choice for preventing constipation than taking a fiber laxative because it allows a pregnant patient to receive nutrients from the food as well as prevent constipation. The pregnant patient should not use mineral oil to relieve constipation because it can prevent absorption of fat-soluble vitamins A, D, K, and E, vitamins necessary for both good fetal and maternal health. Eating more meat products can add to the constipation. The patient should not be advised to stop prescribed prenatal vitamins.

31. The nurse is planning a prenatal educational program for a community health center. What information should the nurse include that supports the 2020 National Health Goals for nutrition in pregnancy? (Select all that apply.) A) Avoid foods high in fats and calories. B) Take prenatal vitamins as prescribed. C) Ensure a daily intake of foods with folic acid. D) Limit the intake of foods high in simple carbohydrates. E) Maintain adequate nutrition before becoming pregnant.

Ans: B, C, E Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 284 Feedback: Information that the nurse should include that supports the 2020 National Health Goals for nutrition in pregnancy include taking prenatal vitamins as prescribed because these will contain iron and folic acid. The nurse should also teach the participants to have a daily intake of foods with folic acid and to maintain adequate nutrition before becoming pregnant so that those entering pregnancy will have adequate nutritional stores. There are no specific foods that a pregnant patient should avoid such as those high in fat and calories. All pregnant patients do not need to limit the intake of foods high in simple carbohydrates.

20. A pregnant patient tells the nurse that drinking enough fluids has always been a problem for her. What should the nurse counsel the patient as being an adequate daily amount of fluid to drink while pregnant? A) Two glasses B) Four glasses C) Eight glasses D) Ten glasses

Ans: C Client Needs: Health Promotion and Maintenance Client Needs 2: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Page: 291 Feedback: Extra amounts of water are needed during pregnancy to promote kidney function because a woman must excrete waste products for two. Eight glasses of fluid daily is a common recommendation. Two or four glasses of fluid would not be an adequate amount. Ten glasses of fluid might be too much for the patient to consume each day.

5. A pregnant woman tells you that she does not drink much fluid daily. How many glasses of fluid would the nurse recommend that the woman ingest daily during pregnancy? A) 2 B) 4 C) 6 D) 10

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 291 Feedback: Fluid is important during pregnancy to supply fluid for the increased blood volume and to maintain kidney function so both fetal and maternal wastes can be evacuated. Eight glasses of fluid daily (e.g., two glasses of fluid over and above a daily quart of milk) is a common recommendation.

2. You encourage a pregnant woman to eat a diet high in complete protein. Assuming she likes all of the following foods, which of them would you recommend as a source of this for her? A) Applesauce or a whole apple B) A slice of whole grain toast C) A boiled or fried egg D) Green leafy vegetables

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 295 Feedback: Complete protein is supplied by animal or fowl sources.

9. A woman in early pregnancy is concerned because she is nauseated every morning. Which measure would be best to help relieve this? A) Take a teaspoon of baking soda before breakfast. B) Delay toothbrushing until noon. C) Delay breakfast until midmorning. D) Take two aspirin on arising.

Ans: C Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Page: 295 Feedback: The cause of morning sickness is unknown. Delaying eating until the nausea passes can be helpful. Aspirin is irritating to the stomach and would increase symptoms.

15. At a prenatal appointment, a woman who is 3 months pregnant confides to you that she ingests starch because of a craving she has had since adolescence. She is now 26 years old. What would be your most appropriate response? A) Arrange for a separate appointment to prepare instructions about the hazards of ingesting nonfood substances. B) Emphasize the protein, vitamin, and iron needs of pregnancy nutrition. C) Suggest she have a hemoglobin assessment done because of the association between pica and iron-deficiency anemia. D) Kindly but firmly scold her to discourage the habit.

Ans: C Client Needs: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 297 Feedback: Craving nonfood substances is called pica. This is associated with iron-deficiency anemia.

26. A woman of normal weight learns that she is pregnant and asks the nurse how much weight she should gain until delivery. What should the nurse respond to this patient? A) Do not gain over 20 lb. B) Any gain over 30 lb is ideal. C) Twenty-five to 35 lb is ideal. D) The amount of weight gain is not important.

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 285-286 Feedback: A weight gain of 25 to 35 lb encourages fetal growth yet does not lead to a maternal weight gain postpregnancy. A patient who is overweight might be encouraged to limit weight gain to 20 lb while pregnant. A weight gain over 30 lb might be recommended for the patient that is underweight. The amount of weight gain is important to ensure adequate growth and health of the developing fetus and mother.

24. A woman who is 6 weeks pregnant is concerned because she is nauseated every morning. Which measure should the nurse suggest the patient use to help relieve nausea? A) Take two aspirin on arising. B) Delay toothbrushing until noon. C) Delay breakfast until midmorning. D) Take a teaspoon of baking soda before breakfast.

Ans: C Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 295 Feedback: The traditional solution for preventing nausea is for the pregnant patient to keep dry crackers, such as saltines, by the bedside and eat a few before rising because increasing carbohydrate intake seems to relieve nausea better than any other nutrition remedy. The patient can then eat a light breakfast or delay breakfast until 10 or 11 AM, which is past the time nausea seems to persist. Aspirin is irritating to the stomach and should not be taken. Delaying toothbrushing does not affect nausea. A teaspoon of baking soda should not be suggested because this could adversely affect the patient's electrolyte status.

1. What is the most effective way for a nurse to assess a woman's usual food intake during her pregnancy? A) Assess a list she makes describing a good diet. B) Ask her to describe her total intake for a week. C) Assess her skin for hydration and color. D) Ask her to describe her intake for the last 24 hours.

Ans: D Client Needs: Health Promotion and Maintenance Cognitive Level: Remember Page: 292-293 Feedback: A 24-hour food intake history is the best method to assess food intake in all individuals.

16. The nurse is preparing to assess the nutritional status of a patient who is 8 weeks pregnant. What is the most effective way for the nurse to assess the patient's food intake thus far in the pregnancy? A) Assess skin status for hydration and color. B) Ask the patient to describe total intake for a week. C) Assess a list that the patient describes as a good diet. D) Ask the patient to describe intake for the last 24 hours.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 284-287 Feedback: The best method for assessing a woman's nutritional intake during pregnancy is to ask the patient to list all the food eaten within the past 24 hours, starting with waking up until going to sleep. This method of history taking yields much more accurate information than asking a patient how often a specific food is eaten. Assessing skin status may provide more information about hydration that nutritional status. Assessing a total intake for a week would be too extreme for the patient to recall. Assessing the patient from a list of foods does not identify what the patient has most recently eaten.

27. Which nutritional information should the nurse suggest to a pregnant patient who follows a vegetarian eating plan? A) Include at least one serving of meat daily. B) Be careful not to eat more than four servings of fruit daily. C) Discontinue a vegetarian diet for the remainder of pregnancy. D) Anticipate needing a vitamin B12 supplement during pregnancy.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Health Promotion and Maintenance Cognitive Level: Apply Page: 302-303 Feedback: Vitamin B12 is found almost exclusively in animal protein, so if animal protein is excluded from the diet, vitamin B12 deficiency can occur unless this is supplemented. The patient should anticipate needing a vitamin B12 supplement while pregnant. The patient is a vegetarian and will not add meat to the diet. The intake of fruit will not adversely affect the patient or the development fetus. The patient may or may not want to discontinue the vegetarian diet while pregnant.

32. The nurse has identified the diagnosis of imbalanced nutrition for a pregnant patient. Which assessment data did the nurse use to identify this diagnosis for the patient? A) Patient eats salads at least twice a day. B) Patient does not like potatoes or bread. C) Patient eats red meat several times a week. D) Patient does not want to gain any weight while pregnant.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 301 Feedback: Not wanting to gain weight while pregnant could lead to imbalanced nutrition for both the mother and developing fetus. Eating salads and red meat will not lead to imbalanced nutrition. Avoiding potatoes and bread will not lead to imbalanced nutrition.

33. The nurse provides instructions to a patient with hyperemesis gravidarum. Which outcome indicates that teaching has been effective? A) Patient has vomiting episodes only in the morning. B) Patient is able to tolerate soft foods after episodes of vomiting. C) Patient is able to ingest clear liquids between episodes of vomiting. D) Patient is able to ingest a regular diet after progressing through clear liquids and soft foods.

Ans: D Client Needs: Safe, Effective Care Environment: Management of Care Client Needs 2: Physiological Integrity: Reduction of Risk Potential Cognitive Level: Analyze Page: 304 Feedback: The pregnant patient with hyperemesis gravidarum may be hospitalized and treated with intravenous fluids. If there is no vomiting after the first 24 hours of oral restriction, small amounts of clear fluid can be started, and the woman discharged home. If able to take clear fluid without vomiting, small quantities of dry toast, crackers, or cereal can be added every 2 or 3 hours, then the woman may be gradually advanced to a soft diet and then to a regular diet. If vomiting returns at any point, enteral or total parenteral nutrition may be prescribed to ensure she receives adequate nutrition. Vomiting episodes in the morning or tolerating clear liquids or soft foods between vomiting episodes indicates that teaching has not been effective.