Chapter 12: Healthy Eating for Healthy Babies PrepU Quiz Questions

Women who are obese (BMI >30) are encouraged to gain 11 to ______ pounds in pregnancy. Enter the correct number ONLY.

20 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..

All women with a BMI of _____ or higher should be counseled about the risks of unhealthy weight to maternal health and future pregnancies.

25 All women with a BMI of 25 or higher should be counseled about the risks of unhealthy weight to maternal health and future pregnancies and given guidance to help them attain and maintain healthy body weight

The client should consume _____ cups of dairy throughout the pregnancy.

3 According to the My Plate recommendation, Figure 12.5, nonpregnant women and women in all trimesters should consume 3 cups (0.7 L) of dairy per day. 1 cup (0.23 L) from the dairy group counts as 1 cup dairy milk or yogurt, 1 cup lactose-free dairy milk or yogurt, 1 cup fortified soy milk or yogurt or 1.5 ounces (42.5 g) hard cheese.

The nurse is seeing a pregnant 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? a. preterm birth. b. low-birth-weight newborns. c. birth defects. d. learning disabilities

b. 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).

A woman who smokes is ____ as likely to deliver a low-birth-weight baby. a. four times b. twice c. half d. one quarter

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

At her first prenatal visit, an overweight woman asks how much weight she should gain during the course of her pregnancy. What is the nurse's best response? a. "You should not gain any weight during your pregnancy.You have adequate calorie reserves to meet all the energy demands of pregnancy without gaining additional weight." b. "You should try to gain less than 15 pounds." c. "Aim for a 15- to 25-pound weight gain." d. "The recommended weight gain for your weight is 25 to 35 pounds."

c. "Aim for a 15- to 25-pound weight gain."

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? a. "To prevent macrosomia, I will need to gain less weight than the recommended amount." b. "I will need a minimum of 150 grams of carbohydrates daily." c. "I should exercise if there are no medical or obstetrical complications." d." My glucose control may be improved if I allow more carbohydrates at breakfast and fewer at other meals."

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

Which of the following statements is true? a. "Women who breastfeed almost always achieve their pre-pregnancy weight at 6 weeks postpartum." b. "Weight loss during lactation is not recommended because it lowers the quantity and quality of breast milk produced." c. "Most breastfeeding women do not have to increase their intake by the full amount of calories it 'costs' to produce milk because they can mobilize fat stored during pregnancy for some of the extra energy required." d. "Women do not need to increase their calorie intake at all for the first 6 months of breastfeeding because they can use calories stored in fat to produce milk."

c. "Most breastfeeding women do not have to increase their intake by the full amount of calories it 'costs' to produce milk because they can mobilize fat stored during pregnancy for some of the extra energy required."

A mother is at her first prenatal visit and is inquiring about folic acid requirements. What would be the nurse's best reponse? a. "You should consume 100-200 mcg of folic acid per day." b. "You do not need to worry about eating folic acid-fortified cereals as supplementation should suffice." c. "The most important time to take folic acid is 1 month before conception and 2-3 months after conception." d. "Natural folate found in food is better absorbed than supplements."

c. "The most important time to take folic acid is 1 month before conception and 2-3 months after conception." The U.S. Preventive Services Task Force, along with many other health-related organizations, recommends that all women who are planning pregnancy or capable of becoming pregnant take a daily multivitamin supplement containing 400 to 800 mcg of folic acid based on high certainty that the net benefit in preventing neural tube defects in the developing fetus is substantial. Most women do not obtain the recommended daily intake of folate from food alone. The critical period for supplementation begins at least 1 month before conception and continues through the first 2 to 3 months of pregnancy. Because half of all pregnancies are unplanned, all women who are capable of becoming pregnant should be advised to take folic acid supplements. Synthetic folic acid in supplements and fortified food is better absorbed and has greater availability than natural folate in food. Folic acid-fortified foods and food sources of natural folate are encouraged in addition to using either a multivitamin or an individual folic acid supplement.

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? a. 1 cup of fruit juice for breakfast b. 2 cups of green salad for lunch and dinner c. 1 cup of skim milk for breakfast, lunch and dinner d. 2 slices of bread for breakfast only

c. 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.

A pregnant woman has come to the clinic for her first prenatal visit. The nurse is assessing her for a high-risk pregnancy. Which disorder is most likely to result from a high-risk pregnancy due to inadequate nutrition? a. constipation b. low-birth-weight infant c. diabetes insipidus d. large-for-gestational-age infant

b. low-birth-weight infant Inadequate nutrition is most likely to result in a low-birth weight infant. High BMI and excessive food intake are more likely to result in gestational diabetes and large-for-gestational-age infant. Constipation is a common complication in many pregnancies and isn't necessarily related to nutrition.

Recent studies suggest that nutritional deficiencies during the second trimester increase the risk of chronic diseases later in the infant's life. True/False

False Recent studies suggest that nutritional deficiencies during the first trimester increase the risk of certain chronic diseases later in the infant's life.

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.

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).

Women with a BMI equal to or greater than _________ are considered obese. Enter the correct number ONLY.

30 Underweight BMI: less than 18.5 Normal/healthy BMI: 18.5-24.9 Overweight BMI: 25-29.9 Obese: equal to or greater than 30

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

330 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

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

35 Factors associated with high-risk pregnancies are being 17 years old or younger and being 35 years old or older.

Women who are underweight prepregnancy (BMI < 18.5) are encouraged to gain 28 to ______ pounds in pregnancy. Enter the correct number ONLY.

40 Recommended weight gain in pregnancy is 25 to 35 pounds for women of normal weight, 28 to 40 pounds for underweight women, 15 to 25 pounds for those classified as overweight, and 11 to 20 pounds for those who are obese.

The recommended dosage of folate for non-pregnant 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 knows that nutrient needs do not increase proportionately. What percentage does iron intake need to increase during pregnancy? Enter the correct number ONLY.

50 Nutrient needs do not increase proportionately. For instance, the need for iron increases by 50% during pregnancy, yet the requirement for vitamin B12 increases by only about 10%. Actual requirements during pregnancy vary among individuals and are influenced by previous nutritional status and health history including chronic illnesses, multiple pregnancies, and closely spaced pregnancies.

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

6

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.

A recent U.S. study found what percentage of women experience excessive gestational weight gain? Enter the correct number ONLY.

73 Approximately one in five American women begins pregnancy overweight, and one in six is obese at the time of conception (Andres, Shankar, and Badger, 2012).

A client is concerned that she will be unable to consume the recommended amount of calcium during pregnancy as she does not like dairy. Which alternatives will the nurse suggest to the client? Select all that apply. a. Collards b. Okra c. Turnip greens d. Nonfortified almond milk e. Spinach

a. Collards, b. Okra & c. Turnip greens Natural sources that contain calcium are milk, yogurt, hard natural cheese, pasteurized processed American cheese, bok choy, broccoli, Chinese/Napa cabbage, collards, kale, okra, turnip greens, legumes, and almonds. Fortified foods that contain calcium are fortified breakfast cereals, fortified orange juice, and fortified brands of nondairy milks (almond, soy, rice, coconut).

When counseling pregnant clients about weight status, which teaching will the nurse give? a. Women who are overweight or obese frequently exceed gestational weight gain (GWG) recommendations during pregnancy. b. The ideal time to attain healthy weight is just before planning pregnancy. c. All women with a body mass index (BMI) of 20 or higher should be counseled about the risks of unhealthy weight to maternal health and future pregnancies. d .Women who are contemplating pregnancy will need to determine their weight status after they are pregnant.

Women who are overweight or obese frequently exceed gestational weight gain (GWG) recommendations during pregnancy. Women who are overweight or obese frequently exceed gestational weight gain (GWG) recommendations during pregnancy. Because achieving healthy weight can take months to years to accomplish, the ideal time to attain healthy weight may be during adolescence when most women are not planning pregnancy. All women who are contemplating pregnancy should be screened during the preconception period to determine their weight status. All women with a BMI of 25 or higher should be counseled about the risks of unhealthy weight to maternal health and future pregnancies and given guidance to help them attain and maintain healthy body weight. A BMI of 20 is within the healthy range.

A woman who was at her healthy weight when she got pregnant is distraught by her 4-pound weight gain between 20 and 24 weeks of gestation. Her weight gain up to 20 weeks was on target. What is the nurse's best response? a. "A 4-pound-per-month weight gain at this point in your pregnancy is normal." b. "Although it is considerably less than the recommended amount, it is not a cause for concern. Just be sure to follow your meal plan next month so you get enough calories and nutrients." c. "I recommend you write down everything you eat for a few days so we can identify where the problem lies." d. "A 4-pound weight gain in 1 month at this point in your pregnancy may be a sign that you are at risk of preeclampsia. You should cut back on the 'extras' in your eating pattern to limit your weight gain for next month."

a. "A 4-pound-per-month weight gain at this point in your pregnancy is normal."

Despite eating small, frequent meals as suggested, a pregnant client reports continued nausea and vomiting. What additional suggestion should the nurse make? a. "Eat dry crackers before getting out of bed." b. "Drink green tea with each meal." c. "Keep hard candy available." d. "Increase fiber intake."

a. "Eat dry crackers before getting out of bed." Nutrition interventions to help with nausea and vomiting include eating easily digested carbohydrate foods such as dry crackers before getting out of bed in the morning; eating frequent, small snacks of dry carbohydrates; eating small, frequent meals; avoiding liquids with meals; limiting high-fat foods; and eliminating individual intolerances and foods with strong odor. Drinking green tea, sucking hard candy, and increasing fiber intake won't alleviate nausea and vomiting, though fiber can help address constipation associated with pregnancy.

The nurse is seeing a client who is trying to get pregnant. The client asks whether or not she should stop drinking alcohol. Which of the following responses by the nurse is correct? a. "You should completely avoid alcohol before and during pregnancy." b. "The claim that alcohol is a potent teratogen during pregnancy is unfounded." c. "Fetal alcohol syndrome is rare with minimal alcohol intake" d. "It is safe to continue drinking wine at dinner until your pregnancy is confirmed."

a. "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.

A woman is pregnant with twins; her prepregnancy BMI is 30. This woman should gain how much weight in pounds? a. 25-42 pounds b. 31-50 pounds c. 28-40 pounds d. 37-54 pounds

a. 25-42 pounds According to Table 12.1 weight gain is as follows based off of prepregnancy BMI. Underweight (<18.5) is 28-40 pounds with an unspecified weight gain for twins. Normal weight (18.5-24.9) is 25-35 pounds with 37-54 pound weight gain for twins. Overweight (25-29.9) is 15-25 pounds with 31-50 pound weight gain for twins. Obese (30 or greater) is 11-20 pounds with 25-42 pound weight gain for twins.

Which of the following statements express the basic principles of healthy eating before, during, and after pregnancy? Select all that apply. a. Eat whole-grain bread and cereals. b. Eat plenty of fruits and vegetables. c. Use saturated fats when preparing foods. d. Eat lean protein foods. e. Drink whole milk.

a. Eat whole-grain bread and cereals, b. Eat plenty of fruits and vegetables & d. 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.

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

a. False Additional calories are needed to support growth of the fetus and maternal tissues, but the increase is relatively small. Regardless of maternal weight status, the Institute of Medicine (2009) recommends the following: 1st trimester: no extra calories, 2nd trimester: additional 340 cal/day, 3rd trimester: additional 452 cal/day.

Which of the following recommendations promote a healthy eating pattern for pregnant women? Select all that apply. a. Follow food safety guidelines to reduce the risk of food-borne illness. b. Eat a variety of nutrient-dense foods and beverages among the basic food groups. c. Include an adequate amount of vegetables, fruits, whole grains, and milk and milk products. d. Avoid excessive intake of cholesterol, added sugars, and salt. e. Limit intake of polyunsaturated fat.

a. Follow food safety guidelines to reduce the risk of food-borne illness, b. Eat a variety of nutrient-dense foods and beverages among the basic food groups., c. Include an adequate amount of vegetables, fruits, whole grains, and milk and milk products & d. Avoid excessive intake of cholesterol, added sugars, and salt.

During a clinic visit, the mother of a 3-month-old infant tells the nurse the baby is taking phenyl-free formula. For what reason would the infant require this type of formula? a. Inborn error of metabolism b. Constipation c. Gastroesophageal reflux d. Cystic fibrosis

a. Inborn error of metabolism There are specialty formulas for infants with inborn errors of metabolism, such as phenylketonuria or maple syrup urine disease. This type of formula would not be suitable for the other infant conditions in the answer options.

What nutrient is not likely to be consumed in adequate amounts during pregnancy so a supplement may be needed? a. Iron b. Vitamin A c. Vitamin B12 d. Vitamin C

a. Iron

Nutritional requirements for which of the following increase from 18 mg for nonpregnant women to 27 mg during pregnancy? a. Iron b. Calories c. Vitamin A d. Protein

a. Iron The Recommended Dietary Allowance (RDA) for iron increases from 18 to 27 mg/day during pregnancy to support the increase in maternal blood volume and to provide iron for fetal liver storage, which sustains the infant for the first 4 to 6 months of life.

A woman at 5 weeks of gestation is complaining of nausea throughout the day. What should the nurse recommend? a. Small, frequent meals of easily digested carbohydrates b. Small, frequent meals that are high in protein c. A liquid diet until the nausea subsides d. Increasing fluids with all meals and snacks

a. Small, frequent meals of easily digested carbohydrates

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? a. Snack on dry crackers and hard candy throughout the day b. Sip on warm water with lemon juice in the morning c. Drink 8-8 ounce glasses of water each day d. Avoid coffee and other caffeinated beverages

a. 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 providing a list to include which of the following types of fish that should not be eaten by women who are pregnant or breastfeeding? Select all that apply. a. Tilefish b. Shark c. King mackerel d. Albacore/white tuna e. Salmon

a. Tilefish, b. Shark & c. King mackerel Two to 3 servings/week are recommended from among the best choices: anchovy, Atlantic herring, Atlantic mackerel, mussels, oysters, farmed and wild salmon, sardines, canned light tuna, snapper, and trout. Good choices are recommended once a week and include bluefish, Chilean sea bass, grouper, halibut, mahi mahi, monkfish, snapper, and albacore/white tuna (canned, fresh, or frozen). The following fish have the highest mercury levels and should be avoided by pregnant women: king mackerel, marlin, orange roughy, shark, swordfish, tilefish (from the Gulf of Mexico), and bigeye tuna.

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? a. consume 400 micrograms (ug) per day of folic acid. b. increase daily intake by 500 calories c. avoid aerobic exercise d. plan to gain 10 pounds in the first trimester.

a. consume 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.

The nurse is seeing a [pregnant client who reports having constipation. The nurse should recommend which of the following interventions? a. drinking at least eight 8-oz glasses of liquid daily b. avoiding coffee and high-fat foods c. decreasing intake of whole-grain breads and cereals d. eating small frequent meals and eliminate liquids immediately after meals

a. drinking at least eight 8-oz glasses of liquid daily

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? a. Consumes red meat twice a week b. Smokes 5 cigarettes a day c. Drinks 3 glasses of skim milk a day d. Eats fish several times a week

b. 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 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? a. engage in safe exercise, paying attention to fall risk. b. participate in contact sports if she was involved before she became pregnant. c. be in supine position for physical activity during the second and third trimesters. d. get at least 20 minutes of low-impact exercise three times a week.

a. engage in safe exercise, paying attention to fall risk. 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. a. fortified breakfast cereals. b. fish c. white bread and rolls made with enriched flour d. multivitamins e. apples and bananas

a. fortified breakfast cereals, c. white bread and rolls made with enriched flour & d. 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.

A client who is pregnant is concerned about eating fish due to the risk of consuming methylmercury. The nurse should recommend she avoid what type of fish to decrease the exposure to mercury? a. king mackerel b. tuna c. trout d. salmon

a. king mackerel Although most types of fish contain at least some small amount of mercury, the health benefits of eating fish typically outweigh any risks associated with the substance. However, women who are pregnant or may become pregnant, lactating females, and young children are advised to avoid species known to be high in mercury, including shark, marlin, swordfish, king mackerel, and tilefish. Instead, women who are pregnant or breastfeeding should focus on species that contain less mercury, such as salmon, tuna, and trout, anchovies, sardines, and halibut.

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

a. true Items to avoid during pregnancy: alcohol, herbal supplements, unpasteurized juice, milk, and cheese; raw seafood, undercooked eggs and meats, premade deli salads, raw sprouts, cold hot dogs, and luncheon meats. Pregnant women should avoid herbal supplements unless approved by a physician.

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: a. true. b. false.

a. true. The use of nonnutritive sweeteners during pregnancy has been studied extensively. Acesulfame potassium (Sunett, 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: a. true. b. false.

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

Which of the following statements indicates that the pregnant woman understands the recommendations about caffeine intake during pregnancy? a. "I have to give up drinking coffee and cola." b. "I will limit my intake of coffee to about 2-3 cups a day and avoid other sources of caffeine." c. "As long as I don't drink coffee, I can eat other sources of caffeine because they don't contain enough to cause any problems." d. "Caffeine is harmless during pregnancy, so I am allowed to consume as much as I want."

b. "I will limit my intake of coffee to about 2-3 cups a day and avoid other sources of caffeine."

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? a. "You may breastfeed as long as you take your HIV meds and do not miss any doses." b. "No, you should not breastfeed because you are positive for HIV." c. "You may breastfeed as long as you pump and give your baby expressed breast milk." d. "There is no evidence that your baby will be exposed to HIV if you breastfeed."

b. "No, you should not breastfeed because you are positive for HIV." Mothers should not breastfeed or feed expressed breast milk if an infant is diagnosed with galactosemia, a rare genetic metabolic disorder, the mother uses illegal drugs, such as PCP or cocaine, the mother is infected with HIV, the mother is infected with human T-cell lymphotropic virus type 1 or type 2, or the mother has suspected or confirmed Ebola virus disease.

A woman trying to become pregnant was told by her physician to take a daily supplement containing 400 mg of folic acid. She asks why a supplement is better than eating natural sources of folate through food. Which statement is the nurse's best response? a. "There are few natural sources of folate in food." b. "Synthetic folic acid in supplements and fortified foods is better absorbed, more available, and a more reliable source than the folate found naturally in food." c. "Folate in food is equally as good as folic acid in supplements. It is just easier to take it in pill form and then you don't have to worry about how much you're getting in food." d. "If you are sure that you eat at least five servings of fruits and vegetables every day, you don't really need to take a supplement of folic acid."

b. "Synthetic folic acid in supplements and fortified foods is better absorbed, more available, and a more reliable source than the folate found naturally in food."

Mrs. M, a 30-year-old, presents at the labor and delivery suite in active labor. Her prenatal history reveals that Mrs. M was overweight at conception and has gained more than the recommended amount of weight during her pregnancy. What is her infant at risk for later in life? Select all that apply. a. Iron deficiency anemia b. Type 2 diabetes mellitus c. Cancer d. Asthma e. Obesity

b. Type 2 diabetes mellitus, c. Cancer, d. Asthma & e. Obesity

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

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

The nurse is creating a chart to provide visualization of weight gain for women from all body mass index (BMI) categories. What rate should the nurse distinguish for second trimester weight gain for a client who had a prepregnancy BMI of 27.5? a. 0.8 lbs per week b. 0.6 lbs per week c. 1 lbs per week d. 0.4 lbs per week

b. 0.6 lbs per week For women with a BMI less than 18.5 (underweight) they should gain 28-40 lbs (12.7-18.1 kg) with an average weight gain of 1 (1-1.3) lbs per week in the second and third trimester. For women with a BMI 18.5-24.9 (normal weight) they should gain 25-35 ils (11.3-15.8 kg) with an average weight gain of 1 (0.8-1) lbs per week in the second and third trimester. For woman with a BMI of 25-29.9 (overweight) they should gain 15-25 lbs (6.8-11.3 kg) with an average weight gain of 0.6 (0.5-0.7) lbs per week in the second and third trimester. For a woman with a BMI of 30 or greater they should gain 11-20 lbs (4.9-9.0 kg) with an average weight gain of 0.5 (0.4-0.6) lbs per week.

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? a. height b. BMI c. Percent body fat d. weight

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

The nurse is teaching a pregnant client about safety issues during a prenatal visit. The nurse advises the client that infection with which foodborne organism typically results in spontaneous abortion or stillbirth? a. Escherichia coli b. Listeria monocytogenes c. Salmonella d. Clostridium perfringens

b. Listeria monocytogenes The nurse advises the client that infection with Listeria monocytogenes typically results in spontaneous abortion or stillbirth. Clostridium perfringens may cause a potentially fatal illness, called Pig Bel (enteritis necroticans), but is rare in the United States. Up to 10% of Escherichia coli infections result in kidney failure, which may cause permanent damage or death. Long-term arthritis can follow Salmonella infection.

Which statement about listeriosis and pregrnant women reflects understanding by the nurse? a. Pregnant women are 3 times more likely to get listeriosis than other healthy adults. b. Listeriosis is rare except in pregnant women, newborns, older adults, and people with weakened immune systems. c. This is the bacterium that makes it necessary for pregnant women to avoid changing cat litter. d. Listeriosis is usually a mild illness for the fetus or newborn but causes severe disease in the pregnant mother.

b. Listeriosis is rare except in pregnant women, newborns, older adults, and people with weakened immune systems. Listeriosis is rare except in pregnant women, newborns, older adults, and people with weakened immune systems. Listeriosis is usually a mild illness for pregnant women but causes severe disease in the fetus or newborn and may result in miscarriage, stillbirth, preterm labor, or newborn death. Rather than 3 times, pregnant women are 10 times more likely to get listeriosis than other healthy adults. Toxoplasma gondii is a parasite that makes it necessary for pregnant women to avoid changing cat litter, not the bacterium known as listeriosis.

When providing prenatal education, which conditions or circumstances will the nurse exclude from a list of pregnancy high risks? Select all that apply. a. Maternal age of 16 b. Micronutrient supplementation c. Uncontrolled hypertension d. Gestational diabetes e. Smoking, drinking, or using drugs

b. Micronutrient supplementation Lifestyle factors are among the several factors that influence whether a pregnancy is considered high risk, including a maternal age under 17. Preexisting maternal health conditions also contribute to pregnancy risks such as obesity, overweight, underweight, hypertension, diabetes, PCOS, kidney disease, respiratory disease, and autoimmune diseases. Lifestyle behaviors also contribute to pregnancy risks such as alcohol use, tobacco use, and drug use. Conditions of pregnancy such as multiple gestation, gestational diabetes, preeclampsia and eclampsia, previous preterm birth or stillbirth and a history of giving birth to an infant with birth defects are associated with increased pregnancy risks. Although multiple micronutrient supplementation initiated during pregnancy appears to be too little, too late to fundamentally improve child health outcomes, it is not associated with increased pregnancy risks.

How many extra calories per day should a client in her first trimester of pregnancy expect to eat? a. 300 calories/day extra b. No extra calories c. 200 calories/day extra d. 100 calories/day extra

b. No extra calories Additional calories are needed to support growth of the fetus and maternal tissues, but the inrease is relatively small. Regardless of maternal weight status, the Institute of Medicine (2009) recommends the following: 1st trimester: no extra calories; 2nd trimester: +340 cal/day, 3rd trimester: +452 cal/day.

Which of the following statements about preeclampsia are CORRECT? Select all that apply. a. Proper nutrition during pregnancy will prevent preeclampsia. b. Preeclampsia is 3 times more common in obese women. c. Taking calcium during pregnancy will cure preeclampsia. d. Symptomatology of preeclampsia includes gestational hypertension and proteinuria. e. Preeclampsia is 2 times more common in overweight women.

b. Preeclampsia is 3 times more common in obese women, d. Symptomatology of preeclampsia includes gestational hypertension and proteinuria & e. Preeclampsia is 2 times more common in overweight women.

A pregnant woman is in the third trimester of her second pregnancy. Her primary care provider recommended that she take a multivitamin and mineral supplement for which if which of the following conditions are present?. Select all that apply. a. She had twins two years ago and is carrying one fetus for this pregnancy. b. She has iron-deficiency anemia. c. She smokes half a pack of cigarettes a day. d. Her diet includes 6 oz. of chicken or fish two times every day. e. She has HIV but is taking her antiretroviral treatment per protocol.

b. She has iron-deficiency anemia, c. She smokes half a pack of cigarettes a day & e. She has HIV but is taking her antiretroviral treatment per protocol A multivitamin and mineral supplement is recommended for pregnant women who have iron deficiency anemia, consume a poor-quality diet, do not consume enough foods from animal sources, smoke or abuse alcohol or drugs, are carrying two or more fetuses, and/or have HIV, especially if access to antiretroviral treatment is limited (ADA, 2008).

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? a. 23.6 lbs b. 19.7 lbs. c. 9.0 lbs. d. 4.1 lbs.

c. 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.

Proper nutrition is essential in the outcome of maternal phenylketonuria (PKU) pregnancies. The nurse knows that a woman with PKU should be taught which of the following? a. The body will make phenylalanine if it is not provided by the diet. b. A low-phenylalanine diet before and during pregnancy will not prevent fetal brain damage. c. A low-phenylalanine diet is necessary during pregnancy. d. A low-phenylalanine diet is necessary for at least 30 days before conception.

c. A low-phenylalanine diet is necessary during pregnancy. Nutrition plays a key role in the outcome of maternal PKU pregnancies. To prevent intellectual disabilities and other problems associated with maternal PKU, a low-phenylalanine diet is necessary at least 3 months before conception and throughout the duration of the pregnancy to strictly control blood phenylalanine levels and eliminate risks to the developing fetus. However, because phenylalanine is an essential amino acid, it must be provided in the diet in limited amounts to support growth and protein synthesis.

When does gestational diabetes usually occur during a pregnancy? a. After 30 weeks b. After 20 weeks c. After 24 weeks d. After 16 weeks

c. After 24 weeks Gestational diabetes, which appears in the latter half (after 24 weeks) of pregnancy, increases the risk of macrosomia and can make delivery difficult, increasing the risk of infant shoulder dislocation and cesarean birth.

The nurse is seeing a pregnant woman who has phenylketonuria (PKU). The client should be taught which of the following? a. Fewer calories should be consumed to prevent a large for gestational age infant. b. A regular diet will not provide an excessive intake of phenylalanine. c. Foods high in phenylalanine are meat, fish, poultry, and dairy products. d. Artificial sweeteners, such as aspartame (NutraSweet), should be substituted for sugar.

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

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? a. The client will not need nutrition management until after pregnancy. b. The client was diagnosed with diabetes mellitus before her pregnancy. c. The client is at high risk for developing type 2 diabetes later in life. d. The client will be insulin-dependent for at least 3 months after pregnancy.

c. The client is at high 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 pregnant 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? a. learning disabilities b. preterm birth. c. low-birth-weight newborns. d. birth defects.

c. 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).

A pregnant woman has phenylketonuria (PKU). The nurse knows that further teaching is needed when the woman makes which statement? a. "Most infants do not inherit PKU and will not benefit from a low-phenylalanine diet after birth." b. "Excessive serum phenylalanine can cause microcephaly." c. "I should consume the recommended diet to control and lower my phenylalanine levels at least 3 months prior to conception." d. "I should consume a normal diet during pregnancy."

d. "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.

The nurse is seeing an adolescent client in the office for a prenatal visit. The client is afraid of gaining more than 7 pounds of weight during the pregnancy. Which response by the nurse explains why the suggested amount of weight gain is more than 7 pounds? a. "Many women only gain 7 pounds because they are conscientious of what food they consume." b. "You should expect to only gain 7 pounds as that is the average weight of the baby once born." c. "There is another life involved and it is selfish to think about yourself." d. "Numerous body changes will affect your weight gain, such as your placenta, amniotic fluid and blood volume."

d. "Numerous body changes will affect your weight gain, such as your placenta, amniotic fluid and blood volume." The weight gain distribution in normal pregnancy is as follows: birth weight of baby 7.5 lbs (3.4 kg), placenta 1.5 lbs (0.68 kg), increase in maternal blood volume 4 lbs (1.8 kg), increase in maternal fluid volume 4 lbs (1.8 kg), increase in uterus 2 lbs (0.9 kg), increae in breast tissue 2 lbs (0.9 kg), amniotic fluid 2 lbs. (0.9 kg), and maternal fat tissue 7 lbs (3.17 kg). The amount of weight gained during pregnancy does not always correspond to the weight of a baby once born. Comments like "There is another life involved and it is selfish to think about yourself," and "Many women only gain 7 pounds because they are conscientious of what food they consume" are nontherapeutic communication.

A client is concerned about the recommendation to eat 8 oz of fish per week because of the mercury content in fish. What statement by the nurse best explains this recommendation? a. "Eating fish is not necessary and you can receive these nutrients elsewhere." b. "There is so little mercury in all fish that you shouldn't worry about it." c. "Your best bet to consume the least amount of mercury and get the benefit of fish would be to eat bigeye tuna." d. "The benefit of DHA and omega-3 offset the mercury content in the approved list of fish to consume."

d. "The benefit of DHA and omega-3 offset the mercury content in the approved list of fish to consume." The intake of omega-3 fatty acids from at least 8 oz of fish/week during pregnancy, especially docosahexaenoic acid (DHA), is associated with improved infant visual and cognitive develop- ment (Mulder et al., 2014). Nearly all fish contain trace amounts of mercury because it occurs naturally in the environment, including waterways. Mercury can cause fetal neurologic damage, however, the possible risk from mercury in fish is offset by the neurobehavioral benefits of adequate DHA intake (Hagan et al., 2017). Good choices are recommended once a week and include bluefish, Chilean sea bass, grouper, halibut, mahi mahi, monkfish, snapper, and albacore/white tuna (canned, fresh, or frozen). The following fish have the highest mercury levels and should be avoided by pregnant women: king mackerel, marlin, orange roughy, shark, swordfish, tilefish (from the Gulf of Mexico), and bigeye tuna.

A client has asked the nurse, "What is the recommended intake for iron during pregnancy?" What is the nurse's correct response? a. 18 mg/day b. 35 mg/day c. 45 mg/day d. 27 mg/day

d. 27 mg/day The recommended intake for iron increases to 27 mg daily from a prepregnancy value of 18 mg. This likely requires supplementation.

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? a. 30 to 50 pounds b. 40 to 50 pounds c. 20 to 30 pounds d. 28 to 40 pounds

d. 28 to 40 pounds According to Table 12.1 weight gain is as follows based off of prepregnancy BMI. Underweight (<18.5) is 28-40 pounds. Normal weight (18.5-24.9) is 25-35 pounds. Overweight (25-29.9) is 15-25 pounds. Obese (30 or greater) is 11-20 pounds.

When educating high school students about adolescent pregnancy, which teaching will the nurse give? a. Nutrient stores are adequate since physical maturity has been reached by age 15. b. They tend to seek out prenatal care earlier and more often. c. Adolescent mothers are less likely to smoke while pregnant. d. It increases health risks to both infant and mother.

d. It increases health risks to both infant and mother. Infants born to adolescent mothers are at higher risk of low birth weight (LBW) and preterm delivery, especially in mothers younger than 15 years old. On the contrary, adolescent mothers are more likely to smoke while pregnant and seek prenatal care later and less frequently. Adolescent mothers may not have adequate nutrient stores because they need large amounts of nutrients for their own growth and development. Although adolescent growth for girls is usually complete by the age of 15, physical maturity is not reached until 4 years after menarche, which usually occurs by age 17 years.

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? a. drink when she is thirsty, since thirst is a good indicator of fluid need. b. drink extra fluid to increase her milk supply since she exercises every day. c. drink at least four 8-ounce glasses of whole milk every day. d. drink a glass of fluid every time the baby nurses and a glass of fluid with each meal.

d. 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 knows her instructions on healthy eating during pregnancy have been effective when the woman verbalizes she should a. avoid seafood because of its mercury content. b. limit alcohol to 2 drinks/day. c. increase her intake of milk to 4 cups/day. d. eliminate hot dogs and deli meats unless heated to steaming hot immediately before eating.

d. eliminate hot dogs and deli meats unless heated to steaming hot immediately before eating.

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? a. maintain serum levels of vitamin K for the infant after birth. b. reduce her risk for anemia. c. stimulate release of phosphorous from the bones. d. reduce the risk of abnormal neonatal bone metabolism.

d. 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.

The nurse knows that obesity during pregnancy is associated with all of the following EXCEPT: a. gestational diabetes. b. preeclampsia. c. gestational hypertension. d. small for gestational age infant.

d. small for gestational age infant. Obesity during pregnancy is associated with gestational diabetes, gestational hypertension, preeclampsia, birth defects, cesarean delivery, fetal macrosomia, perinatal deaths, postpartum anemia, and childhood obesity (American Dietetic Association [ADA], 2008).