Chapter 09: Nutrition for Childbearing My Nursing Test Banks

Chapter 09: Nutrition for Childbearing

MULTIPLE CHOICE

1. When planning a diet with a pregnant client, what should the nurses first action be?

a.

Teach the client about MyPlate.

b.

Review the clients current dietary intake.

c.

Instruct the client to limit the intake of fatty foods.

d.

Caution the client to avoid large doses of vitamins, especially those that are fat-soluble.

ANS: B

The first action should be to assess the clients current dietary pattern and practices because instruction should be geared to what she already knows and does. Teaching the food guide MyPlate is important but not the first action when planning a diet with a pregnant client. Limiting intake of fatty foods is important in a pregnant clients diet but not the first action. Cautioning about excessive fat-soluble vitamins is important but not the first action.

PTS: 1 DIF: Cognitive Level: Application REF: 144

OBJ: Nursing Process Step: Planning MSC: Client Needs: Physiologic Integrity

2. A nurse is teaching a nutrition class to a group of pregnant clients. The nurse should include that the major source of nutrients in the diet of a pregnant woman should be composed of which?

a.

Fats

b.

Fiber

c.

Simple sugars

d.

Complex carbohydrates

ANS: D

Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. Fats provide 9 calories in each gram, in contrast to carbohydrates and proteins, which provide only 4 calories in each gram. Fiber is supplied mainly by the complex carbohydrates. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients.

PTS: 1 DIF: Cognitive Level: Application REF: 145

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

3. To increase the absorption of iron in a pregnant client, with what should an iron preparation be given?

a.

Tea

b.

Milk

c.

Coffee

d.

Orange juice

ANS: D

A vitamin C source may increase the absorption of iron. Tannin in the tea reduces the absorption of iron. The calcium and phosphorus in milk decrease iron absorption. Decreased intake of caffeine is recommended during pregnancy.

PTS: 1 DIF: Cognitive Level: Application REF: 149

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

4. When should iron supplementation during a normal pregnancy begin?

a.

Before pregnancy

b.

In the first trimester

c.

In the third trimester

d.

In the second trimester

ANS: D

Vitamin supplements should be prescribed in the second trimester, when the need for iron is increased. Healthy young women do not usually need iron supplementation for their diets. Morning sickness in the first trimester increases the routine side effects of iron supplements. The iron supplements may continue to be prescribed in the third trimester and during the postpartum period.

PTS: 1 DIF: Cognitive Level: Understanding REF: 155

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

5. What is the recommended weight gain during pregnancy for a client who begins pregnancy at a normal weight?

a.

10 to 15 lb

b.

15 to 20 lb

c.

20 to 25 lb

d.

25 to 35 lb

ANS: D

A weight gain of 25 to 35 lb is believed to reduce intrauterine growth restriction that may result from inadequate nutrition, and also allows for variations in individual needs. There is no precise weight gain appropriate for all women. A 10-lb weight gain is not sufficient to meet the needs of the pregnancy. A 15- to 20-lb weight gain is recommended for women who are overweight before the pregnancy. A 20- to 25-lb weight gain is recommended for women who are overweight before the pregnancy.

PTS: 1 DIF: Cognitive Level: Understanding REF: 161

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

6. A client in her fifth month of pregnancy asks the nurse, How many more calories should I be eating daily? What should the nurses response be?

a.

180 more calories a day

b.

340 more calories a day

c.

452 more calories a day

d.

500 more calories a day

ANS: B

The increased nutritional needs of pregnancy can be met with an additional 340 calories per day. 180 calories are not enough to meet the increased nutritional needs of pregnancy. 452 calories are more than the recommended calories for pregnancy. 500 calories are more than the recommended calories for pregnancy.

PTS: 1 DIF: Cognitive Level: Application REF: 145

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

7. A pregnant clients diet may not meet her need for folate. What is a good source of this nutrient?

a.

Chicken

b.

Cheese

c.

Potatoes

d.

Green leafy vegetables

ANS: D

Sources of folate include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken is a good source of protein, but poor in folate. Cheese is an excellent source of calcium, but poor in folate. Potatoes contain carbohydrates and vitamins but are poor in folate.

PTS: 1 DIF: Cognitive Level: Understanding REF: 147, 148

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

8. A pregnant client asks the nurse if she can double her prenatal vitamin dose because she doesnt like to eat vegetables. What is the nurses response about the danger of taking excessive vitamins?

a.

Increases caloric intake

b.

Has toxic effects on the fetus

c.

Increases absorption of all vitamins

d.

Promotes development of pregnancy-induced hypertension (PIH)

ANS: B

The use of vitamin supplements in addition to food may increase the intake of some nutrients to doses much higher than the recommended amounts. Overdoses of some vitamins have been shown to cause fetal defects. Vitamin supplements do not contain calories. Vitamin supplements do not have better absorption than natural vitamins and minerals. There is no relationship between vitamin supplements and PIH.

PTS: 1 DIF: Cognitive Level: Application REF: 154

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

9. A nurse is conducting a prenatal nutritional education class for a group of nursing students. Which should the nurse include as the definition of pica?

a.

Iron deficiency anemia

b.

Intolerance to milk products

c.

Ingestion of nonfood substances

d.

Episodes of anorexia and vomiting

ANS: C

The practice of eating substances not normally thought of as food is called pica. Clay, dirt, and solid laundry starch are the substances most commonly ingested. Pica may produce iron deficiency anemia if proper nutrition is decreased. Intolerance to milk products is termed lactose intolerance. Pica is not related to anorexia and vomiting.

PTS: 1 DIF: Cognitive Level: Application REF: 155

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

10. Which is the common effect of both smoking and cocaine use on the pregnant client?

a.

Vasoconstriction

b.

Increased appetite

c.

Increased metabolism

d.

Changes in insulin metabolism

ANS: A

Both smoking and cocaine use cause vasoconstriction, which results in impaired placental blood flow to the fetus. Smoking and cocaine use do not increase appetite, change insulin metabolism, or increase metabolism.

PTS: 1 DIF: Cognitive Level: Understanding REF: 156

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

11. The breastfeeding client whose recommended prepregnancy caloric intake was 2000 calories per day would need how many calories per day to meet her current needs?

a.

2300

b.

2500

c.

2750

d.

3000

ANS: B

The increase for a breastfeeding client is 500 calories above her recommended prepregnancy caloric intake. 2300 calories is not enough to meet her needs. 2750 calories may be too many calories and may lead to weight gain. 3000 calories is too many for this client and will lead to weight gain.

PTS: 1 DIF: Cognitive Level: Understanding REF: 151

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

12. Which is the most important reason for evaluating the pattern of weight gain in pregnancy?

a.

Prevents excessive adipose tissue deposits

b.

Determines cultural influences on the womans diet

c.

Assesses the need to limit caloric intake in obese women

d.

Identifies potential nutritional problems or complications of pregnancy

ANS: D

Deviations from the recommended pattern of weight gain may indicate nutritional problems or developing complications. Excessive adipose tissue may occur with excess weight gain but is not the reason for monitoring the weight gain pattern. The pattern of weight gain is not affected by cultural influences. It is important to monitor the pattern of weight gain for the developing complications.

PTS: 1 DIF: Cognitive Level: Understanding REF: 160

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

13. A pregnant client would like to know a good food source of calcium other than dairy products. Which is the best answer that the nurse should give?

a.

Legumes

b.

Lean meat

c.

Whole grains

d.

Yellow vegetables

ANS: A

Although dairy products contain the greatest amount of calcium, it can also be found in legumes, nuts, dried fruits, and some dark green leafy vegetables. Lean meats are rich in protein and phosphorus. Whole grains are rich in zinc and magnesium. Yellow vegetables are rich in vitamin A.

PTS: 1 DIF: Cognitive Level: Application REF: 154

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

14. To determine cultural influences on a clients diet, what should the nurse do first?

a.

Evaluate the clients weight gain during pregnancy.

b.

Assess the socioeconomic status of the client.

c.

Discuss the four food groups with the client.

d.

Identify the food preferences and methods of food preparation common to the clients culture.

ANS: D

Understanding the clients food preferences and how she prepares food will assist the nurse in determining whether the clients culture is adversely affecting her nutritional intake. Evaluating a clients weight gain during pregnancy should be included for all clients, not just for those who are culturally different. The socioeconomic status of the clients may alter the nutritional intake, but not the cultural influence. Teaching the food groups to the client should come after assessing food preferences.

PTS: 1 DIF: Cognitive Level: Application REF: 160

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Physiologic Integrity

15. Which pregnant adolescent is most at risk for a nutritional deficit during pregnancy?

a.

A 16-year-old who is 10 lb overweight

b.

A 17-year-old who is 10 lb underweight

c.

A 15-year-old of normal height and weight

d.

A 16-year-old of normal height and weight

ANS: B

The adolescent who is pregnant and underweight is most at risk because she is already deficient in nutrition and must now supply the nutritional intake for both herself and her fetus. An overweight pregnant teen is at risk for deficiency but is not at the highest risk. Being underweight is the most risky because she is already deficient. A 15-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency. A 16-year-old has special nutritional needs during pregnancy, but she is not at the highest risk for deficiency.

PTS: 1 DIF: Cognitive Level: Application REF: 151

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

16. What should be the goal of a client with the nursing diagnosis Imbalanced nutrition: Less than body requirements (related to diet choices inadequate to meet the nutrient requirements of pregnancy)?

a.

Gain a total of 30 lb.

b.

Decrease intake of snack foods.

c.

Take daily supplements consistently.

d.

Increase intake of complex carbohydrates.

ANS: A

A weight gain of 30 lb is one indication that the client has gained a sufficient amount for the nutritional needs of pregnancy. Decreasing snack food may be the problem and should be assessed. However, assessing the weight gain is the best method of monitoring intake for this pregnancy. A daily supplement is not the best goal for this client. It does not meet the basic need of proper nutrition during pregnancy. Increasing the intake of complex carbohydrates is important for this client, but monitoring the weight gain should be the end goal.

PTS: 1 DIF: Cognitive Level: Application REF: 157

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

17. A client who is in week 28 of gestation is concerned about her weight gain of 17 lb. Which is the nurses best response?

a.

You should not gain any more weight until you reach the third trimester.

b.

You should try to decrease your amount of weight gain for the next 12 weeks.

c.

You have not gained enough weight for the number of weeks of your pregnancy.

d.

You have gained an appropriate amount for the number of weeks of your pregnancy.

ANS: D

A woman in her 28th week of gestation should have gained between 17 and 20 lb. The normal pattern of weight gain is about 3.5 lb total in the first trimester (by 13 weeks) and 1 lb per week after that. The client has gained the appropriate amount of weight. It would be inappropriate to have her decrease her weight gain. She has gained an appropriate amount of weight and should not increase the weight gain. Weight gain needs to be consistent during the last part of the pregnancy and should not be suppressed.

PTS: 1 DIF: Cognitive Level: Application REF: 162

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

18. In teaching a pregnant adolescent about nutrition, what should the nurse plan to do?

a.

Determine the weight gain needed to meet adolescent growth and add 35 lb.

b.

Suggest that she not eat at fast food restaurants to avoid foods of poor nutritional value.

c.

Realize that most adolescents are unwilling to make dietary changes during pregnancy.

d.

Emphasize the need to eliminate common teen snack foods because they are too high in fat and sodium.

ANS: A

Adolescents should gain in the upper range of the recommended weight gain. They also need to gain weight that would be expected for their own normal growth. Adolescents are willing to make changes; however, they still need to be like their peers. Eliminating fast foods will make her appear different from her peers. She should be taught to choose foods that add needed nutrients. Changes in the diet should be kept at a minimum and snacks should be included. Snack foods can be included in moderation and other foods added to make up for the lost nutrients.

PTS: 1 DIF: Cognitive Level: Application REF: 162

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

19. The traditional diet of Asian women includes little meat and few dairy products and may be low in calcium and iron. The nurse can help a client increase her intake of these foods by which action?

a.

Suggest that she eat more tofu, bok choy, and broccoli.

b.

Suggest that she eat more hot foods during pregnancy.

c.

Emphasize the need for increased milk intake during pregnancy.

d.

Tell her husband that she must increase her intake of fruits and vegetables for the babys sake.

ANS: A

The diet should be improved by increasing foods acceptable to the woman. These foods are common in the Asian diet and are good sources of calcium and iron. Pregnancy is considered hot; therefore, the woman would eat cold foods. Because milk products are not part of this womans diet, it should be respected and other alternatives offered. Also, lactose intolerance is common. Fruits and vegetables are cold foods and should be included in the diet. In regard to the family dynamics, however, the husband does not dictate to the wife in this culture.

PTS: 1 DIF: Cognitive Level: Application REF: 152

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity

20. When planning a diet for a pregnant client, which nutritional interventions should be implemented?

a.

Fluids should be restricted to 6 glasses a day to minimize fluid retention and occurrence of edema.

b.

Protein in the diet should be increased to meet growth and development needs.

c.

Nutrient density should be used only if there are problems with weight gain during the course of the pregnancy.

d.

Advise the client that the pattern of weight gain is not as important as the overall weight gained during the pregnancy.

ANS: B

An increase in protein consumption is recommended as compared with prepregnancy diet recommendations. Fluid intake should be 8 to 10 glasses per day to maintain hydration. Nutrient density should be used throughout the pregnancy to meet increasing caloric needs. The pattern of weight gain is critical in helping identify potential risks associated with the development of fluid retention and preeclampsia.

PTS: 1 DIF: Cognitive Level: Application REF: 144

OBJ: Nursing Process Step: Planning

MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort

21. A pregnant client asks the nurse if she should take herbal supplements during pregnancy. What is the best response to her query?

a.

As long as you have had no reaction to them in the past, they would be safe to use during pregnancy.

b.

Prenatal vitamins are the only things that should be taken during pregnancy.

c.

Nutritional supplements will be prescribed by the health care provider based on individual needs.

d.

During pregnancy, no supplementation is required because this is considered to be a healthy state.

ANS: B

Prenatal vitamins are noted as the standard of care in the medical treatment of pregnancy. A nurse should not encourage the use of herbal supplements to a pregnant client (or to any client) without obtaining information relative to constituent ingredients and assessment of potential interactions. This discussion should include the health care provider as a member of the interdisciplinary team. Nutritional supplements are not indicated during pregnancy, other than prenatal vitamins. During pregnancy, the client will not be able to meet their nutritional needs without the use of prenatal vitamins.

PTS: 1 DIF: Cognitive Level: Application REF: 150

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort

22. Which client would require additional calories and nutrients?

a.

A 36-year-old female gravida 2, para 1, in her first trimester of pregnancy

b.

An 18-year-old female who delivered a 7-lb baby and is bottle feeding

c.

A 23-year-old female who had a cesarean section birth and is bottle feeding

d.

A 20-year-old female who had a vaginal birth 5 months ago and is breastfeeding

ANS: D

A client who is breastfeeding will require more calories and nutrients than individuals who are pregnant, delivered regardless of the type of birth, and whether they are bottle feeding.

PTS: 1 DIF: Cognitive Level: Application REF: 145

OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Physiologic Integrity: Basic Care and Comfort

23. A client post-delivery is concerned about getting back to her prepregnancy weight. She had only gained 15 pounds during her pregnancy. Which assessment factor would be of concern at her 6-week postpartum checkup?

a.

Client has lost 35 pounds during the 6-week period prior to her scheduled checkup.

b.

Client states that she is eating healthy and limiting intake of processed foods.

c.

Client relates increased consumption of fruits and vegetables in her diet postbirth.

d.

Client has resumed her usual exercise pattern of walking around the neighborhood for 10 minutes each night.

ANS: A

Although a certain amount of weight loss is expected in the postpartum period, the fact that the reported weight loss is double the amount of weight gained during the pregnancy places the client at risk for malnutrition. Further inquiry is needed. Limiting the intake of processed foods is a healthy dietary alternative to decreasing sodium intake. Increases in fruits and vegetables are a healthy dietary alternative to decrease possible occurrence of hypertension. An exercise program is part of a healthy nutrition approach.

PTS: 1 DIF: Cognitive Level: Application REF: 143

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

24. Which of the following is associated with inadequate maternal weight gain during pregnancy?

a.

Prolonged labor

b.

Preeclampsia

c.

Gestational diabetes

d.

Low-birth-weight infant

ANS: D

Inadequate maternal weight gain during pregnancy can manifest in the birth of a low- birth-weight infant. Prolonged labor and gestational diabetes are associated with excess weight gain during pregnancy. Preeclampsia is based on maternal hypertension, proteinuria, and edema states.

PTS: 1 DIF: Cognitive Level: Application REF: 161

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

25. A nurse is developing information to give to a group of pregnant women who are interested in nutritional management of their pregnancy with regard to expected weight gain. The nurse bases the amount of weight gain for pregnant women on calculation of their:

a.

EDC (expected date of confinement).

b.

prepregnancy weight.

c.

BMI (body mass index).

d.

basal energy expenditure (BEE).

ANS: C

BMI takes into account height, weight, and body frame characteristics. Weight gain is not based on the EDC. Although the prepregnancy weight is important, it must be looked at in correlation to a calculated BMI. The calculation of BEE is used for clients who are at nutritional risk and are receiving enteral and/or parenteral nutrition therapies.

PTS: 1 DIF: Cognitive Level: Application REF: 143

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

26. A pregnant client comes to the OB clinic and informs you that she is very concerned about the amount of weight gain associated with pregnancy. She then tells you that she wants to switch to a low-fat diet during pregnancy. BMI measurements indicate a BMI of 22.7. What would be the best nursing response to this clients stated plan?

a.

Tell the client that as long as she maintains a varied diet with regard to the other nutrients, there should be no problems.

b.

Refer the client to a dietician for assistance in planning the low-fat diet.

c.

Advise the client that it is important to maintain the intake of essential fatty acids during pregnancy.

d.

Schedule the client for more frequent visits during the next few months to evaluate her weight pattern.

ANS: C

It is important to teach the client that essential fatty acids are needed in the diet to assist fetal development (visual and cognitive). Dieting during pregnancy is not advised. Clients should maintain a regular diet that has a varied intake of nutrient sources. There is no need for referral at this time because dieting is not recommended during pregnancy. The clients BMI indicates that she is within the normal weight range. There is no need to add additional appointments at this time.

PTS: 1 DIF: Cognitive Level: Application REF: 145

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

27. A pregnant client arrives for her first prenatal visit at the clinic. She tells you that she has been taking an additional 400 mcg of folic acid prior to her pregnancy. Based on information obtained, she is at 8 weeks gestation. What recommendation would you give regarding folic acid supplementation?

a.

Have the client continue to take 400 mcg folic acid throughout her pregnancy.

b.

Tell the client that she no longer has to take additional folic acid because it will be included in her prenatal vitamins.

c.

Have the client increase her folic acid intake to 1000 mcg throughout the rest of her pregnancy.

d.

Schedule the client to go for an AFP (alpha-fetoprotein) test.

ANS: B

Prenatal vitamins include adequate folic acid supplementation, so clients should not take additional supplementation as long they continue their prenatal vitamins. During pregnancy, the recommendation is to increase the folic acid intake to 600 mcg. 1000 mcg of folic acid would be an excessive dose. The AFP test should be done at 15 to 18 weeks gestation. This is not clinically indicated because the client is at 8 weeks gestation.

PTS: 1 DIF: Cognitive Level: Application REF: 146

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

28. Which food selections would lead to enhanced iron absorption during pregnancy?

a.

Eating additional fiber and grains in the diet

b.

Drinking coffee with meals

c.

Drinking orange juice

d.

Including spinach in the diet two to three times a week

ANS: C

Drinking orange juice, which contains ascorbic acid, acts to enhance iron absorption. Foods that are high in fiber and grains contain phytates, which can decrease iron absorption. Coffee intake can affect iron binding and therefore decrease absorption. Spinach contains oxalates, which can interfere with iron absorption.

PTS: 1 DIF: Cognitive Level: Application REF: 150

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

29. Which client is most at risk for a low-birth-weight infant?

a.

22-year-old, 60 inches tall, normal prepregnant weight

b.

18-year-old, 64 inches tall, body mass index is <18.5

c.

30-year-old, 78 inches tall, prepregnant weight is 15 lb above the norm

d.

35-year-old, 75 inches tall, total weight gain in previous pregnancies was 33 lb

ANS: B

The client who has a low prepregnancy weight is associated with preterm labor and low- birth-weight infants. Women who are underweight should gain more during pregnancy to meet the needs of pregnancy as well as their own need to gain weight; clients who have a normal prepregnancy weight, who start pregnancy overweight, or who have a history of excessive weight gain in pregnancy are not at risk for low-birth-weight infants.

PTS: 1 DIF: Cognitive Level: Analysis REF: 144

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

30. Changes in the diet of the pregnant client who has phenylketonuria would include:

a.

adding foods high in vitamin C.

b.

eliminating drinks containing aspartame.

c.

restricting protein intake to <20 g a day.

d.

increasing caloric intake to at least 1800 cal/day.

ANS: B

Use of aspartame by women with phenylketonuria can result in fetal brain damage because these women lack the enzyme to metabolize aspartame. Adding vitamin C, restricting protein, and increasing caloric intake are not necessary for the pregnant client with phenylketonuria.

PTS: 1 DIF: Cognitive Level: Analysis REF: 145

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

31. When explaining the recommended weight gain to your client, the nurses teaching should include which statement?

a.

All pregnant women need to gain a minimum of 25 to 35 pounds.

b.

The fetus, amniotic fluid, and placenta require 15 pounds of weight gain.

c.

Weigh gain in pregnancy is based on the clients prepregnant body mass index.

d.

More weight should be gained in the first and second trimesters and less in the third.

ANS: C

Recommendations for weight gain in pregnancy are based on the womans prepregnancy weight for her height (body mass index). Depending on the prepregnant weight, recommendation for weight gain may be more or less than 25 to 35 pounds. The combination of the fetus, amniotic fluid, and placenta averages about 11 pounds in the client who has a normal BMI. Less weight should be gained in the first trimester, when the fetus needs fewer nutrients for growth, and more in the third trimester, when fetal growth is accelerated.

PTS: 1 DIF: Cognitive Level: Application REF: 143

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

32. Identify the appropriate weight gain at 28 weeks gestation for a client with a normal BMI (body mass index) before pregnancy.

a.

10 pounds

b.

19 pounds

c.

25 pounds

d.

30 pounds

ANS: B

The woman with a normal BMI before pregnancy will gain approximately 4.4 pounds during the first trimester and 1 pound per week during the second and third trimesters. At 28 weeks, normal weight gain would be 4 pounds during the first trimester and 15 pounds in the second trimester. Ten pounds at 29 weeks gestation is adequate weight gain. Twenty-five and 30 pounds at 28 weeks is excessive weight gain.

PTS: 1 DIF: Cognitive Level: Application REF: 143

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

33. Which client has correctly increased her caloric intake from her recommended pregnancy intake to the amount necessary to sustain breastfeeding in the first 6 postpartum months?

a.

From 1800 to 2200 calories per day

b.

From 2000 to 2500 calories per day

c.

From 2200 to 2530 calories per day

d.

From 2500 to 2730 calories per day

ANS: C

The increased calories necessary for breastfeeding are 500, with 330 calories coming from increased caloric intake and 170 calories from maternal stores. An increase of 230 calories is insufficient for breastfeeding. An increase of 400 and 500 calories is above the recommended amount.

PTS: 1 DIF: Cognitive Level: Analysis REF: 145

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

34. The pregnant woman of normal weight enters her 13th week of pregnancy. If the client eats and exercises as directed, what will the nurse anticipate as the ongoing weight gain for the remaining trimesters?

a.

0.3 pound every week

b.

1 pound every week

c.

1.8 pounds every week

d.

2 pounds every week

ANS: B

After the first 12 weeks (first trimester), the pregnant woman should gain 0.35 to 0.5 kg (0.8 to 1 lb) per week for the remainder of the pregnancy.

PTS: 1 DIF: Cognitive Level: Knowledge REF: 157

OBJ: Nursing Process Step: Assessment MSC: Client Needs: Health Promotion and Maintenance

35. A client with a BMI of 32 has a positive pregnancy test. What is the maximum number of pounds that the nurse will advise the client to gain during the pregnancy?

a.

20

b.

25

c.

28

d.

40

ANS: A

The weight gain for obese women is 5 to 9 kg (11 to 20 lb). A BMI of 30 or higher categorizes the client as obese. The other options refer to minimal or maximal weight gain for clients in other BMI categories.

PTS: 1 DIF: Cognitive Level: Application REF: 143

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

36. The pregnant client with significant iron deficiency anemia is prescribed iron supplements. The client confides to the nurse that she cant take iron because it makes her nauseous. What is the best response by the nurse?

a.

Iron will be absorbed more readily if taken with orange juice.

b.

It is important to take this drug regardless of this side effect.

c.

Taking the drug with milk may decrease your symptoms.

d.

Try taking the iron at bedtime on an empty stomach.

ANS: D

Iron taken at bedtime may be easier to tolerate. All the answers are true statements; however, only the option that states that iron taken at bedtime may be easier to tolerate addresses both optimal absorption of iron and alleviation of nausea, which will not be noticeable during sleep. It is true that taking iron with milk will decrease the symptoms, but it will also decrease absorption.

PTS: 1 DIF: Cognitive Level: Application REF: 149

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Physiologic Integrity: Pharmacologic Therapies

37. What will the nurse advise when providing nutrition education to the pregnant client?

a.

Every day you need to have at least 6 ounces of protein from sources such as meat, fish, eggs, beans, nuts, soybean products, and tofu.

b.

High-dose vitamin A supplements will promote optimal vision while preventing a common cause of blindness in neonates.

c.

Meals such as sushi with a cold deli salad made with raw sprouts combine high-fiber foods with protein sources to meet multiple nutritional needs.

d.

Vitamin and mineral supplements can meet your nutrient needs if you have inadequate intake because of nausea or a sensation of fullness.

ANS: A

Protein sources include meat, poultry, fish, eggs, legumes (e.g., beans, peas, lentils), nuts, and soybean products such as tofu. Pregnant women need 6 to 6.5 oz of protein daily. Vitamin A can cause fetal anomalies of the bones, urinary tract, and central nervous system when taken in high doses. Pregnant women should avoid raw fish and foods such as cold deli salads and raw sprouts. Supplements do not generally contain protein and calories and may lack many necessary nutrients; therefore, they cannot serve as food substitutes.

PTS: 1 DIF: Cognitive Level: Application REF: 151

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

38. For the pregnant client who is a vegan, what combination of foods will the nurse advise to meet the nutritional needs for all essential amino acids?

a.

Eggs and beans

b.

Fruits and vegetables

c.

Grains and legumes

d.

Vitamin and mineral supplements

ANS: C

Combining incomplete plant proteins with other plant foods that have complementary amino acids allows intake of all essential amino acids. Dishes that contain grains (e.g., wheat, rice, corn) and legumes (e.g., garbanzo, navy, kidney, or pinto beans, peas, peanuts) are combinations that provide complete proteins. Eggs are not eaten by vegans. Fruits and vegetables alone will not provide the essential amino acids. Vitamin and mineral supplements do not provide amino acids.

PTS: 1 DIF: Cognitive Level: Application REF: 153

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

39. A pregnant client has lactose intolerance. What recommendation will the nurse provide to best help the client meet dietary needs for calcium?

a.

Add foods such as nuts, dried fruit, and broccoli to the diet.

b.

Consume dairy products but take an over-the-counter anti-gas product.

c.

Increase the intake of dark leafy vegetables, such as spinach and chard.

d.

Use powdered milk instead of liquid forms of milk.

ANS: A

Calcium is present in legumes, nuts, dried fruits, and broccoli, so these foods can be added to increase calcium intake. Although dark leafy vegetables contain calcium, they also contain oxalates that decrease the availability of calcium. Powdered milk contains lactase, just like the nondehydrated varieties. Milk products can be avoided by those with lactose intolerance because adequate calcium may be obtained from food and supplements.

PTS: 1 DIF: Cognitive Level: Understanding REF: 149

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

40. The nurse is reviewing the changes in nutrition related to pregnancy with a 17-year-old who is 12 weeks pregnant. They are specifically focusing on the dairy requirements. What is the nurses next action?

a.

Ask, Do you like milk, yogurt and cheese?

b.

Ask, How many servings from the dairy group do you eat each day?

c.

Tell her, You need to add no less than 3 cups of dairy-based foods each day.

d.

Inform her, If you do not like to drink milk, you can eat a spinach salad every day

ANS: B

To individualize the patients teaching plan, the nurse must first assess the patients calcium intake. Then the nurse can modify the instructions for adequate calcium intake, based on the patients actual needs. Milk, yogurt, and cheese are calcium-rich foods but are inappropriate for the lactose-intolerant patient. The adolescent pregnant patient requires more daily calcium than the recommendation of 3 cups per day for the adult woman. Spinach is a source of calcium but it also contains oxalates, which decrease calcium availability.

PTS: 1 DIF: Cognitive Level: Analysis REF: 150

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

41. The health care provider has recommended an iron supplement for the patient who is 20 weeks pregnant. The nurse is reviewing the recommendation with the patient. What fluid is best for the nurse to recommend when taking an iron supplement?

a.

8 ounces of milk

b.

8 ounces of water

c.

4 ounces of orange juice

d.

4 ounces of apple juice

ANS: C

Iron absorption is enhanced when taken with a source of vitamin C. Calcium can block the absorption of vitamin C. Water and apple juice to not facilitate or block the absorption of iron.

PTS: 1 DIF: Cognitive Level: Application REF: 149

OBJ: Nursing Process Step: Implementation

MSC: Client Needs: Health Promotion and Maintenance

42. The nurse is reviewing a list of foods high in folic acid with a patient who is considering becoming pregnant. The nurse determines that the patient understands the teaching when the patient states she will include which list of foods in her diet?

a.

Peaches, yogurt, and tofu

b.

Strawberries, milk, and tuna

c.

Asparagus, lemonade, and chicken breast

d.

Spinach, orange juice, and fortified bran flakes

ANS: D

Prepregnant, the recommendation for folic acid is 800 mcg. Foods high in folic acid are dark green leafy vegetables, legumes (beans, peanuts), orange juice, asparagus, spinach, and fortified cereal and pasta. In the United States, folic acid is added to orange juice and wheat-based products.

PTS: 1 DIF: Cognitive Level: Application REF: 146

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

43. A patient at 8 weeks gestation complains to the nurse, I feel sick almost every morning. And I throw up at least two or three times a week. What is the nurses best advice to the patient?

a.

Do you like cheese?

b.

Try eating four meals a day instead of three meals a day.

c.

Try eating peanut butter on whole wheat bread right before going to bed.

d.

If you can eat enough throughout the day, you dont have to worry about being sick.

ANS: C

Eating a bedtime protein snack helps maintain glucose levels throughout the night. Cheese is high in fat and can aggravate nausea. Small and frequent meals is the recommendation; four meals a day is not frequent enough. Consumption is not the patients stated concernit is the nausea and vomiting.

PTS: 1 DIF: Cognitive Level: Analysis REF: 154

OBJ: Nursing Process Step: Analysis MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

44. The nurse is teaching a client taking prenatal vitamins how to avoid constipation. Which should the nurse plan to include in the teaching session? (Select all that apply.)

a.

Advise taking a daily laxative for constipation.

b.

Recommend a diet high in fruits and vegetables.

c.

Encourage an increase in fluid consumption during the day.

d.

Increase the intake of whole grains and whole grain products.

e.

Suggest increasing the intake of dairy products, especially cheeses.

ANS: B, C, D

Common sources of dietary fiber include fruits and vegetables (with skins when possibleapples, strawberries, pears, carrots, corn, potatoes with skins, and broccoli), whole grains, and whole grain productswhole wheat bread, bran muffins, bran cereals, oatmeal, brown rice, and whole wheat pasta. Increased intake of fluids can help prevent constipation. A pregnant client should not take a daily laxative unless prescribed by her health care provider. Increased intake of dairy products, especially cheese, can increase constipation.

PTS: 1 DIF: Cognitive Level: Application REF: 162

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

45. The nurse is teaching a breastfeeding client about substances to avoid while she is breastfeeding. Which substances should the nurse include in the teaching session? (Select all that apply.)

a.

Caffeine

b.

Alcohol

c.

Omega-6 fatty acids

d.

Appetite suppressants

e.

Polyunsaturated omega-3 fatty acids

ANS: A, B, D

Foods high in caffeine should be limited. Infants of mothers who drink more than two or three cups of caffeinated coffee or the equivalent each day may be irritable or have trouble sleeping. Although the relaxing effect of alcohol was once thought to be helpful to the nursing mother, the deleterious effects of alcohol are too important to consider this suggestion appropriate today. An occasional single glass of an alcoholic beverage may not be harmful, but larger amounts may interfere with the milk ejection reflex and may be harmful to the infant. Nursing mothers should avoid appetite suppressants, which may pass into the milk and harm the infant. The long-chain polyunsaturated omega-3 and omega-6 fatty acids are present in human milk. Therefore, they should be included in the mothers diet during lactation.

PTS: 1 DIF: Cognitive Level: Application REF: 158

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

46. The nurse is advising a lactose-intolerant pregnant client about calcium intake. Which calcium sources are approximately equivalent to 1 cup of milk? (Select all that apply.)

a.

cup yogurt

b.

1 cup of sherbet

c.

oz of hard cheese

d.

cups of ice cream

e.

cup of low-fat cottage cheese

ANS: A, C, D

Calcium sources approximately equivalent to 1 cup of milk include cup yogurt, oz of hard cheese, and cups of ice cream. It takes 3 cups of sherbet and cups of low-fat cottage cheese to equal the calcium equivalent of 1 cup of milk.

PTS: 1 DIF: Cognitive Level: Application REF: 149

OBJ: Nursing Process Step: Planning MSC: Client Needs: Health Promotion and Maintenance

47. The nurse is teaching a pregnant client about food safety during pregnancy and lactation. Which statements by the client indicate she understood the teaching? (Select all that apply.)

a.

I will limit my intake of shrimp to 12 oz a week.

b.

I will avoid the soft cheeses made with unpasteurized milk.

c.

I plan to continue to pack my bologna sandwich for lunch.

d.

I am glad I can still go to the sushi bar during my pregnancy.

e.

I will not eat any swordfish or shark while I am pregnant or nursing.

ANS: A, B, E

Statements that indicate the client understood the teaching are limiting shrimp to 12 oz a week, avoiding soft cheeses, and not eating any swordfish. A bologna sandwich should be avoided unless it is reheated until steaming hot. Raw or undercooked fish should be avoided.

PTS: 1 DIF: Cognitive Level: Analysis REF: 151

OBJ: Nursing Process Step: Evaluation MSC: Client Needs: Health Promotion and Maintenance

MATCHING

Match each term with the correct definition.

a.

Necessary for metabolism of calcium

b.

Necessary for mineralization of fetal bones and teeth

c.

Deficiency in first weeks of pregnancy may cause spontaneous abortion and neural tube defects

48. Folic acid

49. Vitamin D

50. Calcium

48. ANS: C PTS: 1 DIF: Cognitive Level: Understanding

REF: 146 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Folic acid deficiency in the first weeks of pregnancy may cause spontaneous abortion and neural tube defects in the fetus. Vitamin D is necessary for the metabolism of calcium. Calcium is necessary for mineralization of fetal bones and teeth.

49. ANS: A PTS: 1 DIF: Cognitive Level: Understanding

REF: 147 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Folic acid deficiency in the first weeks of pregnancy may cause spontaneous abortion and neural tube defects in the fetus. Vitamin D is necessary for metabolism of calcium. Calcium is necessary for mineralization of fetal bones and teeth.

50. ANS: B PTS: 1 DIF: Cognitive Level: Understanding

REF: 148 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Folic acid deficiency in the first weeks of pregnancy may cause a spontaneous abortion and neural tube defects in the fetus. Vitamin D is necessary for metabolism of calcium. Calcium is necessary for mineralization of fetal bones and teeth.

Match each term with the correct definition.

a.

Important in cell growth and neuromuscular function

b.

Important in thyroid function

c.

Important in DNA and RNA synthesis

51. Iodine

52. Magnesium

53. Zinc

51. ANS: B PTS: 1 DIF: Cognitive Level: Understanding

REF: 148 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Iodine is important in thyroid function. Magnesium is important in cell growth and neuromuscular function. Zinc is important in DNA and RNA synthesis.

52. ANS: A PTS: 1 DIF: Cognitive Level: Understanding

REF: 148 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Iodine is important in thyroid function. Magnesium is important in cell growth and neuromuscular function. Zinc is important in DNA and RNA synthesis.

53. ANS: C PTS: 1 DIF: Cognitive Level: Understanding

REF: 148 OBJ: Nursing Process Step: Assessment

MSC: Client Needs: Health Promotion and Maintenance

NOT: Iodine is important in thyroid function. Magnesium is important in cell growth and neuromuscular function. Zinc is important in DNA and RNA synthesis.

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