Chapter 13: The Nursing Role in Promoting Nutritional Health During Pregnancy
A patient is concerned about the mercury levels in fish and asks the nurse which fish are safe to eat. The best response is Mackerel, king fish, tilefish, and shrimp Fresh salmon, shark, and swordfish Tilefish, shark, and tuna Shrimp, canned tuna, pollack, and catfish
shrimp, canned tuna, pollack, and catfish
After teaching a pregnant woman about nutrition during pregnancy, the woman discusses her dietary plan with the nurse. Which patient statement indicates to the nurse that additional teaching is needed? "To get enough folic acid, I should eat fruits and vegetables and supplement with 400 mcg of folic acid a day." "I need to have a total of 200 mg of iron a day." "I drink plenty of milk and eat dairy, so I should be able to consume the recommended 1300 mg of calcium a day without taking a supplement." "Because I'm not outside during the day, I should take 400 units of vitamin D a day."
i need to have a total of 200 mg of iron a day
The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy? "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." "I need to gain 0.5 pounds (0.23 kg) per week during this pregnancy." "I need to gain less than 25 pounds (11 kg) during this pregnancy." "I need to gain 1 pound (0.45 kg) per week throughout this pregnancy."
"I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy."
The recommended weight gain during the first trimester for a woman who was in the normal weight range prepregnancy is 2 to 4 pounds. After the first trimester, what is the recommended weekly weight gain for a woman who was considered normal weight prepregnancy? 0.5 pound 0.66 pound 1 pound 2 pounds
1 pound
A patient of normal weight and new to the obstetric clinic asks the nurse how much weight to gain during pregnancy. What is the best response the nurse can give? 5 lbs over the first 3 months; 5 lbs over the second three months; 10 lbs over the last three months 7 lbs over the first 3 months; 7 lbs over the second three months; 7 lbs over the last three months 10 lbs over the first 20 weeks; 1 lb per week after that 5 lbs over the first 20 weeks; 2 lbs per week after that
10 lbs over the first 20 weeks 1 lb per week after that
x A woman entering her third trimester of pregnancy asks the nurse how much weight she should gain during this trimester. What is the nurse's best answer? 0.5 lb/week 1 lb/week 1.5 lb/week 2 lbs/week
1lb/ week
The nurse is teaching an active pregnant woman about nutritional needs to maintain a healthy pregnancy. The nurse determines that the teaching was successful when the woman states that she need about how many calories per day? 1,500 calories per day 2,500 calories per day 3,500 calories per day 4,000 calories per day
2,500 calories per day
A pregnant client of normal weight is concerned about excessive weight gain during her pregnancy. She states, "I don't want to get fat!" The nurse should inform her that she can expect to gain how much weight during her pregnancy? 20 to 25 pounds 25 to 30 pounds 15 to 20 pounds 35 to 40 pounds
25 to 30 pounds
Mrs. M 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? 15 to 20 pounds 20 to 25 pounds 25 to 35 pounds 35 to 40 pounds
25 to 35 pounds
You are 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? 40 to 50 pounds 35 to 50 pounds 28 to 40 pounds 20 to 30 pounds
28 to 40 pounds
At the client's third prenatal visit, a twin gestation pregnancy is diagnosed. The client's prepregnancy BMI was 26.5. Given the new diagnosis, the nurse would set the weight gain goal for this client to what weight? 31 to 50 lb (14 to 23 kg) 11 to 20 lb (5 to 9 kg) 15 to 25 lb (7 to 11 kg) 25 to 35 lb (7 to 16 kg)
31 to 50 lb (14 to 23 kg)
A pregnant client at 34 weeks' gestation reports a burning sensation in the lower esophagus. What action would the nurse recommend to increase her comfort? Select all that apply. Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating. Eat a large amount of carbohydrates. Do not drink liquids with meals.
Eat five to six small meals per day. Do not eat fried, fatty foods. Do not lie down immediately after eating.
The nurse is completing the teaching for a newly pregnant client with a BMI of 23. Which statement by the client indicates an understanding of weight gain during this pregnancy? "I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy." "I need to gain 0.5 pounds (0.23 kg) per week during this pregnancy." "I need to gain less than 25 pounds (11 kg) during this pregnancy." "I need to gain 1 pound (0.45 kg) per week throughout this pregnancy."
I need to gain 25 to 35 pounds (11 to 16 kg) during this pregnancy
At 28 weeks' gestation, the client has gained 7.5 lb (3.4 kg) since the last visit. What assessments would the nurse complete next? Select all that apply. Inspect hands for edema. Measure blood glucose level. Examine for excessive amniotic fluid. Auscultate fetal heart rate. Perform a 24-hour diet recall.
Inspect hands for edema. Measure blood glucose level. Examine for excessive amniotic fluid.
Nutritional requirements generally go up during pregnancy. Which nutritional requirement proportionally increases the most during pregnancy? Calories Protein Iron Vitamin A
Iron
A client with hyperemesis gravidarum is on a clear liquid diet. Which foods would be appropriate for the nurse to serve? Select all that apply: Milk and ice chips Decaffeinated coffee and scrambled eggs Tea and gelatin Ginger ale and apple juice Cranberry juice and chicken broth Oatmeal and egg substitutes
Tea and gelatin Ginger ale and apple juice Cranberry juice and chicken broth
When counseling a Japanese American about nutrition and diet in pregnancy, it would be important to include Alternatives to foods high in monounsaturated fats Healthy ways to increase salt intake A list of foods that contain calcium A list of foods that are high in omega-3 fatty acids
a list of foods that contain calcium
When developing a plan of care, the nurse needs to make which assessments for a pregnant client with a BMI of 18.3? Select all that apply. assess for maternal fatigue assess for poor fetal growth assess for preterm labor assess for gestational diabetes assess for eclampsia
assess for maternal fatigue assess for poor fetal growth assess for preterm labor
How can the nurse best counsel a patient with pyrosis? "It is important to continue to eat three meals a day." "Chest pain is common and is not a concern in pregnancy." "Avoid lying down 2 hours after eating." "Avoid sleeping in an upright position."
avoid lying down 2 hours after eating
A client with hyperemesis gravidarum is started on total parenteral nutrition (TPN). What parameter does the nurse need to assess at least twice a day? blood glucose hemoglobin and hematocrit blood ketones potassium level
blood glucose
A pregnant client reports being unable to find snacks at work. Which snacks would the nurse recommend she prepare in advance to take to work? Select all that apply. carrot sticks cheese and crackers pretzels and mustard doughnuts and juice candy bar with almonds
carrot sticks cheese and crackers
The nurse is teaching about an iron supplement that the client is going to take every day. The nurse teaches the client to take the iron supplement with which type of fluid? citrus juice ice water low-fat milk hot tea
citrus juice
A nurse is providing education to a client who is 8 weeks' pregnant. The client stated she does not like milk. What is a source of calcium that the nurse can recommend to the client? dark, leafy green vegetables deep red or orange vegetables white bread and rice meat, poultry, and fish
dark, leafy green vegetables
A nurse assesses a primigravida client in the eighth week of gestation. The client reports nausea and vomiting in the mornings. The client tells the nurse, "I'm not able to keep liquids down and I'm eating like a bird." The client also expresses concerns about hormonal changes and how the pregnancy will affect her physical appearance. Which client problem should the nurse assess first? Deficient fluid volume Disturbed body image Knowledge deficit Slow weight gain
deficient fluid volume
A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant? Drink plenty of fluids at bedtime. Avoid foods such as cheese. Avoid eating spicy food. Eat dry crackers or toast before rising.
eat dry crackers or toast before rising
A client at 28 weeks' gestation is asking for a laxative for constipation. What action would the nurse recommend? Eat fiber-rich foods. Take a fiber-based laxative. Use a water-based enema. Insert a glycerin suppository.
eat fiber-rich foods
When counseling a lacto-ovo-vegetarian client, the nurse would recommend including which source of protein in the diet during pregnancy? eggs fish chicken brown rice
eggs
A nurse is assessing a client's nutritional intake during pregnancy. What is the best method for accomplishing this? enacting a 24-hour nutrition recall weighing the client calculating the client's BMI having the client describe her food cravings
enacting a 24 hour nutritional recall
The nurse is describing pregnancy danger signs to a pregnant woman who is in her first trimester. Which danger sign might occur at this point in her pregnancy? dyspnea lower abdominal pressure swelling of extremities excessive vomiting
excessive vomiting
A woman relates to the nurse that she understands that dietary fat is bad for her and that she should avoid it during pregnancy. How should the nurse respond? Fats are essential during pregnancy, and vegetable oils are a good source. Fats are essential during pregnancy, and fish such as marlin and orange roughy are good sources. Fats are not essential during pregnancy and thus are optional. Fats should be avoided during pregnancy.
fats are essential during pregnancy, and vegetable oils are a good source.
All of the following are physical signs of protein deficiency in pregnancy EXCEPT Pale or brittle fingernails Dull, brittle, and lifeless hair Fissures at the corner of the mouth or pale mucous membranes Poor muscle tone or diminished reflexes
fissures at the corner of the mouth or pale mucous membranes
The nurse is discussing nutritional supplementation with a 27-year-old pregnant client. Which element would the nurse encourage as essential in preventing neural tube defects? iron calcium iodine folic acid
folic acid
A woman who is obese comes to the clinic because she thinks that she is pregnant. The pregnancy is confirmed. The nurse is developing a teaching plan for this woman about pregnancy and challenges associated with it related to obesity. The nurse would most likely plan to address which condition(s) as being an increased risk? Select all that apply. Gestational diabetes Placenta previa Large for gestational age (LGA) neonate Difficult vaginal birth Spina bifida
gestational diabetes large for gestational age (LGA) neonate difficult vaginal birth
When caring for a client with lactose intolerance, the nurse would be aware of which potential problem during pregnancy? inadequate calcium for skeletal growth inadequate protein for muscle development inadequate iron for red blood cell production inadequate folate for neural tube closure
inadequate calcium for skeletal growth
A young woman in her first trimester confesses to the nurse when questioned that she is probably not consuming enough calories. The nurse should explain to this client that deficient nutrition can hinder the baby's growth, which at this point in her pregnancy is primarily via an increase in the number of cells formed. This type of growth is known as which of the following? Hyperplasia Hypertrophy Hypercholesterolemia Hyperemesis gravidarum
hyperplasia
A client with a prepregnant BMI of 26 is concerned about gaining weight during pregnancy. Which statement by the client indicates an appropriate goal for this pregnancy? "I need to consume at least 1,500 nutrient-dense calories each day." "I will eliminate carbohydrates from my diet to control my weight." "I will eat two large meals with high protein content each day." "I am eating for two now, so the baby will burn the extra calories."
i need to consume at least 1,500 nutrient-dense calories each day
A 22-year-old female is 25 weeks pregnant. She explains that she is having difficulty getting an adequate amount of protein into her diet because she is a vegetarian. How can the nurse best counsel this patient? "Try to eat at least 5 servings of fish a week." "In addition to getting protein from eating dairy, eat complementary proteins such as beans and rice together, or beans and wheat together." "Eat more leafy greens such as spinach and romaine lettuce and more vegetable oils, almonds, and avocados." "For your baby's growth and development, you are going to have to start to eat poultry."
in addition to getting protein from eating dairy eat complementary proteins such as beans and rice together or beans and wheat together
A client in her second trimester of pregnancy arrives at a health care facility reporting heartburn. What instructions should the nurse offer to help the client deal with heartburn? Select all that apply. Limit consumption of food before bedtime. Consume lots of liquids before bedtime. Sleep in a semi-Fowler position. Avoid use of antacids. Avoid overeating.
limit consumption of food before bedtime sleep in a semi-fowler position avoid overeating
Which nursing intervention for a pregnant adolescent client in her first trimester has the highest priority? Schedule the client for a screening glucose tolerance test. Make sure the client receives nutritional counseling and reinforce the teaching. Teach the client she's at increased risk for having a macrosomic neonate. Monitor the client for signs and symptoms of placenta previa.
make sure the client receives nutritional counseling and reinforce the teaching
A nurse counsels a pregnant woman regarding her recommended daily allowance of calories. She advises her to obtain her carbohydrate calories from complex carbohydrates rather than simple carbohydrates. What is the best rationale for this guidance? More consistent regulation of glucose and insulin Provision of a greater amount of calories per gram Faster digestion of complex than simple carbohydrates Greater fatty acid content
more consistent regulation of glucose and insulin
Women who are obese in pregnancy are at higher risk for developing all of the following EXCEPT Macrosomia Pregnancy-induced hypertension Gestational diabetes Neural tube defects Cesarean birth
neural tube defects
The nutritional needs of an adolescent pregnant patient are unique because A pregnant adolescent should consume more calories than a pregnant 30-year-old with the same BMI Owing to typical food choices, an adolescent is often lacking calcium, iron, and folic acid in the diet Although most adolescents do not snack during the day, they usually have no problem finding time to consume three meals Adolescents are very independent and believe it is not necessary to talk with anyone else regarding their diet
owing to typical food choices an adolescent if often lacking calcium, iron, and folic acid in the diet
During the initial prenatal visit, the nurse performs what assessment to guide teaching about nutrition during pregnancy? prepregnancy BMI current weight height and bone structure hemoglobin level
prepregnancy BMI
Untreated hyperemesis can lead to preterm birth. What is the cause of the preterm birth? severe dehydration resulting in hypoperfusion of the placenta ketonuria resulting in neurologic changes in the fetus poor nutrient intake resulting in poor fetal growth class B drugs used to control the vomiting resulting in uterine contractions
severe dehydration resulting in hypo-perfusion of the placenta
A woman whose body mass index (BMI) is 32 has just learned that she is pregnant. Which of the following should the nurse advise her regarding her weight over the course of her entire pregnancy? She should gain 11 to 20 lb She should lose 5 to 10 lb She should strive to keep her weight constant She should gain 5 to 10 lb
she should gain 11 to 20 lb
The nurse educates the vegetarian client about which nutritional need during pregnancy? taking a B12 supplement limiting the intake of fiber supplementing the diet with vitamins A and C avoiding high intake of dark green vegetables.
taking a B12 supplement
When needed, total parenteral nutrition (TPN) is often administered at home to reduce health care costs. When teaching a patient how to safely administer TPN, the home care nurse emphasizes Keeping the solution cold during administration Testing only fasting blood glucose to decrease the chance of infection Testing blood glucose every 6 hours Leaving the insertion site open to air to facilitate observation
testing blood glucose every 6 hours
The nurse is reviewing the charts of a group of clients. Which client's weight gain should the nurse be concerned about? the client who gained 8 lb (4 kg) in the first trimester the client who gained 4 lb (2 kg) in the first trimester the client who gained 15 lb (7 kg) and is in the second trimester the client who gained 25 lb (11 kg) and is in the third trimester
the client who gained 8 lb (4 kg) in the first trimester
A pregnant client states, "I am only 6 weeks pregnant, but the morning sickness is awful. When is it going to stop?" What is the best response by the nurse? "Usually after 12 weeks, when the placenta starts managing the production of progesterone, morning sickness ends." "You will probably have some morning sickness throughout your entire pregnancy." "This is part of being pregnant for some women. You have to expect that this is going to happen." "This is going to occur for the first 16 weeks, while estrogen stores are depleted."
usually after 12 weeks when the placenta starts managing the production of progesterone morning sickness ends
During the examination of a pregnant client, the nurse observes pale mucous membranes and cracks at the corners of the mouth. The nurse recognizes that these findings suggest what type of deficiency? vitamin A vitamin C iron calcium
vitamin A
The nurse teaches a sedentary pregnant client with a BMI of 35 about the importance of healthy lifestyle during pregnancy. Which goal would be appropriate for this client? Walk for 30 minutes 5 days a week. Adhere to a weight reduction diet. Participate in a daily aerobic dance program. Begin lifting weights for 30 minutes per day.
walk for 30 minutes 5 days a week