Dukek Chapter 11: Healthy Eating for Healthy Babies

The nurse is caring for a new mother immediately after delivery. The mother wants to know the benefits of breastfeeding. Which of the following statements by the nurse are CORRECT? Select all that apply.

"Breastfeeding promotes optimal bonding between you and your infant." "Breastfeeding will help to stimulate uterine contractions and decrease postpartum bleeding." "Breastfeeding will help your uterus to return to a prepregnant size." "Breastfeeding improves bone density and reduces risk for hip fracture."

The nurse reviews the caloric intake requirement for a client with a prepregnancy body mass index (BMI) 21 of in the 20th week of gestation. Which client statement indicates that teaching has been effective?

"I should add 400 calories per day to my diet" A healthy eating pattern for a pregnant client of healthy body weight increases by 400 cal/day beginning in the second trimester and lasting through the course of pregnancy. Oil allowance increases by 4 g/day, and an additional 80 calories are allotted for solid fat. Following the same eating plan as during the 1st trimester does not provide an adequate amount of calories. Gaining 20 lbs. during the 3rd trimester is too much of weight to gain for a client with a prepregnancy BMI of 21.

A pregnant woman has phenylketonuria (PKU). The nurse knows that further teaching is needed when the woman makes which statement?

"I should consume a normal diet during pregnancy" Women who have phenylketonuria (PKU) and who consume a normal diet before and during pregnancy have very high blood levels of phenylalanine, which are devastating to the developing fetus. As a teratogen, excess serum phenylalanine can cause microcephaly, intellectual disability, growth retardation, and/or congenital heart abnormalities in any offspring born to a woman with PKU (Lenke and Levy, 1980). The primary determinants of infant outcome are the degree of elevated phenylalanine and the gestational age when phenylalanine control is achieved (van Calcar and Ney, 2012). Most of these infants do not inherit PKU and cannot benefit from a low-phenylalanine diet after birth.

A woman who is 32 weeks pregnant was diagnosed with gestational diabetes one week ago. The nurse knows that teaching has been effective when the woman states which of the following?

"I should exercise if there are no medical or obstetrical complications."

The nurse is seeing a client who has lost 5 lbs in the second trimester of her pregnancy. Which statement by the pregnant woman indicates that she may be experiencing pica?

"I want to eat only ice" Pica is the purposeful ingestion of nonfood substances such as dirt, clay, starch, and ice.

A mother who just delivered her baby is positive for HIV. The mother asks the nurse if she can breastfeed her infant. Which of the following is the best response by the nurse?

"No, you should not breastfeed because you are positive for HIV."

A pregnant woman is in the first trimester of her first pregnancy. The nurse knows that this woman needs more teaching when she states the following?

"With careful food selections during pregnancy, I will be able to consume enough iron in my diet to avoid the possibility of having iron-deficiency anemia." A, C, and D are correct answers, and the pregnant woman will need no further teaching related to these statements. B is incorrect because even with careful selections, women are not likely to consume adequate amounts of iron during pregnancy from food alone.

The nurse is seeing a client whether she should stop drinking alcohol because she is trying to get pregnant. Which of the following responses by the nurse is CORRECT?

"You should completely avoid alcohol before and during pregnancy" Women are advised to completely avoid alcohol before and during pregnancy because alcohol is a potent teratogen, and a safe level of consumption is not known.

Women ________ years or older are associated with high-risk pregnancy. Enter the correct number ONLY.

35 Factors associated with high-risk pregnancies are being 15 years old or younger and being 35 years old or older.

The nurse reviews dietary choices made by a client in the 16th week of gestation. Which selection indicates that the client is adhering to the MyPlate dietary recommendations for pregnancy?

1 cup of skim milk for breakfast, lunch, and dinner According to the MyPlate recommendations for pregnancy, 3-1 cup servings of dairy should be consumed each day. Having bread for breakfast only does not adhere to any level of dietary intake during pregnancy. Two cups of salad twice a day is under the recommended 3 cups per day for a client in the 2nd trimester of pregnancy. One cup of fruit juice per day is under the recommended 2 cups of fruit per day in the 2nd trimester of pregnancy.

Gestational hypertension is defined as a systolic blood pressure greater than or equal to _____ mmHg or a diastolic reading greater than or equal to 90 mmHg with onset after 20 weeks of gestation and without proteinuria. Enter the correct number ONLY.

140 Gestational hypertension is defined as a systolic blood pressure greater than or equal to 140 mmHg or a diastolic reading greater than or equal to 90 mmHg with onset after 20 weeks of gestation and without proteinuria.

Teens, especially those ______ years or younger, are associated with high-risk pregnancy. Enter the correct number ONLY.

15 Factors associated with high-risk pregnancies are being 15 years old or younger and being 35 years old or older.

All women with a body mass index (BMI) of ______ or lower should be counseled about the risks of unhealthy weight to maternal health and future pregnancies. Enter number to the nearest 1/10th. Enter the correct number ONLY.

18.5 All women with a body mass index (BMI) of 18.5 or lower or 25 or higher should be counseled about the risks of unhealthy weight to maternal health and future pregnancies, including the risk of infertility. Clinical care recommendations are based on BMI (CDC, 2012b).

The World Health Organization (WHO) recommends that breastfeeding should continue up to the age of at least _________ years. Enter the correct number ONLY.

2 The World Health Organization (WHO) recommends that infants be exclusively breastfed for the first 6 months of life with the introduction of complementary foods thereafter as breastfeeding continues up to the age of 2 years or beyond (WHO, 2011).

Most pregnant women need a total of ________ to 2900 cal/day. Enter the correct number ONLY.

2200 Most pregnant women need a total of 2200 to 2900 cal/day (ADA, 2008).

The nurse is seeing a pregnant client who has a BMI of 27. This nurse should encourage this client to limit weight gain to ______ pounds in her pregnancy. Enter the correct number ONLY.

25 Recommended weight gain in pregnancy is 15 to 25 pounds for overweight women and 11 to 20 pounds for women who are obese at the time of conception..

The nurse is discussing weight gain with a group of pregnant women in a prenatal clinic. One of the women in the group has been measured with a body mass index (BMI) of 17.5. The nurse knows this client should gain how much weight during her pregnancy?

28-49 lbs It is recommended that women with a BMI less than 18.5 gain 28 to 40 pounds during pregnancy.

Women with a BMI of ≥ _________ are considered obese. Enter the correct number ONLY.

30

Women of normal prepregnancy weight (BMI 18.5 to 24.9) are encouraged to gain 25 to _________pounds in pregnancy. Enter the correct number ONLY.

30 Recommended weight gain in pregnancy is 25 to 35 pounds for women of normal weight, 28 to 40 pounds for underweight women,

An extra _____ calories per day for the second 6 months are recommended for women who exclusively breastfeed. Enter the correct number ONLY.

400 An extra 330 calories per day are recommended for the first 6 months of lactation, and an extra 400 calories per day are recommended for the second 6 months for women who exclusively breastfeed; partial breastfeeding uses fewer calories

The recommended dosage of folate for nonpregnant women is _____ μg.

400 The recommended daily intake of folate for non-pregnant women is 400 μg. Women who are pregnant or who are attempting to become pregnant should consume a total of 600 μg daily of which 400 μg is from a supplement or fortified food and the remaining amount is folate naturally present in food.

The nurse is seeing a client who is not taking birth control and is considering pregnancy. Which of the following recommendations should the nurse make for this client?

400 micrograms (ug) per day of folic acid. Women of childbearing age who may become pregnant should consume 400 micrograms (ug) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet.

Using the Dietary Approaches to Stop Hypertension (DASH) eating pattern during pregnancy is associated with up to ________ % lowered risk of gestational diabetes. Enter the correct number ONLY.

48% Dietary Approaches to Stop Hypertension (DASH) eating pattern (Chapter 20) are associated with a 24% to 48% lower risk of gestational diabetes.

The recommended dosage of folate for women who are lactating is _____ ug. Enter the correct number ONLY.

500 The recommended dosage of folate is 400 ug for nonpregnant women, 600 ug for pregnant women, and 500 ug for lactating women.

Women use approximately _____ calories above their normal total daily calorie needs to produce breast milk. Enter the correct number ONLY.

500 Women use approximately 500 calories above their normal total daily calorie needs to produce breast milk. Approximately 100 to 150 of these calories come from fat stored during pregnancy, and the remaining calories come from extra calories consumed.

The World Health Organization (WHO) recommends that infants be exclusively breastfed for the first ______ months of life. Enter the correct number ONLY.

6

A pregnant woman in the second trimester of her fourth pregnancy is wondering what foods she should eat to increase her intake of iron. Which of the following menus should the nurse recommend?

6 oz. chicken, 1/2 cup of lima beans, one baked potato with skin on

The recommended dosage of folate for pregnant women is _____ ug. Enter the correct number ONLY.

600 The recommended dosage of folate is 400 ug for nonpregnant women, 600 ug for pregnant women, and 500 ug for lactating women.

The recommended amount of folic acid to be consumed every day by all pregnant women is how much?

600 micrograms The recommended amount of folic acid to be consumed every day by all pregnant women is 600 ug/day from all sources (natural and synthetic).

The nurse evaluates the weight gain of a client in the 26th week of gestation who had a prepregnancy body mass index (BMI) of 27.5. Which weight gain thus far in the pregnancy indicates that teaching has been effective?

9.0 lbs The client is in the last week of the second trimester and started the pregnancy overweight. If the client gained between 1.1 to 4.4 lbs. in the first trimester, the weight gain for the second should be an average of 0.6 lbs. per week. The weight gain thus far should be between 8.9 and 11.9 lbs. A gain of 4.1 lbs. should occur during the first trimester. The weights of 19.7 lbs. and 23. 6 lbs. could be the total weight gain for the entire pregnancy, depending upon the first trimester weight gain.

The nurse is seeing a client in her first trimester of pregnancy. The client asks at what rate and how much weight she should gain. The nurse should inform the client that the amount of weight she needs to gain is based on which pre-pregnancy factor?

BMI All women should receive guidelines on an appropriate rate and amount of weight gain based on their prepregnancy BMI (Josefson, 2011).

A pregnant client comes into the clinic and wants to know whether she should plan to bottle-feed or breastfeed her infant. Which of the following statements about breastfeeding are CORRECT? Select all that apply.

Breastfeeding promotes optimal maternal-infant bonding. Breastfeeding is important for improving infant and child morbidity and mortality. Breastfeeding improves maternal morbidity. Breastfeeding is less expensive than bottle feeding. Breastfeeding is an important public health strategy for improving infant and child morbidity and mortality and improving maternal morbidity (ADA, 2009b). The benefits of breastfeeding for both mother and infant are well recognized.

Which of the following recommendations promote a healthy eating pattern for pregnant women? Select all that apply.

Eat a variety of nutrient-dense foods and beverages among the basic food groups. Include an adequate amount of vegetables, fruits, whole grains, and milk and milk products. Follow food safety guidelines to reduce the risk of food-borne illness. Avoid excessive intake of cholesterol, added sugars, and salt. Pregnant women, like all Americans, are urged to follow a healthy eating pattern while staying within their calorie needs (USDA, USDHHS, 2010). This means that pregnant women should eat a variety of nutrient-dense food and beverages among the basic food groups; be sure to include enough vegetables, fruits, whole grains, and milk and milk products because these foods provide nutrients of concern in the typical American diet, namely, potassium, fiber, calcium, and vitamin D; limit their intake of saturated fat, trans fats, cholesterol, added sugars, and salt; and follow food safety guidelines to reduce the risk of food-borne illness.

Which of the following statements express the basic principles of healthy eating before, during, and after pregnancy? Select all that apply.

Eat plenty of fruits and vegetables. Eat whole-grain bread and cereals. Eat lean protein foods. The basic principles of healthy eating that apply to healthy people are also appropriate before, during, and after pregnancy: eat plenty of fruits and vegetables of various kinds and colors, whole-grain bread and cereals, lean protein foods, low-fat or fat-free milk and dairy product, and healthy fats in moderation.

The nurse ia seeing a pregnant woman who has phenylketonuria (PKU). The client should be taught which of the following?

Foods high in phenylalanine are meat, fish, poultry, and dairy products.

Food-borne risks are more dangerous during pregnancy. Which of the following statements about listeriosis and pregnancy is CORRECT?

Listeriosis during pregnancy can lead to miscarriage, stillbirth, premature delivery, or neonatal infection. Food-borne risks are more dangerous for pregnant women than for most other adults. During pregnancy, listeriosis, caused by the bacterium Listeria monocytogenes, may cause only mild, flu-like illness in the mother but may lead to miscarriage, stillbirth, premature delivery, or neonatal infection (Ricciotti, 2008). Pregnant women are 20 times more likely to get listeriosis than other healthy adults, and approximately one third of all listeriosis cases occur during pregnancy.

A breastfeeding mother wants to know whether she should continue taking her prenatal vitamin. Which of the following does the nurse know? Select all that apply.

Many vitamin and mineral requirements are higher during lactation than pregnancy. There are no consistent recommendations regarding the use of supplements during lactation. The breastfeeding mother is encouraged to obtain nutrients from food, not prenatal vitamins. For many vitamins and minerals, requirements are higher during lactation than during pregnancy, but the increase in calories from nutrient-dense foods can generally meet increased needs. One exception is iron. Iron supplements may be needed to replace depleted iron stores, not to increase the iron content of breast milk. Although there is no routine recommendation for maternal supplements during lactation, many clinicians recommend continued use of prenatal vitamins (AAP, 2012).

Which of the following statements about preeclampsia are CORRECT? Select all that apply.

Preeclampsia is 2 times more common in overweight women. Preeclampsia is 3 times more common in obese women. Symptomatology of preeclampsia includes gestational hypertension and proteinuria. The causes of preeclampsia are unknown, but it is believed to be related to an inadequate placental blood supply, possibly from maternal hypertension and involving an inflammatory response (ADA, 2009a). Preeclampsia is twice as prevalent in overweight women and approximately three times as high in obese women (Catalano, 2007). Proper nutrition and calcium supplements may reduce the risk of preeclampsia, but there is no known cure other than delivery of the infant.

According to Dietary Reference Intakes (DRIs), pregnant women need to begin adding at least 250 calories during the first trimester. This statement is:

false According to Dietary Reference Intakes (DRIs), pregnant women do not need any additional calories until the second trimester.

Women who are pregnant with twins should gain two times the amount of weight recommended for single-birth women. This statement is:

false Women who are pregnant with twins need to gain somewhat more weight than that recommended for single births but not double the amount.

Women with a BMI of 22 should be evaluated for eating disorders and distorted body image. This statement is:

false Women who are underweight (BMI less than 18.5) should be evaluated for eating disorders and distorted body image.

Mercury poisoning related to consuming fish during pregnancy can lead to which for the newborn? Select all that apply.

developmental delay in walking and talking cerebral palsy seizures intellectual disability Mercury poisoning in a fetus can result in problems ranging from learning delays in walking or talking to more severe problems such as cerebral palsy, seizures, and intellectual disability.

A breastfeeding mother who lives in Florida and runs two miles every morning asks how much fluid is needed while she is breastfeeding. Which of the following is the nurse's best response?

drink a glass of fluid every time the baby nurses and a glass of fluid with each meal. Fluid intake is an important consideration during lactation. It is suggested that breastfeeding mothers drink a glass of fluid every time the baby nurses and a glass of fluid with each meal. Thirst is a good indicator of need except among women who live in a dry climate or who exercise in hot weather. Fluids consumed in excess of thirst quenching do not increase milk volume.

The nurse is seeing a [pregnant client who reports having constipation. The nurse should recommend which of the following interventions?

drinking at least eight 8-oz glasses of liquid daily

A healthy 22-year-old pregnant woman who is having a low-risk pregnancy is currently in her first trimester should be encouraged to do which of the following?

engage in a safe exercise, paying attention to fall risks Healthy pregnant women who do not have medical or obstetric complications are urged to follow the advice for all healthy adults: Get at least 30 minutes of moderate exercise on most days of the week (American College of Obstetricians and Gynecologists, 2009). Safe exercise should be encouraged, with attention paid to fall risk and avoiding supine positions during the second and third trimesters (Fig. 11.2).

The nurse is seeing a pregnant client who asks what foods to eat to increase intake of folic acid. Which are the following are sources of folic acid? Select all that apply.

fortified breakfast cereals. white bread and rolls made with enriched flour multivitamins Sources of folic acid are 100% fortified ready-to-eat breakfast cereals and white bread, rolls, pasta, and crackers made with enriched flour. Naturally occurring folate is found in leafy green vegetables, such as spinach; citrus fruits; and dried peas and beans, such as lentils, soybeans, and pinto beans.

Excessive weight gain during pregnancy increases the risk for which of the following? Select all that apply.

gestational diabetes cesarean delivery complications during delivery Excess weight increases the risk of gestational diabetes, gestational hypertension (not hypotension), preeclampsia, a cesarean delivery, complications during delivery, and postpartum weight retention (not weight loss after delivery) (Ricciotti, 2008).

Nutritional requirements for which of the following increase from 18 mg for nonpregnant women to 27 mg during pregnancy?

iron According to Table 11.2, requirements for iron increase from 18 mg for nonpregnancy to 27 mg for pregnancy.

The nurse is seeing a preganant client who states she drinks approx. 24 ounces of coffee per day. The nurse should explain to the client that a high intake of caffeine during pregnancy is associated with which of the following?

low-birth-weight newborns A high caffeine intake is associated with low birth weight but not with birth defects (ADA, 2008) or preterm birth (Maslova, Bhattacharya, Lin, and Michels, 2010). The half-life of caffeine increases during pregnancy from 3 hours in the first trimester to 80 to 100 hours in late pregnancy (Procter & Campbell, 2014). Results of studies are mixed on the effect of caffeine on the risk of adverse pregnancy outcomes (Brent, Christian, & Diener, 2011; Hoyt, Browne, Richardson, Romitti, & Druschel, 2014). The ACOG (2010) recommends pregnant women limit their intake of caffeine to less than 200 mg/day, which is the approximate amount in 16 oz of coffee (Table 11.3).

An expectant mother, pregnant with her third baby, is due in 6 weeks. She does not like milk or ready-to-eat cereals. She often leaves for her office job before the sun comes up and does not get home until after dark. The nurse knows that this pregnant woman needs vitamin D supplements for which of the following reasons?

reduce the risk of abnormal neonatal bone metabolism Women who do not consume adequate vitamin D or have insufficient sunlight exposure should consume supplemental vitamin D to reduce the risk of low serum calcium in the infant and abnormal neonatal bone metabolism.

A postpartum client who is breastfeeding desires to return to the prepregnancy weight as quickly as possible. What dietary intake should the nurse recommend to this client?

restrict caloric intake to 1400 calories a day A postpartum client who is breastfeeding desires to return to the prepregnancy weight as quickly as possible. What dietary intake should the nurse recommend to this client?

The nurse suspects that a client in the 10th week of gestation would benefit from a nutritional supplement. Which information in the client's prenatal history did the nurse use to make this clinical determination?

smokes 5 cigarettes a day Vitamin and mineral supplements may be necessary for certain populations, such as women who are dependent on tobacco. Vitamin and mineral supplements may not be required if the client regularly consumes fish, red meat, and milk.

A client in the 8th week of gestation is experiencing nausea and vomiting every morning and throughout the day. What should the nurse suggest to help with this client's nutritional status?

snack on dry crackers and hard candy throughout the day Nausea and vomiting commonly occur during the 1st trimester of pregnancy. The nurse should suggest that the client snack on dry crackers and hard candy throughout the day to prevent a drop in the client's glucose level. Drinking water throughout the day helps with constipation. Avoiding coffee and caffeinated beverages helps with heartburn. Sipping on warm water with lemon juice in the morning helps with constipation.

The nurse is seeing a client with gestational diabetes mellitus. Which of the following information should the nurse consider when planning long term care for this client?

the client is at risk for developing type 2 diabetes later in life Gestational diabetes appears after 24 weeks of pregnancy, and although symptoms of gestational diabetes disappear after delivery, women who have had gestational diabetes, especially those who continue to have impaired glucose tolerance in the postpartum period, are at high risk for type 2 diabetes later in life.

The nurse is seeing a client who has been diagnosed with gestational diabetes. The nurse should share which of the following information with this client?

the risk of birth trauma is increased Gestational diabetes, defined as glucose intolerance diagnosed during the second or third trimester of pregnancy, is associated with increased risk of delivering an LGA infant, which in turn increases the risk of prolonged labor, cesarean delivery, shoulder dystocia, birth trauma, fetal hypoxia, and intrauterine death (Kim, Sharma, Sappenfield, Wilson, & Salihu, 2014). An LGA infant is more likely to develop diabetes, obesity, metabolic syndrome, asthma, and cancer later in life (Walsh & McAuliffe, 2012). For the mother, GDM increases the risk of type 2 diabetes. Shortly after pregnancy, 5% to 10% of women with GDM are diagnosed with diabetes, usually type 2; women who have GDM have a 35% to 60% chance of developing diabetes in the next 10 to 20 years (CDC, 2014b).

The nurse should provide a list including which of the following types of fish that should not be eaten by women who are pregnant or breastfeeding? Select all that apply.

tilefish shark king mackerel Women who are pregnant or breastfeeding should not eat tilefish, shark, swordfish, or king mackerel, owing to the high methyl mercury content.

Herbal supplements are technically unapproved drugs and should not be consumed during pregnancy and lactation. This statement is:

true Because little is known about the safety and efficacy of herbal supplements during pregnancy, it is recommended that they not be used during pregnancy and lactation. Herbal products, including herbal teas, are technically unapproved drugs; most drugs cross the placental barrier to some degree, exposing the fetus to potentially teratogenicity effects. Unlike approved drugs, little animal or human testing has been done to determine whether herbs can cause birth defects or potentially harm mothers and infants.

Nonnutritive sweeteners, consumed at levels within the U.S. Food and Drug Administration guidelines, are believed to be safe for all pregnant women unless the woman has phenylketonuria. This statement is:

true The use of nonnutritive sweeteners during pregnancy has been studied extensively. Acesulfame potassium (Sunette, Sweet One), aspartame (NutraSweet, Spoonful, Equal), saccharin (Sweet 'N Low), and sucralose (Splenda) are all deemed to be safe during pregnancy when consumed at levels within the U.S. Food and Drug Administration (FDA) Acceptable Daily Intake (ADI) guidelines (ADA, 2008). The exception is that women with phenylketonuria (PKU) should not use aspartame because it is made from phenylalanine.

Weight gain during pregnancy has been shown to independently predict long-term weight gain and obesity. This statement is:

true Weight gain during pregnancy has been shown to independently predict long-term weight gain and obesity in women (Mamun et al., 2010).

A woman who smokes is ____ as likely to deliver a low-birth-weight baby.

twice Smoking doubles a woman's risk of delivering a low-birth-weight baby.