Family Test 1: Ch 8. (Care of Family During Pregnancy); Ch 9. Maternal child

A pregnant patient would like to know a good food source of calcium other than dairy products. Your best answer is: a. Legumes b. Yellow vegetables c. Lean meat d. Whole grains

ANS: A Although dairy products contain the greatest amount of calcium, it also is found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Yellow vegetables are rich in vitamin A. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium

All pregnant women should be instructed to recognize and report potential complications for each trimester of pregnancy. Match the sign or symptom with a possible cause. a.Severe vomiting in early pregnancy b.Epigastric pain in late pregnancy c.Severe backache and flank pain d.Decreased fetal movement e.Glycosuria 1. Fetal jeopardy or intrauterine fetal death 2. Kidney infection or stones 3. Gestational diabetes 4. Hyperemesis gravidarum 5. Hypertension, preeclampsia

1. ANS: D DIF: Cognitive Level: Understand REF: p. 314 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Planning the education needed by the pregnant woman is essential for the nurse to complete to ensure that the client recognizes and reports these potential complications in a timely manner. A trusting relationship contributes to a positive outcome for the pregnancy. 2. ANS: C DIF: Cognitive Level: Understand REF: p. 314 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Planning the education needed by the pregnant woman is essential for the nurse to complete to ensure that the client recognizes and reports these potential complications in a timely manner. A trusting relationship contributes to a positive outcome for the pregnancy. 3. ANS: E DIF: Cognitive Level: Understand REF: p. 314 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Planning the education needed by the pregnant woman is essential for the nurse to complete to ensure that the client recognizes and reports these potential complications in a timely manner. A trusting relationship contributes to a positive outcome for the pregnancy. 4. ANS: A DIF: Cognitive Level: Understand REF: p. 314 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Planning the education needed by the pregnant woman is essential for the nurse to complete to ensure that the client recognizes and reports these potential complications in a timely manner. A trusting relationship contributes to a positive outcome for the pregnancy. 5. ANS: B DIF: Cognitive Level: Understand REF: p. 314 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance NOT: Planning the education needed by the pregnant woman is essential for the nurse to complete to ensure that the client recognizes and reports these potential complications in a timely manner. A trusting relationship contributes to a positive outcome for the pregnancy.

A pregnant womans diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse would be most concerned about this womans intake of: a. Calcium. b. Protein. c. Vitamin B12. d. Folic acid

ANS: C This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this womans total recommended weight gain during pregnancy should be at least: a. 20 kg (44 lb). b. 16 kg (35 lb). c. 12.5 kg (27.5 lb). d. 10 kg (22 lb).

ANS: C This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy. A weight gain of 20 kg would be unhealthy for most women. A weight gain 35 lb is the high end of the range of weight this woman should gain in her pregnancy. A weight gain of 22 lb would be appropriate for an obese woman

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned that during and after tennis matches this woman consumes: a. Several glasses of fluid. b. Extra protein sources such as peanut butter. c. Salty foods to replace lost sodium. d. Easily digested sources of carbohydrate

ANS: A If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise because dehydration can trigger premature labor. The womans calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise

A newly pregnant patient visits her providers office for the first prenatal appointment. To estimate accurate weight gain throughout the pregnancy, the nurse will be evaluating the appropriateness of weight for height using the body mass index (BMI). The patient weighs 51 kg and is 1.57 m tall. The BMI is: ________

ANS: 20.7 BMI = weight divided by height squared. BMI = 51 kg/(1.57m)2, or 20.7. Prepregnant BMI can be classifiedinto the following categories: <18.5, underweight or low; 18.5-24.9, normal; 25-29.9 overweight or high; >30, obese

What is the primary role of the doula during labor? a.Helps the woman perform Lamaze breathing techniques and to provide support to the woman and her partner b.Checks the fetal monitor tracing for effects of the labor process on the fetal heart rate c.Takes the place of the father as a coach and support provider d.Administers pain medications as needed by the woman

ANS: A A doula is professionally trained to provide labor support, including physical, emotional, and informational support, to both the woman and her partner during labor and the birth. The doula does not become involved with clinical tasks.

What is important for the nurse to recognize regarding the new father and his acceptance of the pregnancy and preparation for childbirth? a.The father goes through three phases of acceptance of his own. b.The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after the birth. c.In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d.Typically, men remain ambivalent about fatherhood right up to the birth of their child.

ANS: A A father typically goes through three phases of development to reach acceptance of fatherhood: the announcement phase, the moratorium phase, and the focusing phase. The father-child attachment can be as strong as the mother-child relationship and can also begin during pregnancy. During the last 2 months of the pregnancy, many expectant fathers work hard to improve the environment of the home for the child. Typically, the expectant father's ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and then to focusing on his role.

Which women should undergo prenatal testing for the human immunodeficiency virus (HIV)? a.All women, regardless of risk factors b.Women who have had more than one sexual partner c.Women who have had a sexually transmitted infection (STI) d.Woman who are monogamous with one partner

ANS: A An HIV test is recommended for all women, regardless of risk factors. The incidence of perinatal transmission from an HIV-positive mother to her fetus ranges from 25% to 35%. Women who test positive for HIV can then be treated.

With regard to medications, herbs, boosters, and other substances normally encountered by pregnant women, what is important for the nurse to be aware of? a.Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b.The greatest danger of drug-caused developmental deficits in the fetus is observed in the final trimester. c.Killed-virus vaccines (e.g., tetanus) should not be administered during pregnancy, but live-virus vaccines (e.g., measles) are permissible. d.No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

ANS: A Both prescription and OTC drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, during which a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

A client has arrived for her first prenatal appointment. She asked the nurse to explain exactly how long the pregnancy will be. What is the nurse's best response? a.Normal pregnancy is 10 lunar months. b.Pregnancy is made up of four trimesters. c.Pregnancy is considered term at 36 weeks. d.Estimated date of delivery (EDD) is 40 completed weeks.

ANS: A Pregnancy spans 9 calendar months; but, health care providers prefer to use the lunar month of 28 days or 4 weeks. Pregnancy consists of three trimesters, each approximately 13 weeks long. A pregnancy is considered term at 37 completed weeks; however, EDD is based upon 40 weeks of gestation.

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? a.She keeps all prenatal appointments. b.She "eats for two." c.She slowly drives her car. d.She wears only low-heeled shoes.

ANS: A The goal of prenatal care is to foster a safe birth for the infant and mother. Although properly eating, carefully driving, and using proper body mechanics all are healthy measures that a mother can take, obtaining prenatal care is the optimal method for providing safety for both herself and her baby.

Which condition is likely to be identified by the quadruple marker screen? a.Down syndrome b.Diaphragmatic hernia c.Congenital cardiac abnormality d.Anencephaly

ANS: A The maternal serum level marker of alpha-fetoprotein is used to screen for Down syndrome, trisomy 18, neural tube defects, and other chromosomal anomalies. The quadruple-marker screen will not detect diaphragmatic hernia. Additional testing, such as ultrasonography, is required to diagnose diaphragmatic hernia. Congenital cardiac abnormality will most likely be identified during an ultrasound examination. The quadruple-marker screen will not detect anencephaly.

A client at 34 weeks of gestation seeks guidance from the nurse regarding personal hygiene. Which information should the nurse provide? a.Tub bathing is permitted even in late pregnancy unless membranes have ruptured. b.The perineum should be wiped from back to front. c.Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. d.Expectant mothers should use specially treated soap to cleanse the nipples.

ANS: A The primary danger from taking baths is falling in the tub. The perineum should be wiped from front to back. Bubble baths and bath oils should be avoided because they may irritate the urethra. Soap, alcohol, ointments, and tinctures should not be used to cleanse the nipples because they remove protective oils. Warm water is sufficient.

Identify a goal of a patient with the following nursing diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to diet choices inadequate to meet nutrient requirements of pregnancy. a. Gain a total of 30 lb. b. Take daily supplements consistently. c. Decrease intake of snack foods. d. Increase intake of complex carbohydrates.

ANS: A A weight gain of 30 lb is one indication that the patient has gained a sufficient amount for the nutritional needs of pregnancy. A daily supplement is not the best goal for this patient. It does not meet the basic need of proper nutrition during pregnancy. Decreasing snack foods may be a problem and should be assessed; however, assessing weight gain is the best method of monitoring nutritional intake for this pregnant patient. Increasing the intake of complex carbohydrates is important for this patient, but monitoring the weight gain should be the end goal

Which statement regarding acronyms in nutrition is accurate? a. Dietary reference intakes (DRIs) consist of recommended dietary allowances (RDAs), adequate intakes (AIs), and upper limits (ULs). b. RDAs are the same as ULs except with better data. c. AIs offer guidelines for avoiding excessive amounts of nutrients. d. They all refer to green leafy vegetables, whole grains, and fruit

ANS: A DRIs consist of RDAs, AIs, and ULs. AIs are similar to RDAs except that they deal with nutrients about which data are insufficient for certainty (RDA status). ULs are guidelines for avoiding excesses of nutrients for which excess is toxic. Green leafy vegetables, whole grains, and fruit are important, but they are not the whole nutritional story.

Which nutritional recommendation about fluids is accurate? a. A womans daily intake should be eight to ten glasses (2.3 L) of water, milk, or juice. b. Coffee should be limited to no more than two cups, but tea and cocoa can be consumed without worry. c. Of the artificial sweeteners, only aspartame has not been associated with any maternity health concerns. d. Water with fluoride is especially encouraged because it reduces the childs risk of tooth decay

ANS: A Eight to ten glasses is the standard for fluids; however, they should be the right fluids. All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or drunk only in limited amounts. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus; however, mothers with phenylketonuria should avoid aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay.

With regard to protein in the diet of pregnant women, nurses should be aware that: a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins. b. Many women need to increase their protein intake during pregnancy. c. As with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. d. High-protein supplements can be used without risk by women on macrobiotic diets

ANS: A 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

To prevent gastrointestinal upset, clients should be instructed to take iron supplements: a. On a full stomach. b. At bedtime. c. After eating a meal. d. With milk.

ANS: B Clients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.

Which nutrients recommended dietary allowance (RDA) is higher during lactation than during pregnancy? a. Energy (kcal) b. Iron c. Vitamin A d. Folic acid

ANS: A Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs.

After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy? a. Protein will help my baby grow. b. Eating protein will prevent me from becoming anemic. c. Eating protein will make my baby have strong teeth after he is born. d. Eating protein will prevent me from being diabetic

ANS: A Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid. Iron intake prevents anemia. Calcium intake is needed for fetal bone and tooth development. Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she: a. Try a tart food or drink such as lemonade or salty foods such as potato chips. b. Drink plenty of fluids early in the day. c. Brush her teeth immediately after eating. d. Never snack before bedtime

ANS: A Some women can tolerate tart or salty foods when they are nauseous. The woman should avoid drinking too much when nausea is most likely, but she should make up the fluid levels later in the day when she feels better. The woman should avoid brushing her teeth immediately after eating. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning

Which signs and symptoms should a woman immediately report to her health care provider? (Select all that apply.) a.Vaginal bleeding b.Rupture of membranes c.Heartburn accompanied by severe headache d.Decreased libido e.Urinary frequency

ANS: A, B, C Vaginal bleeding, rupture of membranes, and severe headaches are signs of potential complications in pregnancy. Clients should be advised to report these signs to their health care provider. Decreased libido and urinary frequency are common discomforts of pregnancy that do not require immediate health care interventions.

Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. The nurse or midwife should refer a client to a registered dietitian for in-depth nutritional counseling in the following situations (Select all that apply). a. Preexisting or gestational illness such as diabetes b. Ethnic or cultural food patterns c. Obesity d. Vegetarian diet e. Allergy to tree nuts

ANS: A, B, C, D The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation. To prevent issues with hypoglycemia and hyperglycemia and an increased risk for perinatal morbidity and mortality, this patient would benefit from a referral to a dietitian. Consultation with a dietitian may ensure that cultural food beliefs are congruent with modern knowledge of fetal development and that adjustments can be made to ensure that all nutritional needs are met. The obese pregnant patient may be under the misapprehension that because of her excess weight little or no weight gain is necessary. According to the Institute of Medicine, a client with a body mass index in the obese range should gain at least 7 kg to ensure a healthy outcome. This patient may require in-depth counseling on optimal food choices. The vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimal combination of amino acids and protein intake is achieved. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. A patient with a food allergy would not alter that component of her diet during pregnancy; therefore, no additional consultation is necessary.

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, the nurse learns that the client has not had any immunizations. Which immunizations should she receive at this point in her pregnancy? (Select all that apply.) a.Tetanus b.Diphtheria c.Chickenpox d.Rubella e.Hepatitis B

ANS: A, B, E Vaccines consisting of killed viruses may be used. Those that may be administered during pregnancy include tetanus, diphtheria, recombinant hepatitis B, and rabies vaccines. Immunizations with live or attenuated viruses are contraindicated during pregnancy because of their potential teratogenicity. Live-virus vaccines include those for measles (rubeola and rubella), chickenpox, and mumps.

What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a.Religion b.Modesty c.Ignorance d.Belief that physicians are evil

ANS: B A concern for modesty is a deterrent to many women seeking prenatal care. For some women, exposing body parts, especially to a man, is considered a major violation of their modesty. Many cultural variations are found in prenatal care. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group to which she belongs.

During the first trimester, which of the following changes regarding her sexual drive should a client be taught to expect? a.Increased sexual drive, because of enlarging breasts b.Decreased sexual drive, because of nausea and fatigue c.No change in her sexual drive d.Increased sexual drive, because of increased levels of female hormones

ANS: B A pregnant woman usually experiences a decrease, not an increase, in libido during the first trimester. Maternal physiologic changes, such as breast enlargement, nausea, fatigue, abdominal changes, perineal enlargement, leukorrhea, pelvic vasocongestion, and orgasmic responses, may affect sexuality and sexual expression. Libido may be depressed in the first trimester but often increases during the second and third trimesters. During pregnancy, the breasts may become enlarged and tender, which tends to interfere with coitus, thereby decreasing the desire to engage in sexual activity.

Which sign of a potential complication is the most important for the nurse to share with the client? a.Constipation b.Alteration in the pattern of fetal movement c.Heart palpitations d.Edema in the ankles and feet at the end of the day

ANS: B An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation, heart palpitations, and ankle and foot edema are normal discomforts of pregnancy that occur in the second and third trimesters.

A 3-year-old girl's mother is 6 months pregnant. What concern is this child most likely to verbalize? a.How the baby will get out? b.How will the baby eat? c.Will you die having the baby? d.What color eyes will the baby have?

ANS: B By age 3 or 4 years, children like to be told the story of their own beginning and accept it being compared with the present pregnancy. They like to listen to the fetal heartbeat and feel the baby move. Sometimes they worry about how the baby is being fed and what it will wear. School-age children take a more clinical interest in their mother's pregnancy and may want to know "How did the baby get in there?" and "How will it get out?" Whether the child's mother will die does not tend to be the focus of her questions about the impending birth of a sibling. The baby's eye color does not tend to be the focus of children's questions about the impending birth of a sibling.

The nurse working with pregnant clients must seek to gain understanding of the process whereby women accept their pregnancy. Which statement regarding this process is most accurate? a.Nonacceptance of the pregnancy very often equates to a rejection of the child. b.Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. c.Ambivalent feelings during pregnancy are usually only expressed in emotionally immature or very young mothers. d.Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will naturally resolve themselves after birth.

ANS: B Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for the mature or immature woman and for the younger or older woman. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need to be resolved. The baby ends the pregnancy but not all the issues.

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. Which intervention should the nurse recommend? a.Kegel exercises b.Pelvic rock exercises c.Softer mattress d.Bed rest for 24 hours

ANS: B Pelvic rock exercises may help stretch and strengthen the abdominal and lower back muscles and relieve low back pain. Stretching and other exercises to relieve back pain should be performed several times a day. Kegel exercises increase the tone of the pelvic area, not the back. A softer mattress may not provide the support needed to maintain proper alignment of the spine and may contribute to back pain.

Ideally, when should prenatal care begin? a.Before the first missed menstrual period b.After the first missed menstrual period c.After the second missed menstrual period d.After the third missed menstrual period

ANS: B Prenatal care should begin soon after the first missed menstrual period. This offers the greatest opportunities to ensure the health of the expectant mother and her infant. Prenatal care before missing the first menstrual period is too early. It is unlikely the woman is even aware of the pregnancy. Ideally, prenatal visits should begin soon after the first period is missed. Beginning prenatal care after the third missed menstrual period is too late. The woman will have completed the first trimester by that time.

The client is instructed to place her thumb and forefinger on the areola and gently press inward. What is the purpose of this exercise? a.To check the sensitivity of the nipples b.To determine whether the nipple is everted or inverted c.To calculate the adipose buildup in the abdomen d.To see whether the fetus has become inactive

ANS: B Sometimes known as the pinch test, this exercise is used to determine whether the nipple is everted or inverted. Nipples must be everted to allow breastfeeding. The pinch does not determine the level of sensitivity of the nipples, nor is it not used to determine the level of adipose tissue in the abdomen. Fetal activity is not determined by using the pinch test.

During the physical examination of a client beginning prenatal care, which initial action is most important for the nurse to perform? a.Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse. b.The client should empty her bladder before the pelvic examination. c.The distribution, amount, and quality of body hair are of no particular importance. d.The size of the uterus is discounted in the initial examination because it will be increasing in size during the second trimester.

ANS: B The nurse should instruct the client to empty her bladder. An empty bladder facilitates the examination and also provides an opportunity to obtain a urine sample for a number of tests. All women should be assessed for a history of physical abuse, particularly because the likelihood of abuse increases during pregnancy. Noting body hair is important because body hair reflects nutritional status, endocrine function, and hygiene. Particular attention is paid to the size of the uterus because it is an indication of the duration of gestation.

Which client might be well advised to continue condom use during intercourse throughout her pregnancy? a.Unmarried pregnant women b.Women at risk for acquiring or transmitting STIs c.All pregnant women d.Women at risk for candidiasis

ANS: B The objective of safer sex is to provide prophylaxis against the acquisition and transmission of STIs. Because these diseases may be transmitted to the woman and then to her fetus, condom use is recommended throughout the pregnancy if the woman is at risk for acquiring an STI. Pregnant women are encouraged to practice safer sex behaviors. An unmarried pregnant woman may be in a monogamous relationship and not require the use of a condom. The client should be educated as to what may place both herself and her fetus at risk. Any pregnant woman can develop candidiasis, which is an infection not related to condom use.

Which statement regarding multifetal pregnancy is incorrect? a.The expectant mother often develops anemia because the fetuses have a greater demand for iron. b.Twin pregnancies come to term with the same frequency as single pregnancies. c.The mother should be counseled to increase her nutritional intake and gain more weight. d.Backache and varicose veins often are more pronounced with a multifetal pregnancy.

ANS: B Twin pregnancies often end in prematurity. Serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often develops anemia, suffers more or worse backache, and needs to gain more weight. Counseling is needed to help her adjust to these conditions.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: a. The mothers intake of vitamin C, zinc, and protein now can be lower than during pregnancy. b. Caffeine consumed by the mother accumulates in the infant, who may be unusually active and wakeful. c. Critical iron and folic acid levels must be maintained. d. Lactating women can go back to their prepregnant calorie intake.

ANS: B A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall

Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance? a. I always have heartburn after I drink milk. b. If I drink more than a cup of milk, I usually have abdominal cramps and bloating. c. Drinking milk usually makes me break out in hives. d. Sometimes I notice that I have bad breath after I drink a cup of milk

ANS: B Abdominal cramps and bloating are consistent with lactose intolerance. One problem that can interfere with milk consumption is lactose intolerance, which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. Milk consumption may cause abdominal cramping, bloating, and diarrhea people who are lactose intolerant, although many affected individuals can tolerate small amounts of milk without symptoms

In teaching the pregnant adolescent about nutrition, the nurse should: a. Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium. b. Determine the weight gain needed to meet adolescent growth and add 35 lb. c. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value. d. Realize that most adolescents are unwilling to make dietary changes during pregnancy

ANS: B Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Changes in the diet should be kept at a minimum. Snack foods can be included in moderation, and other foods can be added to make up for the lost nutrients. Eliminating fast foods would make the adolescent appear different to her peers. The patient should be taught to choose foods that add needed nutrients. Adolescents are willing to make changes; however, they still have the need to be similar to their peers.

Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish adequately supply the recommended amount of protein for a pregnant woman. Many patients are concerned about the increased levels of mercury in fish and may be afraid to include this source of nutrients in their diet. Sound advice by the nurse to assist the client in determining which fish is safe to consume would include: a. Canned white tuna is a preferred choice. b. Avoid shark, swordfish, and mackerel. c. Fish caught in local waterways are the safest. d. Salmon and shrimp contain high levels of mercury

ANS: B As a precaution, the pregnant patient should avoid eating all of these and the less common tilefish. High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. A pregnant client can 12 ounces a week of canned light tuna; however, canned white, albacore, or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. It is a common misconception that fish caught in local waterways are the safest. Pregnant women and mothers of young children should check with local advisories about the safety of fish caught by families and friends in nearby bodies of water. If no information is available, these fish sources should be avoided, limited to less than 6 ounces, or the only fish consumed that week. Commercially caught fish that are low in mercury include salmon, shrimp, pollock, or catfish

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: a. Spina bifida. b. Intrauterine growth restriction. c. Diabetes mellitus. d. Down syndrome

ANS: B Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Spina bifida, diabetes mellitus, and Down syndrome are not associated with inadequate maternal weight gain

A pregnant woman experiencing nausea and vomiting should: a. Drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. b. Eat small, frequent meals (every 2 to 3 hours). c. Increase her intake of high-fat foods to keep the stomach full and coated. d. Limit fluid intake throughout the day

ANS: B Eating small, frequent meals is the correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated, but should compensate by drinking fluids at other times. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried and other fatty foods

The most important reason for evaluating the pattern of weight gain in pregnancy is to: a. Prevent excessive adipose tissue deposits b. Identify potential nutritional problems or complications of pregnancy c. Assess the need to limit caloric intake in obese women d. Determine cultural influences on the womans diet

ANS: B Maternal and fetal risks in pregnancy are increased when the mother is significantly overweight. Excessive adipose tissue may occur with excess weight gain; however, this is not the reason for monitoring the weight gain pattern. It is important to monitor the pattern of weight gain to identify complications. The pattern of weight gain is not influenced by cultural influences

Maternal nutritional status is an especially significant factor of the many factors that influence the outcome of pregnancy because: a. It is very difficult to adjust because of peoples ingrained eating habits. b. It is an important preventive measure for a variety of problems. c. Women love obsessing about their weight and diets. d. A womans preconception weight becomes irrelevant

ANS: B Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach

Pregnant adolescents are at high risk for _____ because of lower body mass indices (BMIs) and fad dieting. a. Obesity b. Diabetes c. Low-birth-weight babies d. High-birth-weight babies

ANS: C Adolescents tend to have lower BMIs because they are still developing and may follow unsafe nutritional practices. In addition, the fetus and still-growing mother appear to compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Obesity, diabetes, and high-birth-weight babies are conditions associated with higher BMIs.

The number of routine laboratory tests during follow-up visits is limited; however, those that are performed are essential. Which statements regarding group B Streptococcus (GBS) testing are correct? (Select all that apply.) a.Performed between 32 and 34 weeks of gestation. b.Performed between 35 and 37 weeks of gestation. c.All women should be tested. d.Only women planning a vaginal birth should be tested. e.Women with a history of GBS should be retested.

ANS: B, C, D, E GBS testing is recommended between 35 and 37 weeks of gestation; cultures collected earlier will not accurately predict the presence of GBS at birth. All women should be tested, even those planning an elective cesarean birth. Membranes may rupture early, requiring prophylactic antibiotics. Clients with a history of GBS should be retested.

During the initial visit with a client who is beginning prenatal care, which action should be the highest priority for the nurse? a.The first interview is a relaxed, get-acquainted affair during which the nurse gathers some general impressions of his or her new client. b.If the nurse observed handicapping conditions, he or she should be sensitive and not inquire about them because the client will do that in her own time. c.The nurse should be alert to the appearance of potential parenting problems, such as depression or lack of family support. d.Because of legal complications, the nurse should not ask about illegal drug use; that is left to the physician.

ANS: C Besides these potential problems, the nurse needs to be alert to the woman's attitude toward keeping regular health care appointments. If the client lacks insurance, then the nurse may be able to direct her to resources that provide assistance for pregnant women (i.e., Women, Infants, and Children [WIC]; Medicaid). The initial interview needs to be planned, purposeful, and focused on specific content. A lot of ground must be covered. The nurse must be sensitive to special problems; he or she should inquire because discovering individual needs is important. A client with a chronic or handicapping condition might forget to mention it because she has adapted to it. Obtaining information on drug use is important and can be confidentially done. Actual testing for drug use requires the client's consent.

Which statement accurately describes the centering model of care? a.Group sessions begin with the first prenatal visit. b.Blood pressure (BP), weight, and urine dipsticks are obtained by the nurse at each visit. c.Approximately 8 to 12 women are placed in each gestational-age cohort group. d.Outcomes are similar to traditional prenatal care.

ANS: C Gestational-age cohorts comprise the groups, with approximately 8 to 12 women in each group. The groups remain intact throughout the pregnancy. Individual follow-up visits are scheduled as needed. Group sessions begin at 12 to 16 weeks of gestation and end with an early postpartum visit. Before the group sessions, the client has an individual assessment, physical examination, and history. At the beginning of each group meeting, clients measure their own BP, weight, and urine dips and enter these findings in their record. Fetal heart rate assessment and fundal height are obtained by the nurse. Results evaluating this approach have been very promising. In a recent study of adolescent clients, the number of LBW infants decreased and breastfeeding rates increased.

What should the nurse be cognizant of concerning the client's reordering of personal relationships during pregnancy? a.Because of the special motherhood bond, a woman's relationship with her mother is even more important than with the father of the child. b.Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other. c.Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. d.The woman's sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.

ANS: C Love and support help a woman feel better about her pregnancy. The most important person to the pregnant woman is usually the father of the child. Nurses can facilitate communication between partners about sexual matters if, as is common, they are nervous about expressing their worries and feelings to one another. The second trimester is the time when a woman's sense of well-being, along with certain physical changes, increases her desire for sex. Sexual desire is down in the first and third trimesters.

What is the primary role of the nonpregnant partner during pregnancy? a.To provide financial support b.To protect the pregnant woman from "old wives' tales" c.To support and nurture the pregnant woman d.To make sure the pregnant woman keeps prenatal appointments

ANS: C The partner's primary role in pregnancy is to nurture the pregnant woman and respond to her feelings of vulnerability. Although financial support is important, it is not the partner's primary role in pregnancy. Protecting the pregnant woman from "old wives' tales" is not the partner's role. The woman's partner can encourage the client to keep all appointments; however, this is not the most important role during the pregnancy.

Dental care during pregnancy is an important component of good prenatal care. Which instruction regarding dental health should the nurse provide? a.Regular brushing and flossing may not be necessary during early pregnancy because it may stimulate the woman who is already nauseated to vomit. A cleaning is all that is necessary. b.Dental surgery, in particular, is contraindicated during pregnancy and should be delayed until after delivery. c.If dental treatment is necessary, then the woman will be most comfortable with it in the second trimester. d.If a woman has dental anxiety, then dental care may interfere with the expectant mother's need to practice conscious relaxation and to prepare for labor.

ANS: C The second trimester is the best time for dental treatment because the woman will be able to sit most comfortably in the dental chair. Dental care, such as brushing with a fluoride toothpaste, is especially important during pregnancy. Periodontal disease has been linked to both preterm labor and low-birth-weight (LBW) infants. Emergency dental surgery is permissible; however, the mother must clearly understand the risks and benefits. Conscious relaxation is useful and may even help the woman get through any dental appointments, but it is not a reason to avoid them.

Which consideration is essential for the nurse to understand regarding follow-up prenatal care visits? a.The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b.Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c.During the abdominal examination, the nurse should be alert for supine hypotension. d.For pregnant women, a systolic BP of 130 mm Hg and a diastolic BP of 80 mm Hg is sufficient to be considered hypertensive.

ANS: C The woman lies on her back during the abdominal examination, possibly compressing the vena cava and aorta, which can cause a decrease in BP and a feeling of faintness. The interview portion of the follow-up examinations is less extensive than in the initial prenatal visits, during which so much new information must be gathered. Monthly visits are routinely scheduled for the first and second trimesters; visits increase to every 2 weeks at week 28 and to once a week at week 36. For pregnant women, hypertension is defined as a systolic BP of 140 mm Hg or higher and a diastolic BP of 90 mm Hg or higher.

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of the exercise on the fetus. Which guidance should the nurse provide? a."You don't need to modify your exercising any time during your pregnancy." b."Stop exercising because it will harm the fetus." c."You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." d."Jogging is too hard on your joints; switch to walking now."

ANS: C Typically, running should be replaced with walking around the seventh month of pregnancy. The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

A woman arrives at the clinic for a pregnancy test. Her last menstrual period (LMP) was February 14, 2015. What is the client's expected date of birth (EDB)? a.September 17, 2015 b.November 7, 2015 c.November 21, 2015 d.December 17, 2015

ANS: C Using the Nägele's rule, the EDB is calculated by subtracting 3 months from the month of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of February 14, 2015, her due date is November 21, 2015. September 17, 2015, is too short a period to complete a normal pregnancy. Using the Nägele's rule, an EDB of November 7, 2015, is 2 weeks early. December 17, 2015, is almost a month past the correct EDB.

Which meal would provide the most absorbable iron? a. Toasted cheese sandwich, celery sticks, tomato slices, and a grape drink b. Oatmeal, whole wheat toast, jelly, and low-fat milk c. Black bean soup, wheat crackers, orange sections, and prunes d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea

ANS: C Food sources that are rich in iron include liver, meats, whole grain or enriched breads and cereals, deep green leafy vegetables, legumes, and dried fruits. In addition, the vitamin C in orange sections aids absorption. Dairy products and tea are not sources of iron

Which minerals and vitamins usually are recommended to supplement a pregnant womans diet? a. Fat-soluble vitamins A and D b. Water-soluble vitamins C and B6 c. Iron and folate d. Calcium and zinc

ANS: C Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Zinc sometimes is supplemented. Most women obtain enough calcium through their regular diet

The labor and delivery nurse is preparing a bariatric patient for an elective cesarean birth. Which piece of specialized equipment is unnecessary when providing care for this pregnant woman. a. Extra long surgical instruments b. Wide surgical table c. Temporal thermometer d. Increased diameter blood pressure cuff

ANS: C Obstetricians today are seeing more morbidly obese pregnant women weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical needs, a new medical subspecialty bariatric obstetrics has arisen. Extra-wide blood pressure cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to hold the weight of these women are used. Special techniques for ultrasound examination and longer surgical instruments for cesarean birth are also required. A temporal thermometer can be used for a pregnant patient of any size.

While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. This represents a nutritional problem known as: a. Preeclampsia. b. Pyrosis. c. Pica. d. Purging.

ANS: C The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica

A pregnant womans diet may not meet her need for folates. A good source of this nutrient is: a. Chicken b. Cheese c. Potatoes d. Green leafy vegetables

ANS: D Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor in folates. Potatoes contain carbohydrates and vitamins and minerals but are poor in folates

When providing care to the prenatal patient, the nurse understands that pica is defined as: a. Intolerance of milk products b. Iron deficiency anemia c. Ingestion of nonfood substances d. Episodes of anorexia and vomiting

ANS: C The practice of eating substances not normally thought of as food is called pica. Clay or dirt and solid laundry starch are the substances most commonly ingested. Intolerance of milk products is referred to as lactose intolerance. Pica may produce iron deficiency anemia if proper nutrition is decreased. Pica is not related to anorexia and vomiting

If a patients normal prepregnancy diet contains 45 g of protein daily, how many more grams of protein should she consume per day during pregnancy? a. 5 b. 10 c. 25 d. 30

ANS: C The recommended intake of protein for the pregnant woman is 70 g. Intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A protein intake of 30 g is more than is necessary and would add extra calories

In her work with pregnant women of different cultures, a nurse practitioner has observed various practices that seemed unfamiliar. The nurse practitioner has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? a.To promote family unity b.To ward off the "evil eye" c.To appease the gods of fertility d.To protect the mother and fetus during pregnancy

ANS: D Although many cultures consider pregnancy normal, certain practices are expected of women of all cultures to ensure a good outcome. Cultural prescriptions tell women what to do, and cultural proscriptions establish taboos. The purposes of these practices are to prevent maternal illness resulting from a pregnancy-induced imbalanced state and to protect the vulnerable fetus. Promoting family unity is important, although not usually the premise for cultural rituals and practices. Warding off the "evil eye" may be specific to one particular culture; however, it is not the primary purpose of these practices. Appeasing the gods of fertility is not the impetus behind cultural rituals.

Who is most likely to experience the phenomenon of someone other than the mother-to-be having pregnancy-like symptoms such as nausea and weight gain? a.Mother of the pregnant woman b.Couple's teenage daughter c.Sister of the pregnant woman d.Expectant father

ANS: D An expectant father's experiencing of his partner's pregnancy-like symptoms is called the couvade syndrome. The mother of the pregnant woman is unlikely to experience this phenomenon. She may be excited about becoming a grandmother or see her daughter's pregnancy as a reminder that she is getting old. A couple's teenage daughter is usually preoccupied with her own sexual development and may have difficulty accepting the overwhelming evidence of her parents' sexual activity. It is the father of the pregnant woman, not the sister, who experiences these symptoms.

While assessing the vital signs of a pregnant woman in her third trimester, the client complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a.Have the patient stand up, and then retake her BP. b.Have the patient sit down, and then hold her arm in a dependent position. c.Have the patient lie supine for 5 minutes, and then recheck her BP on both arms. d.Have the patient turn to her left side, and then recheck her BP in 5 minutes.

ANS: D BP is affected by maternal position during pregnancy. The supine position may cause occlusion of the vena cava and descending aorta. Turning the pregnant woman to a lateral recumbent position alleviates pressure on the blood vessels and quickly corrects supine hypotension. Pressures are significantly higher when the client is standing. This option causes an increase in systolic and diastolic pressures. The arm should be supported at the same level of the heart. The supine position may cause occlusion of the vena cava and descending aorta, creating hypotension.

A pregnant couple has formulated a birth plan and is reviewing it with the nurse at an expectant parent's class. Which aspect of their birth plan should be considered potentially unrealistic and require further discussion with the nurse? a."My husband and I have agreed that my sister will be my coach because he becomes anxious with regard to medical procedures and blood. He will be nearby and check on me every so often to make sure everything is okay." b."We plan to use the techniques taught in the Lamaze classes to reduce the pain experienced during labor." c."We want the labor and birth to take place in a birthing room. My husband will come in the minute the baby is born." d."Regardless of the circumstances, we do not want the fetal monitor used during labor because it will interfere with movement and doing effleurage."

ANS: D Because monitoring is essential to assess fetal well-being, fetal monitoring is not a factor that can be determined by the couple. The nurse should fully explain its importance. The option for intermittent electronic monitoring could be explored if this is a low-risk pregnancy and as long as labor is normally progressing. The birth plan is a tool with which parents can explore their childbirth options; however, the plan must be viewed as tentative. Having the woman's sister as her coach with her husband nearby is an acceptable request for a laboring woman. Using breathing techniques to alleviate pain is a realistic part of a birth plan. Not all fathers are able to be present during the birth; however, this couple has made a realistic plan that works for their specific situation.

A woman is 3 months pregnant. At her prenatal visit she tells the nurse that she does not know what is happening; one minute she is happy that she is pregnant and the next minute she cries for no reason. Which response by the nurse is most appropriate? a."Don't worry about it; you'll feel better in a month or so." b."Have you talked to your husband about how you feel?" c."Perhaps you really don't want to be pregnant." d."Hormone changes during pregnancy commonly result in mood swings."

ANS: D Explaining that hormone changes can result in mood swings is an accurate statement and the most appropriate response by the nurse. Telling the woman not to worry dismisses her concerns and is not the most appropriate response. Although the woman should be encouraged to share her feelings, asking if she has spoken to her husband about them is not the most appropriate response and does not provide her with a rationale for the psychosocial dynamics of her pregnancy. Suggesting that the woman does not want to be pregnant is completely inappropriate and deleterious to the psychologic well-being of the woman. Hormonal and metabolic adaptations often cause mood swings in pregnancy. The woman's responses are normal. She should be reassured about her feelings.

Many pregnant women have questions regarding work and travel during pregnancy. Which education is a priority for the nurse to provide? a.Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b.Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c.Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d.While working or traveling in a car or on an airplane, women should arrange to walk around at least every hour or so.

ANS: D Periodic walking helps prevent thrombophlebitis. Pregnant women should avoid sitting or standing for long periods and crossing the legs at the knees. Pregnant women must wear lap belts and shoulder restraints. The most common injury to the fetus comes from injury to the mother. Metal detectors at airport security checkpoints do not harm fetuses.

Which sign or symptom is considered a first-trimester warning sign and should be immediately reported by the pregnant woman to her health care provider? a.Nausea with occasional vomiting b.Fatigue c.Urinary frequency d.Vaginal bleeding

ANS: D Signs and symptoms that must be reported include severe vomiting, fever and chills, burning on urination, diarrhea, abdominal cramping, and vaginal bleeding. These symptoms may be signs of complications of the pregnancy. Nausea with occasional vomiting is a normal first-trimester complaint. Although it may be worrisome or annoying to the mother, it is not usually an indication of a problem with the pregnancy. Fatigue is common during the first trimester. Because of physiologic changes that happen during pregnancy, clients should be taught that urinary frequency is normal.

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. Which guidance should the nurse provide? a."Since you're in your second trimester, there's no problem with having one drink with dinner." b."One drink every night is too much. One drink three times a week should be fine." c."Since you're in your second trimester, you can drink as much as you like." d."Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."

ANS: D The statement "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy" is accurate. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? a.Accepts the fetus as distinct from herself—accepts the biologic fact of pregnancy—has feelings of caring and responsibility. b.Fantasizes about the child's gender and personality—views the child as part of herself—becomes introspective. c.Views the child as part of herself—has feelings of well-being—accepts the biologic fact of the pregnancy. d."I am pregnant"—"I am going to have a baby"—"I am going to be a mother."

ANS: D The woman first centers on herself as pregnant, then on the baby as an entity separate from herself, and then on her responsibilities as a mother. The expressions "I am pregnant," "I am going to have a baby," and "I am going to be a mother" sum up the progression through the three phases. In phase one, the woman views the child as part of herself and not as a separate being. This is only the first step of the progression through phases of attachment. Accepting the fetus as distinct from herself occurs during the second phase of emotional attachment. Fantasizing about the child's sex and personality based on fetal activity occurs during the third phase of attachment.

A woman who is 16 weeks pregnant has come in for a follow-up visit with her significant other. To reassure the client regarding fetal well-being, which is the highest priority action for the nurse to perform? a.Assess the fetal heart tones with a Doppler stethoscope. b.Measure the girth of the woman's abdomen. c.Complete an ultrasound examination (sonogram). d.Offer the woman and her family the opportunity to listen to the fetal heart tones.

ANS: D To provide the parents with the greatest sense of reassurance, the nurse should offer to have the client and her significant other the chance to listen to their baby's heartbeat. A fetoscope can detect the fetal heart rate around 20 weeks of gestation. Doppler can detect the fetal heart rate between 10 and 12 weeks and should be performed as part of routine fetal assessment. Abdominal girth is not a valid measure for determining fetal well-being. Fundal height is an important measure that should be determined with precision, with the same technique and positioning of the client consistently used at every prenatal visit. Routine ultrasound examinations are recommended in early pregnancy; they date the pregnancy and provide useful information about the health of the fetus. However, they are not necessary at each prenatal visit.

A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. She can expect the following advice: a. Discontinue all contraception now. b. Lose weight so that you can gain more during pregnancy. c. You may take any medications you have been taking regularly. d. Make sure that you include adequate folic acid in your diet

ANS: D A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A womans folate or folic acid intake is of particular concern in the periconception period. Neural tube defects are more common in infants of women with a poor folic acid intake. Depending on the type of contraception used, discontinuing all contraception may not be appropriate advice. Losing weight is not appropriate advice. Depending on the type of medication the woman is taking, continuing its use may not be appropriate.

Which pregnant woman should restrict her weight gain during pregnancy? a. Woman pregnant with twins b. Woman in early adolescence c. Woman shorter than 62 inches or 157 cm d. Woman who was 20 pounds overweight before pregnancy

ANS: D A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese women should be advised to lose weight before conception to achieve the best pregnancy outcomes. A higher weight gain in twin gestations may help prevent low birth weights. Adolescents need to gain weight toward the higher acceptable range, which provides for their own growth as well as for fetal growth. In the past, women of short stature were advised to restrict their weight gain; however, evidence to support these guidelines has not been found

The major source of nutrients in the diet of a pregnant woman should be composed of: a. Simple sugars b. Fats c. Fiber d. Complex carbohydrates

ANS: D Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fiber is supplied primarily by complex carbohydrates

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that : a. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron. b. Iron absorption is inhibited by a diet rich in vitamin C. c. Iron supplements are permissible for children in small doses. d. Constipation is common with iron supplements.

ANS: D Constipation can be a problem. 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 woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman: a. Substitute other calcium sources for milk in her diet. b. Lie down after each meal. c. Reduce the amount of fiber she consumes. d. Eat five small meals daily

ANS: D Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fiber intake are inappropriate dietary suggestions for all pregnant women and do not alleviate heartburn.

A pregnant womans diet history indicates that she likes the following list of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake? a. Fresh apricots b. Canned clams c. Spaghetti with meat sauce d. Canned sardines

ANS: D Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium

Nutrition is one of the most significant factors influencing the outcome of a pregnancy. It is an alterable and important preventive measure for various potential problems, such as low birth weight and prematurity. While completing the physical assessment of the pregnant client, the nurse can evaluate the clients nutritional status by observing a number of physical signs. Which sign would indicate that the client has unmet nutritional needs? a. Normal heart rate, rhythm, and blood pressure b. Bright, clear, shiny eyes c. Alert, responsive, and good endurance d. Edema, tender calves, and tingling

ANS: D The physiologic changes of pregnancy may complicate the interpretation of physical findings. Lower extremity edema often occurs when caloric and protein deficiencies are present; however, it may also be a common physical finding during the third trimester. It is essential that the nurse complete a thorough health history and physical assessment and request further laboratory testing if indicated. A malnourished pregnant patient may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure. A patient receiving adequate nutrition has bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae all are signs of poor nutrition. This client is well nourished. Cachexia, listlessness, and tiring easily would be indications of poor nutritional status

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? a. This weight gain indicates possible gestational hypertension. b. This weight gain indicates that the womans infant is at risk for intrauterine growth restriction (IUGR). c. This weight gain cannot be evaluated until the woman has been observed for several more weeks. d. The womans weight gain is appropriate for this stage of pregnancy.

ANS: D The statement The womans weight gain is appropriate for this stage of pregnancy is accurate. This womans BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg. Although weight gain does indicate possible gestational hypertension, it does not apply to this patient. 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 womans height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. Although weight gain does indicate risk for IUGR, this does not apply to this patient. Weight gain should occur at a steady rate throughout the pregnancy. The optimal rate of weight gain also depends on the stage of the pregnancy

To determine the cultural influence on a patients diet, the nurse should first: a. Evaluate the patients weight gain during pregnancy b. Assess the socioeconomic status of the patient c. Discuss the four food groups with the patient d. Identify the food preferences and methods of food preparation common to that culture

ANS: D Understanding the patients food preferences and how she prepares food will assist the nurse in determining whether the patients culture is adversely affecting her nutritional intake. Evaluation of a patients weight gain during pregnancy should be included for all patients, not just for patients who are culturally different. The socioeconomic status of the patient may alter the nutritional intake but not the cultural influence. Teaching the food groups to the patient should come after assessing food preferences.

Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother? a. Zinc b. Vitamin D c. Folic acid d. Vitamin A

ANS: D Zinc, vitamin D, and folic acid are vital to good maternal and fetal health and are highly unlikely to be consumed in excess. Vitamin A taken in excess causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy

A woman arrives at the clinic for a pregnancy test. The first day of her LMP was September 10, 2014. Her expected date of birth (EDB) is __________.

June 17, 2015 Using the Nägele's rule, June 17, 2015, is the correct EDB. The EDB is calculated by subtracting 3 months from the first day of the LMP and adding 7 days + 1 year to the day of the LMP. Therefore, with an LMP of September 10, 2014: September 10, 2014 - 3 months = June 10, 2014 + 7 days = June 17, 2014 + 1 year = June 17, 2015.