Chapter 15 EAQs
Which foods does the nurse exclude from the pregnant client's diet plan to ensure good health? Select all that apply.
2. Butter 4. Beef fat 5. Stick margarine It is advisable to include oils rather than solid fats in the diet plan of a pregnant client. Solid fats are fats that are solid at room temperature and cause increased body weight. This may result in greater BMI and obesity. Therefore, solid fats such as butter, beef fat, and stick margarine should be avoided in the diet plan of a pregnant client. Meat is rich in folate, and yogurt is rich in vitamin D. Therefore, these products are recommended for the diet of a pregnant client.
The nurse talks to a client who maintains a vegan diet about food choices to prevent calcium deficiency. Which foods would the nurse suggest for this purpose? Select all that apply.
2. Collards 4. Dried figs 5. Cooked dried beans The client is vegan and therefore would not be consuming any dairy products. In order to prevent calcium deficiency in the mother and the fetus, the nurse should suggest that the client eat non-dairy foods that are good sources of calcium. The client should consume about 10 to 12 dried figs, which is equivalent to one cup of milk in terms of calcium content. Collards and cooked dried beans are also good sources of calcium. The client is a vegan, so the nurse should not recommend that the client consume dairy products such as cheese. Carrots are not a good source of calcium.
Normal weight women should gain 11.3 to 15.9 kg (25-35 lb).
23.24 The BMI of the pregnant client is calculated using the equation BMI = weight/height2. In this equation, the weight is in kilograms and the height is in meters. It implies BMI = 61/(1.62)2, which is approximately 23.24 kg/m2.
A client weighs 60 kg and is 158 cm tall. How does the nurse record the body mass index (BMI) of the client? Record your answer using a whole number. _____________ kg/m2
24 BMI is calculated using the formula BMI = weight ÷ height2 where weight is in kilograms (kg) and height is in meters (m). Because the client weighs 60 kg and is 158 cm tall, the height of the client in meters is 1.58 because 1 m = 100 cm. Therefore the BMI of the client is 60 ÷ (1.58)2 = 24.29 = 24.3. This would be rounded to 24. A BMI below 24.9 is considered normal.
The nurse is caring for a pregnant adult Puerto Rican client. Which food does the nurse instruct the client to consume on a daily basis to prevent calcium imbalance?
Collards
The nurse is caring for a postpartum client. On assessment, the nurse finds that the client's neonate has neural tube defects (NTD). Which intervention would be beneficial for the client?
Daily folic acid supplement of 0.4 mg Neural tube defects (NTDs) are more common in infants born of mothers with low folic acid intake during pregnancy. A patient who has had a pregnancy involving a child with NTD should take 0.4 mg of folic acid daily, even if not planning for another pregnancy.
A pregnant woman at 7 weeks of gestation complains to her nurse-midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse-midwife should suggest that the woman do what?
Eat a high-protein snack before going to bed. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that can contribute to nausea.
A pregnant woman experiencing nausea and vomiting should do what?
Eat small, frequent meals (every 2 to 3 hours)
Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with:
Intrauterine growth restriction Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction
Which mineral intake is restricted in a pregnant client with renal failure?
Sodium Renal failure is a medical condition in which the kidneys fail to adequately filter waste products from the blood. Clients with renal failure are unable to eliminate adequate amounts of sodium. Therefore, sodium is retained in the body, leading to edema and high blood pressure. Thus, sodium intake should be restricted in clients with renal failure.
While assessing the routine diet of a client, the nurse finds that the client takes natural vitamin A supplements in addition to the multivitamin supplements prescribed by the health care provider. The client also eats a lot of carrots and green salads. What instruction should the nurse give to the client?
"Avoid taking natural vitamin A supplements." Excess intake of vitamin A has been associated with spina bifida and cleft palate in the fetus. Therefore, the nurse should ask the client to avoid taking natural vitamin A supplements.
The nurse is caring for a pregnant client who reports constipation. Which instructions does the nurse give to the client about relieving constipation? Select all that apply.
1. "Consume at least 28 g of fiber per day" 3. "Eat whole grains and fresh fruits." 5. "Drink at least 50 ml/kg/day of fluids."
While reviewing the reports of a pregnant client, the nurse finds that the client is severely anemic. Which supplements does the nurse recommend for the client? Select all that apply.
1. Iron 2. Zinc 3. Copper The client is severely anemic. Therefore, the pregnant client needs to take iron supplements in large amounts. Consumption of large amounts of iron supplements inhibits the absorption of zinc and copper. Copper and zinc are important in a pregnant woman to prevent central nervous system malformation in the fetus.
During an assessment, the nurse reviews a pregnant client's medical record and sees that her prepregnant weight was 60 kg. The patient's height is 1.6 m. What should be the maximum weight of the patient by the end of the third trimester? Record your answer using a whole number. ________ kg
76 The client's prepregnant weight was 60 kg and her height was 1.6 m. Therefore, the client's body mass index would be (60/1.62 kg/m2) = 23.43kg/m2. This indicates that the patient has a normal body mass index. A client with a normal body weight index should gain 11.3 to 15.9 kg while pregnant. Therefore, the maximum weight gain of the client would be 60 + 15.9 = 75.9 kg. Therefore, the total weight of the client at the end of pregnancy should be 76 kg.
Which food would be a common protein source for a Mexican client who is pregnant?
Chorizo (sausage)
When counseling a client about getting enough iron in her diet, what should the maternity nurse tell her?
Constipation is common with iron supplements. Constipation can be a problem when taking iron supplements. Certain beverages, including milk, coffee, and tea, inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die.
A pregnant client has severe and persistent vomiting. The client has lost weight, is dehydrated, and has electrolyte abnormalities. Which condition does the nurse suspect that the client has?
Hyperemesis gravidarum Hyperemesis gravidarum is a condition associated with severe and persistent vomiting causing weight loss, dehydration, and electrolyte abnormalities.
A dietician has asked a pregnant client to eat 12 ounces of fish every day. The nurse advises the client to avoid fish such as swordfish, tilefish, and king mackerel. Which fetal complication is the nurse trying to prevent by giving this suggestion?
Impaired neurologic development Swordfish, tilefish, and king mackerel are known to have high mercury content. Consumption of these fish may lead to an increase in serum levels of mercury, which is neurotoxic to the fetus.
Which minerals and vitamins usually are recommended to supplement a pregnant woman's diet?
Iron and folate Iron generally should be supplemented, and folic acid supplements often are needed because folate is important for the prevention of neural tube defects.
With regard to protein in the diet of pregnant women, nurses should be aware of what?
Many protein-rich foods are also good sources of calcium, iron, and B vitamins. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.
The nurse is caring for a pregnant client whose prepregnant body mass index (BMI) is 23.5. Under which BMI category does the nurse categorize the patient?
Normal A commonly used method of evaluating the appropriateness of weight in terms of height is the body mass index (BMI). BMI is calculated by using the formula: BMI = weight/height2. In this formula, the weight is in kilograms and the height is in meters. Prepregnant BMI can be classified as normal if the BMI is in the range of 18.5 to 24.9. If it is less than 18.5, it is classified as underweight or low BMI. If the BMI ranges from 25 to 29.9, it is classified as overweight or high BMI, and if it is greater than 30, it is classified as obese BMI. Because the client's BMI lies between 18.5 and 24.9, the client has normal BMI. The client is not obese, overweight, or underweight.
The nurse is assessing a 25-year-old pregnant client and learns the client is lactose intolerant and avoids consuming any dairy foods. Upon reviewing the client's daily diet chart, the nurse sees that the client eats four pieces of French toast and three cups of cooked dried beans almost every day. The client does not consume any other calcium-rich food in the diet. What does the nurse interpret about the client?
The client requires additional calcium. Four pieces of French toast and three cups of dried beans is equivalent to about two cups of milk in terms of the calcium content. Each cup of milk contains approximately 300 mg of calcium, so the client is getting about 600 mg of calcium daily. The recommended intake of calcium for pregnant women over the age of 19 is 1000 mg/day so the client is falling short of the daily calcium requirement. The nurse should suggest that the client add another 400 mg of calcium every day.
A pregnant client reports an inflamed red tongue. On assessment, the nurse finds that the client also has megaloblastic anemia. Which reason does the nurse suspect is the cause of the client's condition?
Vitamin B12 deficiency Vitamin B12 deficiency can result in megaloblastic anemia, glossitis (inflamed red tongue), and neurologic deficits such as decreased sensation and inability to walk. These clients should be given adequate vitamin B12 supplements. The infants born to affected clients are likely to have megaloblastic anemia and exhibit neurodevelopmental delays.
A client who is 6 months pregnant is diagnosed with diverticulosis. Which diet should the nurse recommend to the client?
Whole grains, bran, vegetables, and fruits Diverticulosis is a condition in which the client develops muscular outpouchings in the colon. Intake of fibrous food reduces the risk of diverticulosis in a pregnant patient. Therefore the nurse should recommend the client to incorporate the diet containing whole grains, bran, vegetables, and fruits.
A client who is in the first trimester of pregnancy reports frequent nausea. Which nursing interventions would help relieve the symptoms of nausea in this client? Select all that apply.
1. Assessing if the client is well hydrated 2. Assessing the client's weight gain pattern during pregnancy 4. Reviewing measures already taken for the prevention of morning sickness Nausea may occur due to morning sickness during the first trimester of pregnancy. To relieve this condition in the client, the nurse should assess the reasons behind it. Therefore, the nurse is required to assess the client's state of hydration and pattern of weight gain during pregnancy. The nurse should also find out what measures the client has taken to relieve morning sickness. Then, the nurse can treat the condition of nausea in the client.
Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? Select all that apply.
1. Underweight women should gain 12.7 to 18.1 kg (28-40 lb). 2. Obese women should gain 5 to 9.1 kg (11-20 lb). 3. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. 5. Normal weight women should gain 11.3 to 15.9 kg (25-35 lb).
A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's best response is to tell the woman that her pattern of weight gain should be approximately:
2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy is about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb per week during the second and third trimesters.
After assessing a pregnant client the nurse finds that the client has a folate intake of approximately 580 mcg/day. What dietary modifications should the nurse suggest to the client? Select all that apply.
3. Add one extra slice of bread daily. 4. Include one boiled egg every day. 5. Include one-half cup of corn daily. The recommended folate intake for the pregnant client is 600 mcg/day. Therefore, the nurse needs to modify the client's diet to add 20 mcg of folate. One slice of bread, one boiled egg, or one-half cup of corn provides 20 mcg of folate. Thus, the nurse should ask the client to add one of these foods in the daily diet
On assessing the laboratory reports of a client who is 12 weeks pregnant, the nurse observes that the client's level of serum ferritin is low. Which condition does the nurse expect in the client?
Anemia Women are at an increased risk for iron deficiency during pregnancy. Iron is needed to allow the transfer of adequate iron to the fetus and for the expansion of the maternal red blood cell (RBC) mass. The serum ferritin level is an indicator of iron content in the body. Poor iron status results in iron-deficiency anemia.
The nurse is caring for a pregnant client receiving anticoagulant therapy. On reviewing the client's lab reports, the nurse finds an abrupt increase in clotting time. What does the nurse suspect that might be the reason for this?
Consumption of ginger Ginger has anticoagulant properties. The client who is receiving anticoagulant therapy and consuming ginger may experience a synergistic effect that leads to a prolonged clotting time. Therefore, the client should not consume ginger.
When planning a diet with a pregnant woman, what is the nurse's first action?
Review the woman's current dietary intake. Reviewing the woman's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required.
A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lb) since conception. How would the nurse interpret this?
The woman's weight gain is appropriate for this stage of pregnancy. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman's height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy. Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy.