Chapter 08: Maternal and Fetal Nutrition My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 08: Maternal and Fetal Nutrition

Test Bank 

MULTIPLE CHOICE

1. 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

Feedback
A Although this is an accurate statement, 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 pre-pregnancy weight for the womans height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy.
B Although this is an accurate statement, 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 pre-pregnancy weight for the womans height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This woman has gained the appropriate amount of weight for her size at this point in her pregnancy.
C Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy.
D This is an accurate statement. This womans BMI is in the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

DIF:Cognitive Level: AnalysisREF:243

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

2. Which of the following meals 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, ambrosia (orange sections, coconut, and pecans), and prunes
d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea

ANS: C

Feedback
A 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. Dairy products are not a source of iron.
B 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. Dairy products are not a source of iron.
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. The foods in this meal are all good sources of iron. In addition, the vitamin C in ambrosia (orange sections) aids absorption.
D 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. Tea is not a source of iron.

DIF:Cognitive Level: ComprehensionREF:241

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

3. 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

Feedback
A Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater during lactation than during pregnancy.
B  Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater during lactation than during pregnancy.
C Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater during lactation than during pregnancy.
D Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater during lactation than during pregnancy.

DIF:Cognitive Level: KnowledgeREF:252

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

4. 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

Feedback
A A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated.
B This is a correct suggestion for a woman experiencing nausea and vomiting.
C A pregnant woman experiencing nausea and vomiting should reduce her intake of fried and other fatty foods.
D A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

DIF:Cognitive Level: ComprehensionREF:259

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

5. 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

Feedback
A 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 in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms.
B These symptoms are consistent with lactose intolerance.
C 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 in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms.
D 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 in such people, although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms.

DIF:Cognitive Level: ApplicationREF:247

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

6. 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

Feedback
A Apricots are not high in calcium.
B Canned clams are not high in calcium.
C Spaghetti with meat sauce is not high in calcium.
D Sardines are rich in calcium.

DIF:Cognitive Level: ComprehensionREF:248

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

7. 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

Feedback
A This weight gain would be unhealthy for most women. This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy.
B This is the high end of the range of weight this woman should gain in her pregnancy.
C This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy.
D This weight gain would be appropriate for an obese woman. This woman has a normal BMI, which indicates that her weight is average.

DIF:Cognitive Level: ComprehensionREF:243

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

8. 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

Feedback
A Eliminating milk in the diet is an inappropriate dietary suggestion for all pregnant women, and it does not alleviate heartburn.
B Lying down after meals may actually increase the symptoms of heartburn.
C Reducing the amount of dietary fiber consumed is not likely to alleviate heartburn.
D Eating small, frequent meals may help with heartburn, nausea, and vomiting.

DIF:Cognitive Level: ComprehensionREF:259

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

9. 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

Feedback
A Depending on the type of contraception used, this may not be an accurate statement.
B This statement is not appropriate advice.
C Depending on the type of medication the woman is taking, this may not be an accurate statement.
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.

DIF:Cognitive Level: ApplicationREF:240

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

10. To prevent gastrointestinal upset, patients 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

Feedback
A Iron supplements are best absorbed if they are taken when the stomach is empty. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.
B Taking the iron supplement at bedtime is helpful in reducing gastrointestinal discomfort.
C Iron supplements are best absorbed if they are taken when the stomach is empty. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.
D Iron supplements are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs may reduce absorption.

DIF:Cognitive Level: ApplicationREF:247

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

11. 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

Feedback
A Obesity is associated with higher BMIs. Adolescents typically have a lower BMI because they are still developing and they may follow unsafe nutritional practices.
B Diabetes is associated with higher BMIs, or obesity. Adolescents typically have a lower BMI because they are still developing and they may follow unsafe nutritional practices.
C Adolescents tend to have lower BMIs. 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.
D High-birth-weight babies are frequently associated with women who have gestational diabetes or obesity. Adolescents typically have a lower BMI, because they are still developing and they may follow unsafe nutritional practices.

DIF:Cognitive Level: ApplicationREF:252

OBJ:Client Needs: Health Promotion and Maintenance

TOP:Nursing Process: Assessment, Diagnosis

12. Which statement about acronyms in nutrition is accurate?

a. Dietary reference intakes (DRIs) consist of RDAs, adequate intakes (AIs), and upper limits (ULs).
b. Recommended dietary allowances (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

Feedback
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.
B 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.
C 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.
D 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.

DIF:Cognitive Level: KnowledgeREF:240

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

13. 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

Feedback
A Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron.
B Most women already eat a high-protein diet and do not need to increase their intake.
C Protein is sufficiently important that specific servings of meat and dairy are recommended.
D High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

DIF:Cognitive Level: KnowledgeREF:241

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

14. Which nutritional recommendation about fluids is accurate?

a. A womans daily intake should be eight to 10 glasses (2.3 L) of water, milk, and/or juice.
b. Coffee should be limited to no more than 2 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

Feedback
A Eight to 10 glasses is the standard for fluids; however, they should be the right fluids.
B All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or drunk only in limited amounts.
C Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria should avoid aspartame.
D No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

DIF:Cognitive Level: ComprehensionREF:245

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

15. 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

Feedback
A Zinc is vital to good maternity and fetal health but is highly unlikely to be consumed in excess.
B Vitamin D is vital to good maternity and fetal health but is highly unlikely to be consumed in excess.
C Folic acid is vital to good maternity and fetal health but is highly unlikely to be consumed in excess.
D 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.

DIF:Cognitive Level: ComprehensionREF:249

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

16. 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

Feedback
A Preeclampsia is a complication of pregnancy.
B Pyrosis is more commonly known as heartburn.
C The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica.
D Purging consists of self-induced vomiting.

DIF:Cognitive Level: KnowledgeREF:251

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis

17. 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

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

DIF:Cognitive Level: KnowledgeREF:259

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

18. Three servings of milk, yogurt, or cheese plus two servings of meat, poultry, or fish will adequately supply the recommended amount of protein for the 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 patient 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

Feedback
A High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the patient in understanding the differences between numerous sources of this product. A pregnant patient can eat as much as 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.
B As a precaution, the pregnant patient should avoid eating all of these and the less common tilefish. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.
C This is a common misconception. 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 or limited to less than 6 ounces or be the only fish consumed that week.
D Commercially caught fish that are low in mercury include salmon, shrimp, pollock, or catfish. The pregnant patient may eat up to 12 ounces per week.

DIF:Cognitive Level: ComprehensionREF:245

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

19. Nutrition is one of the most significant factors in influencing the outcome of a pregnancy. It is an alterable and important preventive measure for a variety of potential problems such as low birth weight and prematurity. While completing the physical assessment of the pregnant patient, the nurse can evaluate the patients nutritional status by observing a number of physical signs. Which sign would indicate that the patient 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

Feedback
A The malnourished pregnant patient may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure.
B A patient receiving adequate nutrition will have bright, shiny eyes with no sores and moist, pink membranes. Pale or red membranes, dryness, infection, dull appearance of the cornea, or blue sclerae are all signs of poor nutrition.
C This patient is well nourished. Cachexia, listlessness, and tiring easily would be indications of poor nutritional status.
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.

DIF:Cognitive Level: AnalysisREF:256

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

1. Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. The nurse or midwife should refer a patient to a registered dietitian for in-depth nutritional counseling when which of the following exist(s)? (Choose all that apply.)

a. Preexisting or gestational illness such as diabetes
b. Ethnic or cultural food patterns
c. Obesity
d. Vegetarian diets

ANS: A, B, C, D

Feedback
Correct 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 will be met. The obese pregnant patient may be under the misapprehension that because of her excess weight that little or no weight gain is necessary. According to the Institute of Medicine, a patient with a body mass index in the obese range should gain at least 7 kg to ensure a healthy outcome. This patient may well require in-depth counseling on optimum food choices. The vegetarian patient needs to have her dietary intake carefully assessed to ensure that the optimum 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.
Incorrect None of the above.

DIF:Cognitive Level: ApplicationREF:257

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

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