Chapter 11 Healthy Eating for Healthy Babies
To prevent birth defects, it is very important to correctly assess the woman's nutritional status. Studies have shown a correlation with impaired cognitive development and a deficiency of which nutrient? A) Iodine B) Omega-3 C) Iron D) Calcium
Ans: A Feedback: An iodine deficiency during pregnancy can cause neurologic damage from fetal hypothyroidism. Population studies correlate iodine deficiency with impaired cognitive development in the fetus and in children.
It is recommended that herbal supplements not be taken during pregnancy or while breastfeeding. Why is that recommendation made? A) They have the potential of crossing the placental barrier. B) They can create nutritional deficiencies in the mother and fetus. C) They are known to cause teratogenic effects in the fetus. D) They have been proven to cause early labor.
Ans: A Feedback: Because little is known about the safety and efficiency of herbal supplements during pregnancy, it is recommended that they are not used during pregnancy and lactation. Because most substances cross the placental barrier, it is not known if the fetus is being exposed to potentially teratogenic effects.
The nurse is doing nutrition counseling with a 21-year-old pregnant woman in the clinic area. What should the nurse explain to the client about caloric intake during the second and third trimesters of her pregnancy? A) She will need approximately 450 cal/day increase during the third trimester. B) She will need approximately 450 cal/day increase during the second trimester. C) She will need approximately 500 cal/day increase during the third trimester. D) She will need approximately 500 cal/day increase during the second trimester.
Ans: A Feedback: It is recommended that a pregnant woman increase her calorie intake by 340 cal/day during the second trimester and 450 cal/day during the third trimester.
Because iron is one nutrient that needs supplementation during pregnancy, what is the recommended dosage for iron during pregnancy? A) 27 mg/day B) 35 mg/day C) 45 mg/day D) 60 mg/day
Ans: A Feedback: It is recommended that pregnant women take an iron supplement of 27 mg of iron daily; women who are anemic may need 60 mg of iron daily until the anemia resolves.
Mercury occurs naturally in the environment, including waterways. Bacteria in the water convert mercury to methylmercury, which is absorbed by fish low on the food chain and becomes concentrated in larger, longer living predatory fish at the top of the food chain. What can mercury exposure during pregnancy cause? A) Brain and neurologic abnormalities in the fetus B) Stunted fetal growth C) Fetal malformations D) Abortion
Ans: A Feedback: Mercury poisoning in a fetus can result in learning delays in walking or talking to more severe problems such as cerebral palsy, seizures, and mental retardation.
A client is having difficulty with nausea and vomiting. She has been eating small, frequent meals as suggested; however, it is not totally effective. What other suggestions should the nurse make? A) Eat frequent, small snacks of dry carbohydrates. B) Drink green tea with each meal. C) Keep hard candy available. D) Increase fiber intake.
Ans: A Feedback: Nutrition interventions to help with nausea and vomiting include eating easily digested carbohydrate foods before getting out of bed in the morning; eating frequent, small snacks of dry carbohydrates; eating small, frequent meals; avoiding liquids with meals; limiting high-fat foods; and eliminating individual intolerances and foods with strong odor.
A common complaint during pregnancy is heartburn. As the clinic nurse, what should be recommended to decrease the discomfort of heartburn? A) Eat small, frequent meals. B) Drink warm liquids with the meals. C) Eat easily digested carbohydrates. D) Drink liquids immediately before meals.
Ans: A Feedback: Nutritional interventions for heartburn include eating small, frequent meals; eliminating fluids immediately before and after meals; and avoiding coffee, high-fat foods, and spices.
During pregnancy, most nutritional needs can be consumed in adequate amounts through the diet. What nutrient is the exception to this statement? A) Iron B) Calcium C) Sodium D) Vitamin D
Ans: A Feedback: The DRI for iron increases by 50% during pregnancy to support the increase in maternal blood volume and to provide iron for fetal liver storage.
The client is requesting suggestions to help increase her folate intake. Which of the following are good sources for folate/folic acid? Select all that apply. A) Spinach B) Breakfast cereals C) Lentils D) Salmon E) Lean beef
Ans: A, B, C Feedback: Sources of folic acid include 100% fortified ready-to-eat breakfast cereals; white breads, rolls, pasta, and crackers (enriched flour is required to be fortified with folic acid); leafy green vegetables, such as spinach; citrus fruits; and dried peas and beans, such as lentils, soybeans, and pinto beans.
Which pregnant client is at risk for poor nutritional status? Select all that apply. A) Teens and women older than 35 years of age B) Prepartum BMI of less than 18.5 or greater than 25 C) Multiparity D) Increased hemoglobin and hematocrit levels E) Exercise of 30 minutes per day
Ans: A, B, C Feedback: There are various factors associated with high-risk pregnancy. They include teens (15 and younger) and women 35 and older; a prepregnancy BMI of less than 18.5 or greater than 25; and poor obstetric history, high parity, and multiparity.
The nurse is meeting with several pregnant clients to discuss breastfeeding. There are several benefits to breastfeeding for both the mother and the infant. Which of the following statements are true about these benefits that the nurse should point out to the women? Select all that apply. A) Breastfeeding may decrease the risk of food allergies in the infant. B) Breastfeeding may be protective against breast cancer in the mother. C) Breastfeeding provides reliable contraception. D) Breastfeeding can mobilize fat stores to help women lose weight, particularly in the lower body. E) Breastfeeding decreases bone density.
Ans: A, B, D Feedback: Breastfeeding offers many benefits to the mother and child. Decreasing food allergies is one for the child, and protection against breast cancer and mobilizing stored fat are beneficial for the mother. Breastfeeding does not provide reliable contraception, and it increases bone density in the mother.
Most pregnant women are at low risk for nutritional deficiencies because they can meet their daily requirements through diet alone. Folic acid is an exception to this statement and requires what? A) The ingestion of enhanced foods B) The ingestion of fortified foods C) The ingestion of biotech foods D) The ingestion of reinforced foods
Ans: B Feedback: All women of childbearing age who are capable of becoming pregnant are urged to consume 400 μg of synthetic folic acid every day from fortified food or supplements.
Nausea and vomiting are common complaints during pregnancy. What nutritional action can be used to lessen nausea and vomiting? A) Drinking liquids with meals B) Limiting fat intake C) Increasing fluid intake D) Limiting carbohydrate intake
Ans: B Feedback: High-fat foods will delay gastric emptying. By limiting their intake, it should lessen the nausea and vomiting experienced during pregnancy.
The client is 24 weeks pregnant. How much have her daily calorie needs increased over her first trimester needs? A) 200 calories B) 300 calories C) 400 calories D) 500 calories
Ans: B Feedback: It is recommended that women increase their daily calorie intake by approximately 340 calories each day during the second trimester.
What are the nutritional recommendations for calcium during a normal pregnancy? A) 800 mg/day B) 1000 mg/day C) 1200 mg/day D) 1400 mg/day
Ans: B Feedback: The recommended dosage of calcium is 1000 mg/day throughout the pregnancy.
For a woman who is obese at conception, the recommended total weight gain should be a minimum of what? A) 13 pounds B) 11 pounds C) 15 pounds D) 17 pounds
Ans: B Feedback: The recommended weight gain for women who are obese at the time of conception is 11 to 20 pounds.
Pica is a craving for nonfood items such as laundry starch, clay, or ice. What problem is associated with pica? A) Excessive weight gain B) Iron deficiency C) Lead contamination D) Diarrhea
Ans: B Feedback: There is no evidence that micronutrient deficiencies cause a physiologic craving; however, the eating of soil and clay may displace the intake of iron-rich foods from the diet and may interfere with iron absorption.
The nurse is preparing the client to make the necessary dietary changes from what she has been doing during her pregnancy to what she should do during lactation. What should breastfeeding mothers be advised? A) Thirst is not a reliable indicator of need. B) Even if a mother has adequate fat stores, calorie intake should be increased. C) The intake does not need to be restricted because the caffeine does not enter breast milk. D) If she does not consume enough calcium, her milk will be calcium deficient.
Ans: B Feedback: Women use approximately 500 calories above their normal total daily calorie needs to produce breast milk. An extra 330 cal/day are recommended for the first 6 months and an extra 400 cal/day for the second 6 months. Thirst can be a reliable indicator of need; caffeine can enter the breast milk; and if she does not consume enough calcium, her body will pull it from other areas to ensure the milk has enough.
The client is now 20 weeks' gestation. At conception her weight was considered "normal." Approximately how much weight should she have gained by this time? A) 6 pounds B) 9 pounds C) 12 pounds D) 15 pounds
Ans: C Feedback: Assuming a 1.1- to 4.4-pound weight gain occurred in the first trimester, normal-weight females are urged to gain approximately 1 pound each week during the second and third trimester. Each trimester is approximately 13 weeks; therefore, 4.4 pounds + 7 pounds = 11.4 pounds.
A 32-year-old client at the clinic asks the nurse why breastfeeding is so highly recommended. What benefit would be named that would affect this client later in life? A) Breastfeeding is associated with a decreased bone density later in life. B) Breastfeeding is associated with an increased risk for hip fracture later in life. C) Breastfeeding is associated with reducing the risk of postpartum depression. D) Breastfeeding is associated with decreased iron stores later in life.
Ans: C Feedback: Breastfeeding offers benefits to the mother. These include conserving iron stores by prolonging amenorrhea, improving bone density and reducing the risk of hip fracture, and reducing the risk of postpartum depression.
The client is a 32-year-old female whose prepregnancy weight is considered "normal." She is carrying a single fetus. What is the recommended amount of total weight gain? A) 15 to 20 pounds B) 20 to 25 pounds C) 25 to 35 pounds D) 35 to 40 pounds
Ans: C Feedback: Current recommendation is 25 to 35 pounds gain in women of normal weight.
The nurse is evaluating the client's nutritional status at her prenatal visit. The client is asking if she should take a supplement. What is the basis for recommending a supplement during pregnancy? A) A decrease in eyesight B) The stress of pregnancy C) Individual circumstances D) Increased nutrient needs during pregnancy
Ans: C Feedback: Each individual should receive a complete assessment to determine the risk and/or presence of any conditions that might indicate a concern. The need for supplements will depend on the individual circumstances.
The nurse is discussing with a nutrition class the health risks to infants of women who gain excessive weight during pregnancy. What risks should the nurse discuss with the class? A) High Apgar score B) Small for gestational age C) Seizures D) Hyperglycemia
Ans: C Feedback: Excessive maternal weight gain increases the risk of hypoglycemia, large for gestational size, a low Apgar score, seizures, or polycythemia in the infant.
The nurse is conducting client teaching for a new breastfeeding mother before she leaves the hospital. The client asks about how much fluid she should drink each day. Which of the following is the best answer? A) Drink at least 10 glasses of fluid every 24 hours. B) Drink a glass of fluid at every meal. C) Drink a glass of fluid every time the baby nurses and at every meal. D) Drink a glass of fluid every two hours around the clock.
Ans: C Feedback: It is suggested that breastfeeding mothers drink a glass of fluid every time the baby nurses and with all meals.
The client is interested in breastfeeding her infant but has to return to work once her maternity leave is over. How long does the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for an infant? A) The first 3 months of age B) The first 4 months of age C) The first 6 months of age D) The first 12 months of age
Ans: C Feedback: The AAP recommends infants be exclusively breastfed for the first 6 months of life and then continued with complementary foods until 1 year of age
The nurse is discussing weight gain with a group of pregnant women at the clinic. One woman is very thin, and her prepregnancy weight falls below the normal weight range for her height. What is her recommended weight gain during her pregnancy? A) 40 to 50 pounds B) 30 to 50 pounds C) 28 to 40 pounds D) 20 to 30 pounds
Ans: C Feedback: Women with a BMI less than 18.5 are recommended to gain 28 to 40 pounds during their pregnancy.
One vitamin has been identified as helping to prevent neural tube defects when consumed in adequate amounts before conception through the early weeks of pregnancy. Which vitamin is it? A) Vitamin B6 B) Riboflavin C) Niacin D) Folic acid
Ans: D Feedback: Folic acid is a necessary nutrient in the development phase of the neural tubes. If the mother is deficient, the developing fetus may suffer a birth defect of the neural tubes.
During lactation, many of the nutrient values go either up or down. Compared with those of pregnancy, what are the Recommended Dietary Allowances during lactation? A) Lower for vitamin D B) Lower for protein C) Higher for calcium D) Lower for iron
Ans: D Feedback: In a healthy woman, the recommendation for iron decreases during lactation (9 mg) from pregnancy (27 mg). There is no change in the recommendation for vitamin D, protein, and calcium.
The client is concerned that her milk may not be providing adequate nutrition for her infant. The nurse recognizes that an inadequate maternal diet generally decreases what in the breast milk of a lactating mother? A) Protein B) Fat C) Calcium D) Vitamins
Ans: D Feedback: In general, an inadequate maternal diet decreases the quantity of milk produced, not the quality. The exceptions are thiamin, riboflavin, vitamin B6, vitamin B12, vitamin A, and iodine. Prolonged inadequate maternal intake reduces their amount in breast milk.
One of the students in the nutrition class is 8 months pregnant and asks the nurse to give her a recommendation to decrease her pregnancy-related constipation. What would be the best response? A) Drink prune juice with every meal. B) Eat vitamin-enriched white bread three times a day. C) Eat iron-fortified cereal. D) Try drinking hot water with lemon juice upon waking.
Ans: D Feedback: Nutritional interventions to try for improving constipation include increase drinking at least 64 oz of liquid daily, increase fiber intake, and drinking hot water with lemon or prune juice first thing in the morning.
The client has come to the clinic for her first prenatal visit. The nurse is assessing her risk for a high-risk pregnancy. Which of the following is a likely result of a high-risk pregnancy? A) Low birth weight infant B) Diabetes insipidus C) Constipation D) High birth weight infant
Ans: A Feedback: A high-risk pregnancy is likely to produce a low birth weight infant.
Nutritional requirements generally go up during pregnancy. Which nutritional requirement proportionally increases the most during pregnancy? A) Calories B) Protein C) Iron D) Vitamin A
Ans: A Feedback: According to the DRIs, pregnant women do not need additional calories until the second trimester. An extra 340 cal/day is recommended during the second trimester. An extra 452 cal/day is recommended during the third trimester.
It is recognized that some substances are dangerous to the fetus and can cause birth defects. The use of what during pregnancy is potentially most harmful to the fetus? A) Alcohol B) Caffeine C) Aspartame D) Acesulfame-K
Ans: A Feedback: Alcohol is a potent teratogen and a safe level of consumption is not known. Women are advised to completely avoid alcohol before and during pregnancy.
Gestational diabetes occurs around the 24th week of gestation. When should every woman be screened for gestational diabetes? A) Between 16 and 20 weeks' gestation B) Between 20 and 24 weeks' gestation C) Between 24 and 28 weeks' gestation D) Between 28 and 32 weeks' gestation
Ans: C Feedback: All women should be screened for gestational diabetes between 24 and 28 weeks of gestation
The nurse has been counseling a group of pregnant women concerning appropriate food choices. Which of the following lunch menus indicates the women understand a recommended diet for a pregnant woman? A) 2-oz prime rib; a medium-baked potato with 2 tbsp of sour cream, 2 tbsp of butter, and 2 oz of grated cheese; 1 cup of creamed corn; 6 oz of green tea; ¾ cup of ice cream B) 6 pieces of sushi, 2 cups of saki, 4 oz of steamed vegetables C) 6 oz of swordfish, ¼ cup tartar sauce, 2 slices of French bread with 1½ teaspoons of butter on each, ¾ cup of sweet peas, 1 4-in slice of apple pie with 1 scoop of vanilla ice cream D) 3 oz of tuna-stuffed tomato, 1 small apple, 8 oz of sugar-free orange drink
Ans: D Feedback: The basic principles of healthy eating that apply to healthy people are also appropriate before, during, and after pregnancy. As with the general public, sodium, solid fats, added sugars, and refined grains should be limited. Fish that is known to be high in methylmercury should be limited in intake should also be avoided.