Olds' Ch. 16: Nutrition

The pregnant teen who was prescribed prenatal vitamins at her initial prenatal visit states that she does not like to take them. How should the nurse respond? Select all that apply. 1. "Folic acid has been found to be essential for minimizing the risk of neural tube defects." 2. "You do not have to take these supplements if you think you are healthy enough." 3. "These medications do the same thing. I will call your doctor to cancel one of your medications." 4. "You can trust your doctor to know what you need." 5. "You need the supplements because your dietary intake may not be adequate for fetal development."

Answer: *"Folic acid has been found to be essential for minimizing the risk for neural tube defects."* *"You need the supplements because your dietary intake may not be adequate for fetal development."* Explanation: 1. The CDC estimates that most neural tube defects could be prevented if women followed folic acid supplementation recommendations before they know they are pregnant. 5. One role of the nurse is educator, and this client needs additional information on why she needs the supplements. This response answers the client's concerns.

The nurse is counseling a group of first-trimester clients on diet increases that are necessary during pregnancy. Which information would be necessary to tell the pregnant women? Select all that apply. 1. An increase of protein is necessary to provide amino acids necessary for fetal development. 2. Protein contributes to the body's overall energy metabolism. 3. The recommended protein during pregnancy is 70 grams each day. 4. The increased amount of protein that a pregnant woman needs is 15 grams a day. 5. The quality of protein is as important as the amount.

Answer: *An Increase of protein is necessary to provide amino acids necessary for fetal development.* * Protein contributes to the body's overall energy metabolism.* *The recommended protein during pregnancy is 70 grams each day.* *The quality of protein is as important as the amount* Explanation: 1. During pregnancy, the woman needs increased amounts of protein to provide amino acids for fetal development, blood volume expansion, and growth of other maternal tissues. 2. Protein contributes to overall energy metabolism. 3. The amount of protein recommended each day during pregnancy is 70 grams. 5. Plant proteins can meet a woman's protein needs; however, more of a given protein may be needed because animal proteins are of higher quality.

Postpartum nutritional status is determined primarily by assessing which of the following? Select all that apply. 1. Dietary history 2. Menstrual history 3. Mother's weight 4. Hemoglobin levels 5. Mother's height

Answer: *Dietiary history* *Mother's weight* *hemoglobin levels* Explanation: 1. Postpartum nutritional status is determined by assessing the new mother's dietary history. 3. Postpartum nutritional status is determined by assessing the new mother's weight. 4. Postpartum nutritional status is determined by assessing the new mother's hemoglobin levels.

A nurse is discussing the serving sizes in the grains food group with a new prenatal patient in the clinic. Which food equals one serving size from the grains food group?Select all that apply. 1. One hamburger roll 2. One slice of bread 3. One cup of pasta 4. One tortilla 5. One ounce of dry cereal

Answer: *One slice of bread.* *One tortilla8 *One ounce of dry cereal* Explanation: 2. One slice of bread is one serving. 4. One tortilla is one serving. 5. One ounce of dry cereal is one serving.

Women with eating disorders who become pregnant are at risk for a variety of complications including which of the following? Select all that apply. 1. Premature birth 2. Too many nutrients available for the fetus 3. Miscarriage 4. High birth weight 5. Perinatal mortality

Answer: *Premature birth.* *Miscarriage* *Perinatal mortality* Explanation: 1. Risks to the mother and baby include premature birth. 3. Risks to the mother and baby include miscarriage. 5. Risks to the mother and baby include perinatal mortality.

The nurse is planning an early-pregnancy class session on nutrition. Which information should the nurse include? Select all that apply. 1. Protein is important for fetal development. 2. Iron helps both mother and baby maintain the oxygen-carrying capacity of the blood. 3. Calcium prevents constipation at the end of pregnancy. 4. Zinc facilitates synthesis of RNA and DNA. 5. Vitamin A promotes development of the baby's eyes.

Answer: *Protein is important for fetal development.* *Iron helps both mother & baby maintain the oxygen-carrying capacity of the blood.* *Zinc facilitates synthesis of RNA & DNA.* *Vitamin A promotes development of the baby's eyes.* Explanation: 1. During pregnancy, the woman needs increased amounts of protein to provide amino acids for fetal development. 2. Iron deficiency anemia is associated with an increased incidence of preterm birth, low-birth-weight infants, and maternal and infant mortality. 4. Zinc is involved in RNA and DNA synthesis, and milk production during lactation. 5. Vitamin A promotes healthy formation and development of the fetal eyes.

A client tells the nurse that she does not like citrus fruits, and would like suggestions for alternate vitamin C sources. What should the nurse suggest as good sources of vitamin C? Select all that apply. 1. Barley and brown rice 2. Strawberries and potatoes 3. Buckwheat and lentils 4. Wheat flour and figs 5. Blueberries and broccoli

Answer: *Strawberries & potatoes.* Explanation: 2. Strawberries and potatoes are very good sources of vitamin C.

The nurse is presenting a preconception counseling class. The nurse instructs the participants that niacin intake should increase during pregnancy to promote metabolic coenzyme activity. The nurse will know that teaching has been effective if a client suggests which food as a source of niacin? 1. Fish 2. Apples 3. Broccoli 4. Milk

Answer: * Fish* Explanation: 1. Dietary sources of niacin include meats, fish, and whole grains.

A pregnant client who is a lacto-vegetarian asks the nurse for assistance with her diet. What instruction should the nurse give? Select all that apply. 1. "Protein is important; therefore, the addition of one serving of meat a day is necessary." 2. "A daily supplement of vitamin B12 is important." 3. "The high fiber in a vegetarian diet is dangerous for pregnant women." 4. "Eggs are important to add to your diet. Eat six eggs per week." 5. "Milk products contain protein, but they are very low in iron."

Answer: *"A daily supplement of vitami nB12 is important."* *"Milk products contain protein, but they are very low in iron."* Explanation: 2. Supplementation may be recommended for vegans who have difficulty meeting the recommended amounts of vitamin B12 through food sources.

A client presents to the antepartum clinic with a history of a 20-pound weight loss. Her pregnancy test is positive. She is concerned about gaining the weight back, and asks the nurse if she can remain on her diet. What is the nurse's best response? 1. "As long as you supplement your diet with the prenatal vitamin, the amount of weight you gain in pregnancy is not significant." 2. "I understand that gaining weight after such an accomplishment might not look attractive, but weight gain during pregnancy is important for proper fetal growth." 3. "Dieting during pregnancy is considered child neglect." 4. "Excessive weight gain in pregnancy is due to water retention, so weight loss following birth will not be an issue."

Answer: *"As long as you supplement your diet with the prenatal vitamin, the amount of weight you gain in pregnancy is not significant."* Explanation: 2. Maternal weight gain is an important factor in fetal growth and in infant birth weight. An adequate weight gain over time indicates an adequate caloric intake.

The nurse is working with a pregnant 14-year-old. Which statement indicates that additional education is required? 1. "Because I am still growing, I need more calories than a pregnant adult." 2. "I need to eat fruit and vegetables every day to get enough vitamins." 3. "My favorite food is pizza, and I eat it once a week." 4. "Because I don't eat breakfast, I'll have to eat more at supper."

Answer: *"Because I don't eat breakfast, I'll ahve to eat more at supper."* Explanation: 4. Pregnant young adolescents should eat breakfast to ensure the adequate calorie and protein intake needed. In assessing the diet of the pregnant adolescent, the nurse should consider the eating pattern over time, not simply a single day's intake.

The nurse is preparing a prenatal class about infant feeding methods. The maternal nutritional requirements for breastfeeding and formula-feeding will be discussed. What statement should the nurse include? 1. "Breastfeeding requires a continued high intake of protein and calcium." 2. "Formula-feeding mothers should protect their health with a lot of calcium." 3. "Producing breast milk requires calories, but any source of food is fine." 4. "Formula-feeding mothers need a high protein intake to avoid fatigue."

Answer: *"Breastfeedign requires a continued high intake of protein & calcium."* Explanation: 1. Lactation requires calories, along with increased protein and calcium intake.

The pregnant client states she does not want "to take all these supplements." What recommendations could the nurse make for the client? Select all that apply. 1. "Folic acid has been found to be essential for minimizing the risk of neural tube defects." 2. "You do not have to take these supplements if you think you are healthy enough." 3. "Most women do not have adequate intake of iron pre-pregnancy, and iron needs increase with pregnancy." 4. "These medications do the same thing. I will call your physician to cancel one of your medications." 5. "You should take the folic acid, but the vitamins are not that important."

Answer: *"Folic acid has been found to be essential for minimizing the risk for neural tube defects."* *"Most women do not have adequate intake of iron-pre-pregnancy, & iron needs increase w/ pregnancy."* Explanation: 1. An inadequate intake of folic acid has been associated with neural tube defects (NTDs) (e.g., spina bifida, anencephaly). 3. Iron is essential because many pregnant women do not have adequate intake of iron before pregnancy.

The breastfeeding mother is concerned that her milk production has decreased. The nurse knows that further client teaching is needed based on which statement? 1. "I am drinking a minimum of 8 to 10 glasses of liquid a day." 2. "I have started cutting back on my protein intake." 3. "At least three times a day, I drink a glass of milk." 4. "My calorie intake is higher than during the pregnancy."

Answer: *"I have started cutting back on my protein intake.* Explanation: 2. An adequate protein intake is essential while breastfeeding because protein is an important component of breast milk.

Which statement is best to include when teaching a pregnant adolescent about nutritional needs of pregnancy? 1. "It is important to eat iron-rich foods like meat every day." 2. "Calcium and milk aren't needed until the third trimester." 3. "Folic acid intake is the key to having a healthy baby." 4. "You just need to pay attention to what you eat now."

Answer: *"It is important to eat iron-rich foods like meat everyday.*" Explanation: 1. An inadequate iron intake is a major concern with the adolescent diet. Iron needs are high for the pregnant teen because of the requirement for iron by the enlarging maternal muscle mass and blood volume. Giving specific examples is helpful when giving nutritional information.

When preparing nutritional instruction, which pregnant client would the nurse consider the highest priority? 1. 40-year-old gravida 2 2. 22-year-old primigravida 3. 35-year-old gravida 4 4. 15-year-old nulligravida

Answer: *15 year old nulligravida* Explanation: 4. An expectant adolescent must meet the nutritional needs for her own growth in addition to the nutritional needs of pregnancy.

A pregnant client who was of normal prepregnancy weight is now 30 weeks pregnant. She asks the nurse what appropriate weight gain for her should be. What is the nurse's best response? 1. "25-35 pounds" 2. "30-40 pounds" 3. "17-18 pounds" 4. "Less than 15 pounds"

Answer: *25-35 pounds* Explanation: 1. An appropriate weight gain for a woman of normal weight before pregnancy would be 25-35 pounds.

In early-pregnancy class, the nurse emphasizes the importance of 8-10 glasses of fluid per day. How many of these should be water? 1. 1 to 2 2. 2 to 4 3. 4 to 6 4. 3 to 5

Answer: *4 to 6* Explanation: 3. A pregnant woman should consume at least 8 to 12 (8 oz) glasses of fluid each day, of which 4 to 6 glasses should be water.

What would the nurse do to accurately assess a pregnant client's food intake? 1. Assess her most recent laboratory values. 2. Ask her to complete a nutritional questionnaire. 3. Observe for signs of hunger. 4. Ask about her cooking facilities.

Answer: *Ask her to compelte a nutritional questionnaire.* Explanation: 2. Diet may be evaluated using a food frequency questionnaire, which lists common categories of foods and asks the woman how frequently in a day (or week) she consumes foods from the list.

A nurse is discussing diet with a pregnant woman. Which food should the nurse advise the client to avoid during her pregnancy? 1. Bologna 2. Cantaloupe 3. Spinach 4. Cornbread

Answer: *Bologa* Explanation: 1. Hot dogs and other luncheon meats should not be eaten during pregnancy unless they are fully cooked.

The nurse is instructing a pregnant client on her nutritional needs. The nurse tells the client that nutrition is needed for fetal development because fetal growth occurs in overlapping stages from increases of which of the following? Select all that apply. 1. Cell numbers 2. Cell membranes 3. Cell size and number 4. Cell size alone 5. Vitamin and mineral intake

Answer: *Cell numbers* *Cell size & Number* *Cell size alone* Explanation: 1. Fetal growth occurs by an increase in cell numbers in one stage. 3. Fetal growth occurs by an increase in cell size and number during one stage. 4. Fetal growth occurs by an increase in cell size alone during one stage.

The nurse is preparing for a postpartum home visit. The client has been home for a week, is breastfeeding, and experienced a third-degree perineal tear after vaginal delivery. The nurse should assess the client for which of the following? 1. Dietary intake of fiber and fluids 2. Dietary intake of folic acid and prenatal vitamins 3. Return of hemoglobin and hematocrit levels to baseline 4. Return of protein and albumin to predelivery levels

Answer: *Dietary intake of fiber and fluids.* Explanation: 1. This mother needs to avoid the risk of constipation. She might be hesitant to have a bowel movement due to anticipated pain from the perineal tear, and constipation will decrease the healing of the laceration.

The nurse is planning an educational session for pregnant vegans. What information should the nurse include? 1. Eating beans and rice provides complete protein needs. 2. Soy is not a good source of protein for vegans. 3. Rice contains a high level of vitamin B12. 4. Vegan diets are excessively high in iron.

Answer: *Eating beans and rice provides complete protein needs.* Explanation: 1. Adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. Consuming an assortment of plant proteins throughout the day such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk ensures that the expectant mother obtains all essential amino acids.

The pregnant client cannot tolerate milk or meat. What would the nurse recommend to the client to assist in meeting protein needs? 1. Wheat bread and pasta 2. Ice cream and peanut butter 3. Eggs and tofu 4. Beans and potatoes

Answer: *Eggs and tofu* Explanation: 3. The best food choices that are nondairy and complete proteins alone are eggs and tofu.

Which of the following is important for the development of the central nervous system of the fetus? 1. Calcium and phosphorus 2. Essential fatty acids 3. Iron 4. Vitamin D

Answer: *Essential fatty acids* Explanation: 2. Essential fatty acids are important for the development of the central nervous system of the fetus. Of particular interest are the omega-3 fatty acids and their derivatives.

The prenatal clinic nurse is caring for a 15-year-old client who is at 8 weeks' gestation. The client asks the nurse why she is supposed to gain so much weight. What is the best response by the nurse? 1. "Gaining 25-35 pounds is recommended for healthy fetal growth." 2. "It's what your certified nurse-midwife recommended for you." 3. "Inadequate weight gain delays lactation after delivery." 4. "Weight gain is important to ensure that you get enough vitamins."

Answer: *Gaining 25-35 pounds is recommended for healthy fetal growth.* Explanation: 1. For an appropriate-weight woman, 25-35 pounds of weight gain is recommended for optimal fetal growth and development.

A pregnant client confides to the nurse that she is eating laundry starch daily. The nurse should assess the client for which of the following? 1. Alopecia 2. Weight loss 3. Iron deficiency anemia 4. Fecal impaction

Answer: *Iron efficiency anemia.* Explanation: 3. Iron deficiency anemia is the most common concern with pica. The ingestion of laundry starch or certain types of clay may contribute to iron deficiency by replacing iron-containing foods from the diet or by interfering with iron absorption.

The school nurse is planning a class about nutrition for pregnant teens, several of whom have been diagnosed with iron-deficiency anemia. In order to increase iron absorption, the nurse would encourage the teens to consume more of what beverage? 1. Gatorade 2. Orange juice 3. Milk 4. Green tea

Answer: *Orange juice* Explanation: 2. Vitamin C is found in citrus fruits and juices, and is known to enhance the absorption of iron from meat and non-meat sources.

The kosher diet followed by many Jewish people forbids the eating of what foods? 1. Pig products and shellfish 2. Dairy products 3. All animal products 4. Dairy products and eggs

Answer: *Pig products & shellfish* Explanation: 1. The kosher diet followed by many Jewish people forbids the eating of pig products and shellfish. Certain cuts of meat from sheep and cattle are allowed, as are fish with fins and scales. In addition, many Jews believe that meat and dairy products should not be mixed or eaten at the same meal.

Carbohydrates provide the body's primary source of energy as well as fiber necessary for proper bowel functioning. If the carbohydrate intake is not adequate, the body will use which of the following for energy? 1. Iron 2. Protein 3. Vitamin C 4. Vitamin D

Answer: *Protein* Explanation: 2. If the carbohydrate intake is not adequate, the body uses protein for energy. Protein then becomes unavailable for growth needs.

A woman confides to the nurse that she has pica. What alternative could the nurse suggest to the client? 1. Replace laundry starch with salt. 2. Replace ice with frozen fruit pops. 3. Replace soap with cream cheese. 4. Replace soil with nuts.

Answer: *Replace ice with frozen fruit pops.* Explanation: 2. Some women are able to switch to frozen fruit pops instead of ice.

The nurse evaluates the diet of a pregnant client and finds that it is low in zinc. The nurse knows that zinc intake should increase during pregnancy to promote protein metabolism. Which food should the nurse suggest in order to increase intake of zinc? 1. Shellfish 2. Bananas 3. Yogurt 4. Cabbage

Answer: *Shellfish* Explanation: 1. Zinc is found in greatest concentration in meats, shellfish, and poultry. Other good sources include whole grains and legumes.

A pregnant client is lactose intolerant. Which alternative food could this client eat to get sufficient calcium? 1. Turnip greens 2. Green beans 3. Cantaloupe 4. Nectarines

Answer: *Turnip greens* Explanation: 1. Turnip greens are rich in calcium.

A pregnant teenage client is diagnosed with iron-deficiency anemia. Which nutrient should the nurse encourage her to take to increase iron absorption? 1. Vitamin A 2. Vitamin C 3. Vitamin D 4. Vitamin E

Answer: *Vitamin C* Explanation: 2. Vitamin C is known to enhance the absorption of iron from meat and nonmeat sources.