Maternal Nutrition NCLEX
The nurse instructs on the importance of niacin during a preconception counseling class. Which food item selected by a participant indicates that teaching about the sources of niacin has been effective? 1. Fish 2. Milk 3. Apples 4. Broccoli
1 ~ 1. Dietary sources of niacin include meats, fish, and enriched grains. 2. Milk will provide sources of other vitamins; however, it does not contain significant niacin. 3. Apples will provide sources of other vitamins; however, they do not contain significant niacin. 4. Broccoli will provide sources of other vitamins; however, it does not contain significant niacin.
A pregnant client who was of normal prepregnancy weight is now 30 weeks pregnant. She asks the nurse what appropriate weight gain for her should be. What is the nurses best response? 1. 25-35 pounds 2. 30-40 pounds 3. 17-18 pounds 4. Less than 15 pounds
1. ~ An appropriate weight gain for a woman of normal weight before pregnancy would be 25-35 pounds.
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? 1. Dietary intake of fiber and fluids 2. Dietary intake of folic acid and prenatal vitamins 3. Return of hemoglobin and hematocrit levels to baseline 4. Return of protein and albumin to predelivery levels
1. ~ 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.
A pregnant client is lactose intolerant. Which alternative food could this client eat to get sufficient calcium? 1. Turnip greens 2. Green beans 3. Cantaloupe 4. Nectarines
1. ~ Turnip greens are rich in calcium.
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? 1. Shellfish 2. Bananas 3. Yogurt 4. Cabbage
1. ~ Zinc is found in greatest concentration in meats, shellfish, and poultry. Other good sources include whole grains and legumes.
A nurse is discussing the serving sizes in the grains food group with a new prenatal patient in the clinic. Which food equals one serving size from the grains food group? (SATA) 1. One hamburger roll 2. One slice of bread 3. One cup of pasta 4. One tortilla 5. One ounce of dry cereal
2, 4, 5 ~ 2. One slice of bread is one serving. 4. One tortilla is one serving. 5. One ounce of dry cereal is one serving.
The nurse is preparing an antenatal nutrition class for pregnant women. Which material should be included in the teaching? 1. During pregnancy, consumption of oily fish should be avoided. 2. Dietary protein can only be obtained through consuming dairy, meat, and eggs. 3. Nutritional iodine requirements generally can be met through intake of iodized salt. 4. Iron absorption is generally higher for vegetable products than for animal products
3 ~ 1. Oily fish provide the best source of docosahexaenoic acid (DHA), which may reduce the risk of preterm birth, preeclampsia, low birth weight, and enhance fetal and infant brain development. 2. Excluding dairy, meat, and eggs, adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. 3. Intake of iodized salt generally provides the recommended intake of iodine. 4. Iron absorption is generally higher for animal products than for vegetable products.
In early-pregnancy class, the nurse emphasizes the importance of 8-10 glasses of fluid per day. How many of these should be water? 1. 1 to 2 2. 2 to 4 3. 4 to 6 4. 3 to 5
3. ~ 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.
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? 1. Alopecia 2. Weight loss 3. Iron deficiency anemia 4. Fecal impaction
3. ~ 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.
The pregnant client cannot tolerate milk or meat. What would the nurse recommend to the client to assist in meeting protein needs? 1. Wheat bread and pasta 2. Ice cream and peanut butter 3. Eggs and tofu 4. Beans and potatoes
3. ~ The best food choices that are nondairy and complete proteins alone are eggs and tofu.
A 15-year-old primipara at 8 weeks' gestation who is 64 inches tall and weighs 115 pounds asks why she is supposed to gain so much weight. What is the best response by the nurse? 1."Inadequate weight gain delays lactation after delivery." 2."It's what your certified nurse-midwife recommended for you." 3."Weight gain is important to assure that you get enough vitamins." 4."Gaining 25 to 35 pounds is recommended for healthy fetal growth."
4 ~ 1. Inadequate weight gain can lead to decreased fetal growth and development. 2. Although this statement might be true, the client has asked a "why" question that should be directly answered. 3. Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet is probably not optimal, and her intake of empty calories or junk food might make up the majority of her caloric intake. 4. Adolescents who become pregnant less than 4 years after menarche are at risk because of their physiologic and anatomic immaturity. They are more likely than older adolescents to still be growing, which can affect the fetus's development.
When preparing nutritional instruction, which pregnant client would the nurse consider the highest priority? 1. 40-year-old gravida 2 2. 22-year-old primigravida 3. 35-year-old gravida 4 4. 15-year-old nulligravida
4. ~ An expectant adolescent must meet the nutritional needs for her own growth in addition to the nutritional needs of pregnancy.
15) The nurse is caring for a pregnant teen. What should the nurse do to accurately assess the teen's nutritional intake? 1. Assess laboratory values. 2. Ask about cooking facilities. 3. Observe for clinical signs of malnutrition. 4. Ask to complete a dietary recall to identify eating patterns.
Answer: 4 Explanation: 1. Laboratory values only provide information about the nutritional status of the client. 2. Cooking facilities might not be related to food intake. 3. Clinical signs of malnutrition only provide information about the nutritional status of the client. 4. In assessing the diet of the pregnant adolescent, it is important to consider the eating pattern over time, not simply a single day's intake. Once the pattern is identified, counseling can be directed toward correcting deficiencies.
14) Being aware that several pregnant students have been diagnosed with iron-deficiency anemia, the school nurse plans a class about nutrition for pregnant teens. What should the nurse encourage the teens to consume to increase iron absorption? 1. Milk 2. Green tea 3. Gatorade 4. Orange juice
Answer: 4 Explanation: 1. Milk does not contain vitamin C. 2. Green tea does not contain vitamin C. 3. Gatorade does not contain vitamin C. 4. Vitamin C is found in citrus fruits and juices and is known to enhance the absorption of iron from meat and nonmeat sources.
The kosher diet followed by many Jewish people forbids the eating of what foods? 1. Pig products and shellfish 2. Dairy products 3. All animal products 4. Dairy products and eggs
1. ~ 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.
The nurse is instructing a pregnant client on her nutritional needs. The nurse tells the client that nutrition is needed for fetal development because fetal growth occurs in overlapping stages from increases of which of the following? (SATA) 1. Cell numbers 2. Cell membranes 3. Cell size and number 4. Cell size alone 5. Vitamin and mineral intake
1, 3, 4 ~ 1. Fetal growth occurs by an increase in cell numbers in one stage. 3. Fetal growth occurs by an increase in cell size and number during one stage. 4. Fetal growth occurs by an increase in cell size alone during one stage.
Postpartum nutritional status is determined primarily by assessing which of the following? (SATA) 1. Dietary history 2. Menstrual history 3. Mother's weight 4. Hemoglobin levels 5. Mother's height
1, 3, 4 ~ 1. Postpartum nutritional status is determined by assessing the new mother's dietary history. 3. Postpartum nutritional status is determined by assessing the new mother's weight. 4. Postpartum nutritional status is determined by assessing the new mother's hemoglobin levels.
Women with eating disorders who become pregnant are at risk for a variety of complications including which of the following? (SATA) 1. Premature birth 2. Too many nutrients available for the fetus 3. Miscarriage 4. High birth weight 5. Perinatal mortality
1, 3, 5 ~ 1. Risks to the mother and baby include premature birth. 3. Risks to the mother and baby include miscarriage. 5. Risks to the mother and baby include perinatal mortality.
It has been identified that a pregnant client's diet is low in zinc. Which food should the nurse suggest to increase intake of this mineral? 1. Yogurt 2. Bananas 3. Cabbage 4. Shellfish
4 ~ 1. Yogurt is high in other nutrients but does not have significant levels of zinc. 2. Bananas are high in other nutrients but do not have significant levels of zinc. 3. Cabbage is high in other nutrients but does not have significant levels of zinc. 4. Zinc is found in greatest concentration in meats and meat by-products. Enriched grains also tend to be high in zinc.
The nurse is working with a pregnant 14-year-old. Which statement indicates that additional education is required? 1. Because I am still growing, I need more calories than a pregnant adult. 2. I need to eat fruit and vegetables every day to get enough vitamins. 3. My favorite food is pizza, and I eat it once a week. 4. Because I don't eat breakfast, I'll have to eat more at supper.
4. ~ Pregnant young adolescents should eat breakfast to ensure the adequate calorie and protein intake needed. In assessing the diet of the pregnant adolescent, the nurse should consider the eating pattern over time, not simply a single days intake.
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? (SATA) 1. Folic acid has been found to be essential for minimizing the risk of neural tube defects. 2. You do not have to take these supplements if you think you are healthy enough. 3. These medications do the same thing. I will call your doctor to cancel one of your medications. 4. You can trust your doctor to know what you need. 5. You need the supplements because your dietary intake may not be adequate for fetal development.
1, 5 ~ 1. The CDC estimates that most neural tube defects could be prevented if women followed folic acid supplementation recommendations before they know they are pregnant. 5. 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.
The nurse is planning an educational session for pregnant vegans. What information should the nurse include? 1. Eating beans and rice provides complete protein needs. 2. Soy is not a good source of protein for vegans. 3. Rice contains a high level of vitamin B12. 4. Vegan diets are excessively high in iron.
1. ~ 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.
Which statement is best to include when teaching a pregnant adolescent about nutritional needs of pregnancy? 1. It is important to eat iron-rich foods like meat every day. 2. Calcium and milk aren't needed until the third trimester. 3. Folic acid intake is the key to having a healthy baby. 4. You just need to pay attention to what you eat now.
1. ~ 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.
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? 1. Fish 2. Apples 3. Broccoli 4. Milk
1. ~ Dietary sources of niacin include meats, fish, and whole grains.
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? 1. Gaining 25-35 pounds is recommended for healthy fetal growth. 2. It's what your certified nurse-midwife recommended for you. 3. Inadequate weight gain delays lactation after delivery. 4. Weight gain is important to ensure that you get enough vitamins.
1. ~ For an appropriate-weight woman, 25-35 pounds of weight gain is recommended for optimal fetal growth and development.
A nurse is discussing diet with a pregnant woman. Which food should the nurse advise the client to avoid during her pregnancy? 1. Bologna 2. Cantaloupe 3. Spinach 4. Cornbread
1. ~ Hot dogs and other luncheon meats should not be eaten during pregnancy unless they are fully cooked.
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? 1. Breastfeeding requires a continued high intake of protein and calcium. 2. Formula-feeding mothers should protect their health with a lot of calcium. 3. Producing breast milk requires calories, but any source of food is fine. 4. Formula-feeding mothers need a high protein intake to avoid fatigue.
1. ~ Lactation requires calories, along with increased protein and calcium intake.
The nurse is counseling a group of first-trimester clients on diet increases that are necessary during pregnancy. Which information would be necessary to tell the pregnant women? (SATA) 1. An increase of protein is necessary to provide amino acids necessary for fetal development. 2. Protein contributes to the body's overall energy metabolism. 3. The recommended protein during pregnancy is 70 grams each day. 4. The increased amount of protein that a pregnant woman needs is 15 grams a day. 5. The quality of protein is as important as the amount.
1, 2, 3, 5 ~ 1. During pregnancy, the woman needs increased amounts of protein to provide amino acids for fetal development, blood volume expansion, and growth of other maternal tissues. 2. Protein contributes to overall energy metabolism. 3. The amount of protein recommended each day during pregnancy is 70 grams. 5. Plant proteins can meet a woman's protein needs; however, more of a given protein may be needed because animal proteins are of higher quality.
The nurse is planning an early-pregnancy class session on nutrition. Which information should the nurse include? (SATA) 1. Protein is important for fetal development. 2. Iron helps both mother and baby maintain the oxygen-carrying capacity of the blood. 3. Calcium prevents constipation at the end of pregnancy. 4. Zinc facilitates synthesis of RNA and DNA. 5. Vitamin A promotes development of the baby's eyes.
1, 2, 4, 5 ~ 1. During pregnancy, the woman needs increased amounts of protein to provide amino acids for fetal development. 2. Iron deficiency anemia is associated with an increased incidence of preterm birth, low-birth-weight infants, and maternal and infant mortality. 4. Zinc is involved in RNA and DNA synthesis, and milk production during lactation. 5. Vitamin A promotes healthy formation and development of the fetal eyes.
The pregnant client states she does not want to take all these supplements. What recommendations could the nurse make for the client? (SATA) 1. Folic acid has been found to be essential for minimizing the risk of neural tube defects. 2. You do not have to take these supplements if you think you are healthy enough. 3. Most women do not have adequate intake of iron pre-pregnancy, and iron needs increase with pregnancy. 4. These medications do the same thing. I will call your physician to cancel one of your medications. 5. You should take the folic acid, but the vitamins are not that important.
1, 3 ~ 1. An inadequate intake of folic acid has been associated with neural tube defects (NTDs) (e.g., spina bifida, anencephaly). 3. Iron is essential because many pregnant women do not have adequate intake of iron before pregnancy.
The nurse is providing nutritional counseling for a postpartum client with a hemoglobin of 8. Which statement indicates that additional teaching is necessary? 1. "I need to increase food sources that contain iron." 2. "If I drink lots of milk, I will increase my iron level faster." 3. "My iron is low, but it will increase as I take iron supplements." 4. "I might feel less energetic and tire more easily while my iron is low."
2 ~ 1. Anemia requires additional iron. Many foods, such as red meat, will provide iron. Increasing iron-rich foods will improve anemia. 2. Milk does not contain iron; it contains calcium. Increased calcium intake will not increase hemoglobin levels. Further, iron should not be taken with milk, as the iron will not be absorbed. 3. Iron supplements are indicated with anemia. This client's hemoglobin level is 8; lower than 10 is considered anemia during pregnancy. Taking iron will increase hemoglobin. 4. Hemoglobin carries oxygen; when the hemoglobin level is low, the muscles are not adequately oxygenated, especially during activity, and fatigue results
A client tells the nurse that she does not like citrus fruits, and would like suggestions for alternate vitamin C sources. What should the nurse suggest as good sources of vitamin C? (SATA) 1. Barley and brown rice 2. Strawberries and potatoes 3. Buckwheat and lentils 4. Wheat flour and figs 5. Blueberries and broccoli
2, 5 ~ 2. Strawberries and potatoes are very good sources of vitamin C. 5. Cantaloupes and broccoli are very good sources of vitamin C.
A pregnant client who is a lacto-vegetarian asks the nurse for assistance with her diet. What instruction should the nurse give? (SATA) 1. Protein is important; therefore, the addition of one serving of meat a day is necessary. 2. A daily supplement of vitamin B12 is important. 3. The high fiber in a vegetarian diet is dangerous for pregnant women. 4. Eggs are important to add to your diet. Eat six eggs per week. 5. Milk products contain protein, but they are very low in iron.
2, 5 ~ 2. Supplementation may be recommended for vegans who have difficulty meeting the recommended amounts of vitamin B12 through food sources. 5. Milk products will provide needed protein, but are not significant sources of iron.
The breastfeeding mother is concerned that her milk production has decreased. The nurse knows that further client teaching is needed based on which statement? 1. I am drinking a minimum of 8 to 10 glasses of liquid a day. 2. I have started cutting back on my protein intake. 3. At least three times a day, I drink a glass of milk. 4. My calorie intake is higher than during the pregnancy.
2. ~ An adequate protein intake is essential while breastfeeding because protein is an important component of breast milk.
What would the nurse do to accurately assess a pregnant clients food intake? 1. Assess her most recent laboratory values. 2. Ask her to complete a nutritional questionnaire. 3. Observe for signs of hunger. 4. Ask about her cooking facilities.
2. ~ 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.
Which of the following is important for the development of the central nervous system of the fetus? 1. Calcium and phosphorus 2. Essential fatty acids 3. Iron 4. Vitamin D
2. ~ 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.
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? 1. Iron 2. Protein 3. Vitamin C 4. Vitamin D
2. ~ If the carbohydrate intake is not adequate, the body uses protein for energy. Protein then becomes unavailable for growth needs.
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 nurses best response? 1. As long as you supplement your diet with the prenatal vitamin, the amount of weight you gain in pregnancy is not significant. 2. I understand that gaining weight after such an accomplishment might not look attractive, but weight gain during pregnancy is important for proper fetal growth. 3. Dieting during pregnancy is considered child neglect. 4. Excessive weight gain in pregnancy is due to water retention, so weight loss following birth will not be an issue.
2. ~ 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.
A woman confides to the nurse that she has pica. What alternative could the nurse suggest to the client? 1. Replace laundry starch with salt. 2. Replace ice with frozen fruit pops. 3. Replace soap with cream cheese. 4. Replace soil with nuts.
2. ~ Some women are able to switch to frozen fruit pops instead of ice.
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? 1. Gatorade 2. Orange juice 3. Milk 4. Green tea
2. ~ Vitamin C is found in citrus fruits and juices, and is known to enhance the absorption of iron from meat and non-meat sources.
A pregnant teenage client is diagnosed with iron-deficiency anemia. Which nutrient should the nurse encourage her to take to increase iron absorption? 1. Vitamin A 2. Vitamin C 3. Vitamin D 4. Vitamin E
2. ~ Vitamin C is known to enhance the absorption of iron from meat & non-meat sources.
16) The nurse is leading a session on nutrition for postpartum clients. Which statement indicates that teaching has been effective? 1. "Breastfeeding requires that I eat lots of protein daily." 2. "Because I am breastfeeding, I need a low calcium intake." 3. "Since I am bottlefeeding, I don't have to eat vegetables." 4. "Bottlefeeding moms like me require a high sodium intake."
Answer: 1 Explanation: 1. Breastfeeding clients should consume 65 g of protein daily during the first 6 months of breastfeeding and 62 g daily during the second 6 months. Protein is a major ingredient in breast milk. 2. Breastfeeding requires an increase of 1000 mg per day of calcium—the same amount of calcium that is recommended during pregnancy. 3. Although vitamin intake is not directly related to bottlefeeding, good nutritional habits are important to form while bottlefeeding, because in the future, the baby will be eating what the mother eats. 4. Sodium intake is not increased during bottlefeeding.
3) The nurse instructs on the importance of niacin during a preconception counseling class. Which food item selected by a participant indicates that teaching about the sources of niacin has been effective? 1. Fish 2. Milk 3. Apples 4. Broccoli
Answer: 1 Explanation: 1. Dietary sources of niacin include meats, fish, and enriched grains. 2. Milk will provide sources of other vitamins; however, it does not contain significant niacin. 3. Apples will provide sources of other vitamins; however, they do not contain significant niacin. 4. Broccoli will provide sources of other vitamins; however, it does not contain significant niacin.
6) The nurse reviews nutritional requirements with a breastfeeding mother who is concerned that her milk production has decreased. Which statement indicates that further teaching is required? 1. "I have started cutting back on my protein intake." 2. "At least 3 times a day, I drink a glass of milk." 3. "I am drinking a minimum of 8 to 10 glasses of liquid a day." 4. "I try to take a nap in the morning and afternoon when the baby is sleeping."
Answer: 1 Explanation: 1. It is especially important for the breastfeeding mother to consume sufficient calories because inadequate caloric intake can reduce milk volume. The decreased intake of protein represents a decrease in calories, which will decrease milk production. 2. The breastfeeding mother must increase her protein and calcium intake. 3. The breastfeeding mother must consume a minimum of 8 to 10 glasses of liquid per day. 4. It has also been found that adequate rest is necessary for the body to maintain its production of milk.
22) A pregnant client is reviewing the tentative buffet menu for her upcoming baby shower. Which items should the nurse suggest be substituted to ensure the health of the client and developing fetus? Select all that apply. 1. Baked brie with crackers 2. Greek salad with feta cheese 3. Caesar salad with sourdough croutons 4. Salmon pate with toasted bread rounds 5. Grilled orange roughy with summer vegetables
Answer: 1, 2, 3, 4 Explanation: 1. Soft cheese such as brie should be avoided because of the potential for harboring Listeria. 2. Soft cheese such as feta should be avoided because of the potential for harboring Listeria. 3. Salad dressings such as caesar are made with raw eggs, which should be avoided because of the potential for a Salmonella infection. 4. Pates should be avoided because of the potential for harboring Listeria. 5. There are no known bacterial infection issues associated with eating grilled orange roughy and summer vegetables while pregnant.
21) The nurse is instructing a newly pregnant client who follows a vegan eating plan about folic acid. What should the nurse include when teaching the client about this nutrient? Select all that apply. 1. The best sources are fresh green leafy vegetables. 2. Overcooking foods high in folic acid is preferred. 3. Foods high in folic acid should be protected from light. 4. Cook foods high in folic acid with small amounts of water. 5. Peanuts and whole-grain breads and cereals are good sources.
Answer: 1, 3, 4, 5 Explanation: 1. Sources for folic acid include fresh green leafy vegetables. 2. To prevent unnecessary loss, foods with folic acid should not be overcooked. 3. To prevent unnecessary loss, foods with folic acid should be stored covered to protect them from light. 4. To prevent unnecessary loss, foods with folic acid should be cooked with only a small amount of water. 5. Sources of folic acid include peanuts and whole-grain breads and cereals, which are all appropriate for the vegan eating plan.
12) When preparing nutritional instruction, which pregnant client should the nurse consider the highest priority? 1. 40-year-old gravida 2 2. 35-year-old gravida 4 3. 15-year-old nulligravida 4. 22-year-old primigravida
Answer: 3 Explanation: 1. The 40-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus. 2. The 35-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus. 3. Adolescent clients typically are still in their own growth cycle. Suddenly, they have to supply nutrition for themselves and the fetus. This places them at greatest risk for malnutrition. 4. The 22-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus.
20) The nurse is preparing a teaching guide to be used for prenatal, pregnancy, and postpartum nutritional classes. Which nutrients should the nurse emphasize that remain consistent throughout these gestational periods? Select all that apply. 1. Fat 2. Iron 3. Protein 4. Vitamin K 5. Pyridoxine
Answer: 1, 4 Explanation: 1. Fat requirements are unchanged during pregnancy and should account for about 20% to 35% of daily caloric intake, of which 10% or less should be saturated fat. 2. Iron requirements increase during pregnancy because of the growth of the fetus and placenta and the increased maternal blood volume. 3. The protein requirement for a pregnant woman is 60 g/day, an increase of 14 g over nonpregnant levels. 4. The recommended daily allowance (RDA) for vitamin K, 90 mcg per day, does not increase during pregnancy. 5. The recommended daily allowance (RDA) during pregnancy for pyridoxine is 1.9 mg/day, an increase of 0.6 mg over the allowance for nonpregnant women.
19) A client who became pregnant at a weight of 60 kg and a BMI of 16 has gained 4 kg at the end of the 5th gestational month. How many more pounds of weight should the nurse counsel this client to gain to achieve the least amount of weight that an underweight person should gain while pregnant?
Answer: 19.2 lb Explanation: For a client with a BMI less than 18.5, the weight gain for the total pregnancy should be between 28 and 40 lb. The client has gained 4 kg, or 8.8 lb. To achieve the minimal amount of weight that the client should gain during the entire pregnancy, subtract the amount of weight gained from the minimal amount, or 28 lb - 8.8 lb = 19.2 lb.
18) A newly pregnant client weighs 75.0 kg and has a body mass index of 28.5. What is the maximum amount of weight in pounds that this client should weigh during the pregnancy?
Answer: 190 lb Explanation: For a client with a BMI between 25.0 and 29.9, the weight gain for the total pregnancy should be between 15 and 25 lb. This client's weight is 75 kg. To determine the maximum amount of weight to gain, first determine the client's weight in pounds by multiplying the weight in kilograms by 2.2, or 75.0 × 2.2 = 165 lb. Then add the maximum amount of weight of 25 lb to this total, or 165 + 25 = 190 lb.
10) Which client statement on cultural or religious influences on nutrition requires intervention? 1. "I avoid milk and meat at meals because I am Jewish." 2. "My auntie sent me clay from the south to eat every day." 3. "Because I am Muslim, I do not ever eat any pork products." 4. "My grandmother makes sure I eat a serving of greens each day."
Answer: 2 Explanation: 1. A kosher diet involves avoiding pork and shellfish and not eating dairy and meat at the same meal. 2. Eating clay is pica. The clay, being a type of soil, can be contaminated with hazardous substances and should be avoided. Some African Americans, especially those from the South, practice clay-eating pica. 3. Dietary restrictions in the Muslim tradition include avoidance of pork. Because other meats are eaten, the client is not at risk for protein or iron deficiency. 4. Greens, such as collard greens and spinach, have high amounts of folic acid and are healthy foods to eat during pregnancy. Women from the southern United States often eat greens.
5) The nurse is providing nutritional counseling for a postpartum client with a hemoglobin of 8. Which statement indicates that additional teaching is necessary? 1. "I need to increase food sources that contain iron." 2. "If I drink lots of milk, I will increase my iron level faster." 3. "My iron is low, but it will increase as I take iron supplements." 4. "I might feel less energetic and tire more easily while my iron is low."
Answer: 2 Explanation: 1. Anemia requires additional iron. Many foods, such as red meat, will provide iron. Increasing iron-rich foods will improve anemia. 2. Milk does not contain iron; it contains calcium. Increased calcium intake will not increase hemoglobin levels. Further, iron should not be taken with milk, as the iron will not be absorbed. 3. Iron supplements are indicated with anemia. This client's hemoglobin level is 8; lower than 10 is considered anemia during pregnancy. Taking iron will increase hemoglobin. 4. Hemoglobin carries oxygen; when the hemoglobin level is low, the muscles are not adequately oxygenated, especially during activity, and fatigue results.
7) The nurse is conducting a postpartum visit to a client who is formula-feeding her infant. Which client statement indicates that teaching about weight maintenance has been effective? 1. "I have increased my caloric intake by 600 calories per day." 2. "My dietician has set my weight loss goal at 1 to 2 pounds per week." 3. "Instead of making another doctor's appointment, I started a diet that my best friend recommended." 4. "My daily regimen includes taking extra vitamin A, vitamin C, and thiamine in order to meet my body's increased need for nutrients after pregnancy."
Answer: 2 Explanation: 1. If the mother has a good understanding of nutritional principles, it is sufficient to advise her to reduce her daily caloric intake by about 300 kcal and to return to prepregnancy levels for other nutrients. 2. Weight loss goals of 1 to 2 pounds (0.45 to 0.9 kg)/week are usually suggested for mothers who formula-feed. 3. The woman should diet only under the guidance of her primary healthcare provider. 4. After birth, the formula-feeding mother's dietary requirements return to prepregnancy levels.
17) The nurse is preparing a prenatal class about infant feeding methods to include maternal nutritional requirements for breastfeeding and formula-feeding. What statement should the nurse include? 1. "Formula-feeding mothers need a high protein intake to avoid fatigue." 2. "Producing breast milk requires calories, but any source of food is fine." 3. "Breastfeeding requires a continued high intake of protein and calcium." 4. "Formula-feeding mothers should protect their health with a lot of calcium."
Answer: 3 Explanation: 1. Formula-feeding moms do not need additional nutrients. 2. Although any food source would provide the additional calories, these needs are best met by using increased protein intake as the source for the required additional calories to support milk production. 3. Lactation requires calories, along with increased protein and calcium intake. 4. Formula-feeding mothers do not need additional nutrients.
2) The nurse is preparing an antenatal nutrition class for pregnant women. Which material should be included in the teaching? 1. During pregnancy, consumption of oily fish should be avoided. 2. Dietary protein can only be obtained through consuming dairy, meat, and eggs. 3. Nutritional iodine requirements generally can be met through intake of iodized salt. 4. Iron absorption is generally higher for vegetable products than for animal products.
Answer: 3 Explanation: 1. Oily fish provide the best source of docosahexaenoic acid (DHA), which may reduce the risk of preterm birth, preeclampsia, low birth weight, and enhance fetal and infant brain development. 2. Excluding dairy, meat, and eggs, adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. 3. Intake of iodized salt generally provides the recommended intake of iodine. 4. Iron absorption is generally higher for animal products than for vegetable products.
13) Which statement is best to include when teaching a pregnant adolescent about nutritional needs? 1. "You just need to pay attention to what you eat now." 2. "Folic acid intake is the key to having a healthy baby." 3. "It is important eat iron-rich foods like meat every day." 4. "Calcium and milk aren't needed until the third trimester."
Answer: 3 Explanation: 1. This response is too vague to be helpful. Adolescents will need specific information to improve nutrition during pregnancy. 2. Although folic acid is important during pregnancy to prevent neural tube defects, and for lactation, there is not one single nutritional element responsible for having a healthy baby. 3. Adolescents often have an iron intake that is inadequate for pregnancy. Giving specific examples is most helpful when providing nutritional information. 4. Calcium is needed throughout pregnancy and should be consumed daily.
11) A pregnant 14-year-old client confides having problems with bulimia nervosa. Which nursing observation best supports the client's statement? 1. The client reports dietary cravings for soil and clay. 2. In terms of food variety and quantity, the client's diet is extremely restrictive. 3. Despite being extremely underweight, the client describes herself as being fat. 4. The client is of normal weight for her height and reports binge eating followed by purging.
Answer: 4 Explanation: 1. Dietary cravings for and consumption of nonnutritive substances is consistent with pica. 2. The dietary intake of individuals with anorexia nervosa is very restrictive in both variety and quantity. 3. Anorexia nervosa is an eating disorder characterized by an extreme fear of weight gain and becoming fat, and it incorporates a self-perception of being overweight even when the individual is extremely underweight. 4. Bulimia is characterized by binge eating and purging, and individuals with bulimia nervosa often maintain normal or near-normal weight for their height.
1) A 15-year-old primipara at 8 weeks' gestation who is 64 inches tall and weighs 115 pounds asks why she is supposed to gain so much weight. What is the best response by the nurse? 1. "Inadequate weight gain delays lactation after delivery." 2. "It's what your certified nurse-midwife recommended for you." 3. "Weight gain is important to assure that you get enough vitamins." 4. "Gaining 25 to 35 pounds is recommended for healthy fetal growth."
Answer: 4 Explanation: 1. Inadequate weight gain can lead to decreased fetal growth and development. 2. Although this statement might be true, the client has asked a "why" question that should be directly answered. 3. Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet is probably not optimal, and her intake of empty calories or junk food might make up the majority of her caloric intake. 4. Adolescents who become pregnant less than 4 years after menarche are at risk because of their physiologic and anatomic immaturity. They are more likely than older adolescents to still be growing, which can affect the fetus's development.
9) A pregnant client who is a lacto-ovo vegetarian asks for help planning a diet that includes adequate protein intake. What instruction should the nurse give? 1. "To improve protein absorption, avoid simultaneous intake of animal protein and plant protein." 2. "Following a lacto-ovo vegetarian diet will require you to take a daily supplement of vitamin B12." 3. "Because you don't eat meat, eggs, or dairy products, it's important to eat adequate plant-based proteins." 4. "In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective sources of plant-based proteins."
Answer: 4 Explanation: 1. Plant protein quality can be improved if it is consumed with certain animal proteins. 2. Vegan diets, in which no animal products are consumed, often require daily supplementation of vitamin B12. 3. While lacto-ovo vegetarians do not eat meat, they do eat eggs, milk, and dairy products. 4. A diet that includes plant proteins, such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk, helps ensure the expectant mother obtains all the essential amino acids.
8) The nurse is planning an educational session for pregnant clients who are vegans. What information should the nurse include? 1. Vegan diets are high in iron. 2. Rice contains a high level of vitamin B12. 3. Soy is not a good source of protein for vegans. 4. Eating beans and rice provides complete protein needs.
Answer: 4 Explanation: 1. Vegan diets are low in iron, and pregnant vegans often experience anemia. 2. Rice does not contain vitamin B12. 3. Soy is a very good source of protein and calcium and is safe during pregnancy. 4. Complete proteins can be obtained by eating different types of plant-based proteins such as beans and rice.
4) It has been identified that a pregnant client's diet is low in zinc. Which food should the nurse suggest to increase intake of this mineral? 1. Yogurt 2. Bananas 3. Cabbage 4. Shellfish
Answer: 4 Explanation: 1. Yogurt is high in other nutrients but does not have significant levels of zinc. 2. Bananas are high in other nutrients but do not have significant levels of zinc. 3. Cabbage is high in other nutrients but does not have significant levels of zinc. 4. Zinc is found in greatest concentration in meats and meat by-products. Enriched grains also tend to be high in zinc.
