MNB Ch. 11 Nutrition

A pregnant client is reviewing the tentative buffet menu for her upcoming baby shower. Which items should the nurse suggest be substituted to ensure the health of the client and developing fetus? Select all that apply. 1. Baked brie with crackers 2. Greek salad with feta cheese 3. Caesar salad with sourdough croutons 4. Salmon pate with toasted bread rounds 5. Grilled orange roughy with summer vegetables

Answer: 1, 2, 3, 4Explanation: 1. Soft cheese such as brie should be avoided because of the potential for harboring Listeria. 2. Soft cheese such as feta should be avoided because of the potential for harboring Listeria. 3. Salad dressings such as caesar are made with raw eggs, which should be avoided because of the potential for a Salmonellainfection. 4. Pates should be avoided because of the potential for harboring Listeria. 5. There are no known bacterial infection issues associated with eating grilled orange roughy and summer vegetables while pregnant.

The nurse is instructing a newly pregnant client who follows a vegan eating plan about folic acid. What should the nurse include when teaching the client about this nutrient? Select all that apply. 1. The best sources are fresh green leafy vegetables. 2. Overcooking foods high in folic acid is preferred. 3. Foods high in folic acid should be protected from light. 4. Cook foods high in folic acid with small amounts of water. 5. Peanuts and whole-grain breads and cereals are good sources.

Answer: 1, 3, 4, 5Explanation: 1. Sources for folic acid include fresh green leafy vegetables. 2. To prevent unnecessary loss, foods with folic acid should not be overcooked. 3. To prevent unnecessary loss, foods with folic acid should be stored covered to protect them from light. 4. To prevent unnecessary loss, foods with folic acid should be cooked with only a small amount of water. 5. Sources of folic acid include peanuts and whole-grain breads and cereals, which are all appropriate for the vegan eating plan.

The nurse is leading a session on nutrition for postpartum clients. Which statement indicates that teaching has been effective? 1. "Breastfeeding requires that I eat lots of protein daily." 2. "Because I am breastfeeding, I need a low calcium intake." 3. "Since I am bottlefeeding, I don't have to eat vegetables." 4. "Bottlefeeding moms like me require a high sodium intake."

Answer: 1. "Breastfeeding requires that I eat lots of protein daily." Explanation: 1. Breastfeeding clients should consume 65 g of protein daily during the first 6 months of breastfeeding and 62 g daily during the second 6 months. Protein is a major ingredient in breast milk. 2. Breastfeeding requires an increase of 1000 mg per day of calcium—the same amount of calcium that is recommended during pregnancy. 3. Although vitamin intake is not directly related to bottlefeeding, good nutritional habits are important to form while bottlefeeding, because in the future, the baby will be eating what the mother eats. 4. Sodium intake is not increased during bottlefeeding.

The nurse reviews nutritional requirements with a breastfeeding mother who is concerned that her milk production has decreased. Which statement indicates that further teaching is required? 1. "I have started cutting back on my protein intake." 2. "At least 3 times a day, I drink a glass of milk." 3. "I am drinking a minimum of 8 to 10 glasses of liquid a day." 4. "I try to take a nap in the morning and afternoon when the baby is sleeping."

Answer: 1. "I have started cutting back on my protein intake." Explanation: 1. It is especially important for the breastfeeding mother to consume sufficient calories because inadequate caloric intake can reduce milk volume. The decreased intake of protein represents a decrease in calories, which will decrease milk production. 2. The breastfeeding mother must increase her protein and calcium intake. 3. The breastfeeding mother must consume a minimum of 8 to 10 glasses of liquid per day. 4. It has also been found that adequate rest is necessary for the body to maintain its production of milk.

The nurse is preparing a teaching guide to be used for prenatal, pregnancy, and postpartum nutritional classes. Which nutrients should the nurse emphasize that remain consistent throughout these gestational periods? Select all that apply. 1. Fat 2. Iron 3. Protein 4. Vitamin K 5. Pyridoxine

Answer: 1. Fat, 4. Vitamin K Explanation: 1. Fat requirements are unchanged during pregnancy and should account for about 20% to 35% of daily caloric intake, of which 10% or less should be saturated fat. 2. Iron requirements increase during pregnancy because of the growth of the fetus and placenta and the increased maternal blood volume. 3. The protein requirement for a pregnant woman is 60 g/day, an increase of 14 g over nonpregnant levels. 4. The recommended daily allowance (RDA) for vitamin K, 90 mcg per day, does not increase during pregnancy. 5. The recommended daily allowance (RDA) during pregnancy for pyridoxine is 1.9 mg/day, an increase of 0.6 mg over the allowance for nonpregnant women.

The nurse instructs on the importance of niacin during a preconception counseling class. Which food item selected by a participant indicates that teaching about the sources of niacin has been effective? 1. Fish 2. Milk 3. Apples 4. Broccoli

Answer: 1. Fish Explanation: 1. Dietary sources of niacin include meats, fish, and enriched grains. 2. Milk will provide sources of other vitamins; however, it does not contain significant niacin. 3. Apples will provide sources of other vitamins; however, they do not contain significant niacin. 4. Broccoli will provide sources of other vitamins; however, it does not contain significant niacin.

A client who became pregnant at a weight of 60 kg and a BMI of 16 has gained 4 kg at the end of the 5th gestational month. How many more pounds of weight should the nurse counsel this client to gain to achieve the least amount of weight that an underweight person should gain while pregnant?

Answer: 19.2 lb Explanation: For a client with a BMI less than 18.5, the weight gain for the total pregnancy should be between 28 and 40 lb. The client has gained 4 kg, or 8.8 lb. To achieve the minimal amount of weight that the client should gain during the entire pregnancy, subtract the amount of weight gained from the minimal amount, or 28 lb - 8.8 lb = 19.2 lb.

A newly pregnant client weighs 75.0 kg and has a body mass index of 28.5. What is the maximum amount of weight in pounds that this client should weigh during the pregnancy?

Answer: 190 lb Explanation: For a client with a BMI between 25.0 and 29.9, the weight gain for the total pregnancy should be between 15 and 25 lb. This client's weight is 75 kg. To determine the maximum amount of weight to gain, first determine the client's weight in pounds by multiplying the weight in kilograms by 2.2, or 75.0 × 2.2 = 165 lb. Then add the maximum amount of weight of 25 lb to this total, or 165 + 25 = 190 lb.

The nurse is providing nutritional counseling for a postpartum client with a hemoglobin of 8. Which statement indicates that additional teaching is necessary? 1. "I need to increase food sources that contain iron." 2. "If I drink lots of milk, I will increase my iron level faster." 3. "My iron is low, but it will increase as I take iron supplements." 4. "I might feel less energetic and tire more easily while my iron is low."

Answer: 2. "If I drink lots of milk, I will increase my iron level faster." Explanation: 1. Anemia requires additional iron. Many foods, such as red meat, will provide iron. Increasing iron-rich foods will improve anemia. 2. Milk does not contain iron; it contains calcium. Increased calcium intake will not increase hemoglobin levels. Further, iron should not be taken with milk, as the iron will not be absorbed. 3. Iron supplements are indicated with anemia. This client's hemoglobin level is 8; lower than 10 is considered anemia during pregnancy. Taking iron will increase hemoglobin. 4. Hemoglobin carries oxygen; when the hemoglobin level is low, the muscles are not adequately oxygenated, especially during activity, and fatigue results.

Which client statement on cultural or religious influences on nutrition requires intervention? 1. "I avoid milk and meat at meals because I am Jewish." 2. "My auntie sent me clay from the south to eat every day." 3. "Because I am Muslim, I do not ever eat any pork products." 4. "My grandmother makes sure I eat a serving of greens each day."

Answer: 2. "My auntie sent me clay from the south to eat every day." Explanation: 1. A kosher diet involves avoiding pork and shellfish and not eating dairy and meat at the same meal. 2. Eating clay is pica. The clay, being a type of soil, can be contaminated with hazardous substances and should be avoided. Some African Americans, especially those from the South, practice clay-eating pica. 3. Dietary restrictions in the Muslim tradition include avoidance of pork. Because other meats are eaten, the client is not at risk for protein or iron deficiency. 4. Greens, such as collard greens and spinach, have high amounts of folic acid and are healthy foods to eat during pregnancy. Women from the southern United States often eat greens.

The nurse is conducting a postpartum visit to a client who is formula-feeding her infant. Which client statement indicates that teaching about weight maintenance has been effective? 1. "I have increased my caloric intake by 600 calories per day." 2. "My dietician has set my weight loss goal at 1 to 2 pounds per week." 3. "Instead of making another doctor's appointment, I started a diet that my best friend recommended." 4. "My daily regimen includes taking extra vitamin A, vitamin C, and thiamine in order to meet my body's increased need for nutrients after pregnancy."

Answer: 2. "My dietician has set my weight loss goal at 1 to 2 pounds per week." Explanation: 1. If the mother has a good understanding of nutritional principles, it is sufficient to advise her to reduce her daily caloric intake by about 300 kcal and to return to prepregnancy levels for other nutrients. 2. Weight loss goals of 1 to 2 pounds (0.45 to 0.9 kg)/week are usually suggested for mothers who formula-feed. 3. The woman should diet only under the guidance of her primary healthcare provider. 4. After birth, the formula-feeding mother's dietary requirements return to prepregnancy levels.

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

Answer: 3. "Breastfeeding requires a continued high intake of protein and calcium." Explanation: 1. Formula-feeding moms do not need additional nutrients. 2. Although any food source would provide the additional calories, these needs are best met by using increased protein intake as the source for the required additional calories to support milk production. 3. Lactation requires calories, along with increased protein and calcium intake. 4. Formula-feeding mothers do not need additional nutrients.

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

Answer: 3. "It is important eat iron-rich foods like meat every day." Explanation: 1. This response is too vague to be helpful. Adolescents will need specific information to improve nutrition during pregnancy. 2. Although folic acid is important during pregnancy to prevent neural tube defects, and for lactation, there is not one single nutritional element responsible for having a healthy baby. 3. Adolescents often have an iron intake that is inadequate for pregnancy. Giving specific examples is most helpful when providing nutritional information. 4. Calcium is needed throughout pregnancy and should be consumed daily.

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

Answer: 3. 15-year-old nulligravida Explanation: 1. The 40-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus. 2. The 35-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus. 3. Adolescent clients typically are still in their own growth cycle. Suddenly, they have to supply nutrition for themselves and the fetus. This places them at greatest risk for malnutrition. 4. The 22-year-old client has completed her growth cycle, and her body can focus on diverting the nutritional needs to the fetus.

The nurse is preparing an antenatal nutrition class for pregnant women. Which material should be included in the teaching? 1. During pregnancy, consumption of oily fish should be avoided. 2. Dietary protein can only be obtained through consuming dairy, meat, and eggs. 3. Nutritional iodine requirements generally can be met through intake of iodized salt. 4. Iron absorption is generally higher for vegetable products than for animal products.

Answer: 3. Nutritional iodine requirements generally can be met through intake of iodized salt. Explanation: 1. Oily fish provide the best source of docosahexaenoic acid (DHA), which may reduce the risk of preterm birth, preeclampsia, low birth weight, and enhance fetal and infant brain development. 2. Excluding dairy, meat, and eggs, adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins. 3. Intake of iodized salt generally provides the recommended intake of iodine. 4.Iron absorption is generally higher for animal products than for vegetable products.

A 15-year-old primipara at 8 weeks' gestation who is 64 inches tall and weighs 115 pounds asks why she is supposed to gain so much weight. What is the best response by the nurse? 1. "Inadequate weight gain delays lactation after delivery." 2. "It's what your certified nurse-midwife recommended for you." 3. "Weight gain is important to assure that you get enough vitamins." 4. "Gaining 25 to 35 pounds is recommended for healthy fetal growth."

Answer: 4. "Gaining 25 to 35 pounds is recommended for healthy fetal growth." Explanation: 1. Inadequate weight gain can lead to decreased fetal growth and development. 2. Although this statement might be true, the client has asked a "why" question that should be directly answered. 3. Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet is probably not optimal, and her intake of empty calories or junk food might make up the majority of her caloric intake. 4. Adolescents who become pregnant less than 4 years after menarche are at risk because of their physiologic and anatomic immaturity. They are more likely than older adolescents to still be growing, which can affect the fetus's development.

The nurse is caring for a pregnant teen. What should the nurse do to accurately assess the teen's nutritional intake? 1. Assess laboratory values. 2. Ask about cooking facilities. 3. Observe for clinical signs of malnutrition. 4. Ask to complete a dietary recall to identify eating patterns.

Answer: 4. Ask to complete a dietary recall to identify eating patterns. Explanation: 1. Laboratory values only provide information about the nutritional status of the client. 2. Cooking facilities might not be related to food intake. 3. Clinical signs of malnutrition only provide information about the nutritional status of the client. 4. In assessing the diet of the pregnant adolescent, it is important to consider the eating pattern over time, not simply a single day's intake. Once the pattern is identified, counseling can be directed toward correcting deficiencies.

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

Answer: 4. Eating beans and rice provides complete protein needs. Explanation: 1. Vegan diets are low in iron, and pregnant vegans often experience anemia. 2. Rice does not contain vitamin B12. 3. Soy is a very good source of protein and calcium and is safe during pregnancy. 4. Complete proteins can be obtained by eating different types of plant-based proteins such as beans and rice.

Being aware that several pregnant students have been diagnosed with iron-deficiency anemia, the school nurse plans a class about nutrition for pregnant teens. What should the nurse encourage the teens to consume to increase iron absorption? 1. Milk 2. Green tea 3. Gatorade 4. Orange juice

Answer: 4. Orange juice Explanation: 1. Milk does not contain vitamin C. 2. Green tea does not contain vitamin C. 3. Gatorade does not contain vitamin C. 4. Vitamin C is found in citrus fruits and juices and is known to enhance the absorption of iron from meat and nonmeat sources.

It has been identified that a pregnant client's diet is low in zinc. Which food should the nurse suggest to increase intake of this mineral? 1. Yogurt 2. Bananas 3. Cabbage 4. Shellfish

Answer: 4. Shellfish Explanation: 1. Yogurt is high in other nutrients but does not have significant levels of zinc. 2. Bananas are high in other nutrients but do not have significant levels of zinc. 3. Cabbage is high in other nutrients but does not have significant levels of zinc. 4. Zinc is found in greatest concentration in meats and meat by-products. Enriched grains also tend to be high in zinc.

A pregnant 14-year-old client confides having problems with bulimia nervosa. Which nursing observation best supports the client's statement? 1. The client reports dietary cravings for soil and clay. 2. In terms of food variety and quantity, the client's diet is extremely restrictive. 3. Despite being extremely underweight, the client describes herself as being fat. 4. The client is of normal weight for her height and reports binge eating followed by purging.

Answer: 4. The client is of normal weight for her height and reports binge eating followed by purging. Explanation: 1. Dietary cravings for and consumption of nonnutritive substances is consistent with pica. 2. The dietary intake of individuals with anorexia nervosa is very restrictive in both variety and quantity. 3. Anorexia nervosa is an eating disorder characterized by an extreme fear of weight gain and becoming fat, and it incorporates a self-perception of being overweight even when the individual is extremely underweight. 4. Bulimia is characterized by binge eating and purging, and individuals with bulimia nervosa often maintain normal or near-normal weight for their height.

A pregnant client who is a lacto-ovo vegetarian asks for help planning a diet that includes adequate protein intake. What instruction should the nurse give? 1. "To improve protein absorption, avoid simultaneous intake of animal protein and plant protein." 2. "Following a lacto-ovo vegetarian diet will require you to take a daily supplement of vitamin B12." 3. "Because you don't eat meat, eggs, or dairy products, it's important to eat adequate plant-based proteins." 4. "In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective sources of plant-based proteins."

Answer: 4."In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective sources of plant-based proteins." Explanation: 1. Plant protein quality can be improved if it is consumed with certain animal proteins. 2. Vegan diets, in which no animal products are consumed, often require daily supplementation of vitamin B12. 3. While lacto-ovo vegetarians do not eat meat, they do eat eggs, milk, and dairy products. 4. A diet that includes plant proteins, such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk, helps ensure the expectant mother obtains all the essential amino acids.