Chapter 14: Maternal and Fetal Nutrition My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 14: Maternal and Fetal Nutrition

Test Bank

MULTIPLE CHOICE

1. Which meal provides 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

Foods 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 group are all good sources of iron. Additionally, the vitamin C in ambrosia (orange sections) aids absorption.

Although there is protein in the cheese sandwich, absorbable iron is not provided.

Oatmeal, toast with jelly, and dairy products are poor sources of iron.

Tea does not contain iron. Although the legumes have some iron, this is not the optimal choice.

DIF: Cognitive Level: Comprehension REF: 310

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

2. 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

Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain greater than nonpregnant needs.

The need for iron is not higher during lactation than pregnancy.

A lactating woman does not have a greater requirement for vitamin A than a nonpregnant woman.

Folic acid requirements are the highest during the first trimester.

DIF: Cognitive Level: Knowledge REF: 319

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

3. A pregnant womans diet consists almost entirely of whole grain breads and cereals, fruits, and vegetables. The nurse is most concerned about this womans intake of:

a.

Calcium

b.

Protein

c.

Vitamin B12

d.

Folic acid

ANS: C

This diet is consistent with that followed by a strict vegetarian (vegan). Vegans consume only plant products. Because vitamin B12 is found in foods of animal origin, this diet is deficient in vitamin B12.

Depending on the womans food choices, this diet may be adequate in calcium.

Protein needs can be sufficiently met by a vegetarian diet.

The nurse should be more concerned with the womans intake of vitamin B12 due to her dietary restrictions. Folic acid needs can be met by enriched bread products.

DIF: Cognitive Level: Knowledge REF: 326

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

4. Which statement made by a lactating woman leads 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

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.

A woman with lactose intolerance is more likely to experience bloating and cramping, not heartburn.

A client that breaks out in hives after consuming milk is more likely to have a milk allergy.

This woman should be advised to simply brush her teeth after consuming dairy products.

DIF: Cognitive Level: Application REF: 316

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

5. A pregnant womans diet history indicates that she likes the following. The nurse encourages this woman to consume more of which food in order to increase her calcium intake?

a.

Fresh apricots

b.

Canned clams

c.

Spaghetti with meat sauce

d.

Canned sardines

ANS: D

Sardines are rich in calcium.

Fresh apricots are not high in calcium.

Canned clams are not high in calcium.

Spaghetti with meat sauce is not high in calcium.

DIF: Cognitive Level: Comprehension REF: 317

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

6. A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. 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

This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy.

A weight gain of 20 kg (44 lb) is unhealthy for most women. This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy.

A weight gain of 16 kg (35 lb) is the high end of the range of weight this woman should gain in her pregnancy.

A weight gain of 10 kg (22 lb) is appropriate for an obese woman. This woman has a normal BMI, which indicates that her weight is average.

DIF: Cognitive Level: Comprehension REF: 311

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

7. 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 you include adequate folic acid in your diet.

ANS: 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.

Depending on the type of contraception used, it may not be appropriate to discontinue all contraception at this time.

Advising the client to lose weight now so that she can gain more during pregnancy is not appropriate advice.

Depending on the type of medications the woman is taking, it may not be appropriate for her to continue taking them regularly.

DIF: Cognitive Level: Application REF: 307, 308

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. To prevent gastrointestinal (GI) upset, clients 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

Taking iron supplements at bedtime may reduce GI upset.

Iron supplements are best absorbed if they are not taken on a full stomach.

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.

Bran, tea, coffee, milk, and eggs may reduce absorption. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.

DIF: Cognitive Level: Application REF: 325

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

9. After you complete your nutritional counseling for a pregnant woman, you ask her to repeat your instructions so that you can assess her understanding of the instructions given. Which statement indicates that she understands the role of protein in her pregnancy?

a.

Protein will help my baby grow.

b.

Eating protein will prevent me from becoming anemic.

c.

Eating protein will make my baby have strong teeth after he is born.

d.

Eating protein will prevent me from being diabetic.

ANS: A

Protein is the nutritional element basic to growth. An adequate protein intake is essential to meeting the increasing demands of pregnancy. These demands arise from the rapid growth of the fetus; the enlargement of the uterus, mammary glands, and placenta; the increase in the maternal blood volume; and the formation of amniotic fluid.

Iron intake prevents anemia.

Calcium intake is needed for fetal bone and tooth development.

Glycemic control is needed in diabetics; protein is one nutritional factor to consider, but this is not the primary role of protein intake.

DIF: Cognitive Level: Application REF: 313

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

10. Pregnant adolescents are at high risk for _______________ due to lower body mass indexes (BMIs) and fad dieting.

a.

Obesity

b.

Gestational diabetes

c.

Low-birth-weight babies

d.

High-birth-weight babies

ANS: C

Adolescents tend to have lower BMIs. Additionally, 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.

Obesity is associated with a higher than normal BMI.

Unless the teen has type 1 diabetes, an adolescent with a low BMI is less likely to develop gestational diabetes. This is often associated with obesity.

High-birth-weight or large for gestational age (LGA) babies are most often associated with gestational diabetes.

DIF: Cognitive Level: Application REF: 319

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment, Diagnosis

11. Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy because:

a.

It is very difficult to adjust because of peoples ingrained eating habits

b.

It is an important preventive measure for a variety of problems

c.

Women love obsessing about their weight and diets

d.

A womans preconception weight becomes irrelevant

ANS: B

Nutritional status draws so much attention not only for its effect on a healthy pregnancy and birth but also because significant changes are within relatively easy reach.

Pregnancy is a time when many women are motivated to learn about adequate nutrition and make changes to their diet that will be of benefit to their baby.

Pregnancy is not the time to begin a weight loss diet.

Clients and their caregivers should still be concerned with appropriate weight gain.

DIF: Cognitive Level: Comprehension REF: 307

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

12. With regard to weight gain during pregnancy, maternity nurses should know that:

a.

In this case, the womans height is not a factor in determining her target weight

b.

Obese women may have their health concerns, but their risk of giving birth to a child with major congenital defects is the same as with normal-weight women

c.

Women with inadequate weight gain have an increased risk of delivering an infant with intrauterine growth restriction (IUGR)

d.

Greater than expected weight gain during pregnancy is almost always due to old-fashioned overeating

ANS: C

IUGR is associated with women with inadequate weight gain.

The primary factor in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the womans height.

Obese women are twice as likely as normal-weight women to give birth to a child with major congenital defects.

Overeating is only one of several likely causes.

DIF: Cognitive Level: Knowledge REF: 309

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

13. Which nutritional recommendation about fluids is accurate?

a.

A womans daily intake should be six to eight glasses 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

Six to eight glasses is still the standard for fluids; however, they should be the right fluids.

All beverages containing caffeine, including tea, cocoa, and some soft drinks, should be avoided or should be drunk only in limited amounts.

Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria (PKU) should avoid aspartame.

No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

DIF: Cognitive Level: Comprehension REF: 314

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

14. Which minerals and vitamins usually are recommended to supplement a pregnant womans diet?

a.

Fat-soluble vitamins A and D

b.

Water-soluble vitamins C and B6

c.

Iron and folate

d.

Calcium and zinc

ANS: C

Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important.

Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women.

Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet.

Zinc sometimes is supplemented. Most women get enough calcium.

DIF: Cognitive Level: Application REF: 315, 318

OBJ: Client Needs: Health Promotion and Maintenance

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

If taken in excess, vitamin A causes a number of problems. An analog of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.

Zinc is vital to good maternity and fetal health and is highly unlikely to be consumed in excess.

Vitamin D is vital to good maternity and fetal health and is highly unlikely to be consumed in excess.

Folic acid is vital to good maternity and fetal health and is highly unlikely to be consumed in excess.

DIF: Cognitive Level: Comprehension REF: 317

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

The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt, laundry starch) is called pica.

Preeclampsia is a vasospastic disease process encountered after 20 weeks of gestation. Characteristics include increasing hypertension, proteinuria, and hemoconcentration.

A burning sensation in the epigastric region is pyrosis, otherwise known as heartburn.

Purging refers to self-induced vomiting after consuming large quantities of food.

DIF: Cognitive Level: Knowledge REF: 318

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

17. Assessment of a womans nutritional status includes a diet history, medication regimen, physical examination, and relevant laboratory tests. A maternity nurse performing such an assessment should be aware that:

a.

Oral contraceptive use may interfere with the absorption of iron

b.

Illnesses that have created nutritional deficits, such as phenylketonuria (PKU), may require nutritional care before conception

c.

The womans socioeconomic status and educational level are not relevant to her examination; they are the province of the social worker

d.

The only nutrition-related laboratory test most pregnant women need is testing for diabetes

ANS: B

A registered dietitian can help with therapeutic diets.

Oral contraceptive use may interfere with the absorption of folic acid. Iron deficiency can appear if placement of an intrauterine device (IUD) results in blood loss.

A womans finances affect her access to good nutrition; her education (or lack thereof) can influence the nurses teaching decisions.

The nutrition-related laboratory test that pregnant women usually need is a screen for anemia.

DIF: Cognitive Level: Comprehension REF: 321

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

18. 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

Interestingly, some women can tolerate tart or salty foods when they are nauseated.

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.

The woman should avoid brushing her teeth immediately after eating.

A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.

DIF: Cognitive Level: Knowledge REF: 326

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

19. 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 clients 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 client in determining which fish is safe to consume includes:

a.

Canned white tuna is a preferred choice

b.

Avoid shark, swordfish, and mackerel

c.

Fish caught in local waterways is the safest

d.

Salmon and shrimp contain high levels of mercury

ANS: B

As a precaution, the pregnant client should avoid eating all of these as well as the less common tilefish. Additional information on levels of mercury in commercially caught fish is available at www.cfsan.fda.gov.

High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. A pregnant client may 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.

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, limited to less than 6 ounces, or the only fish consumed that week.

Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish. The pregnant client may eat up to 12 ounces per week.

DIF: Cognitive Level: Comprehension REF: 314

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

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

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.

The malnourished pregnant client may display rapid heart rate, abnormal rhythm, enlarged heart, and elevated blood pressure.

A client 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 signs of poor nutrition.

This client is well nourished. If she presented as listless, cachectic, easily fatigued, and tired this would be an indication of poor nutritional status.

DIF: Cognitive Level: Analysis REF: 323

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. There are times when the nurse or midwife should refer a client to a registered dietitian for in-depth nutritional counseling. These pregnant women include those with:

a.

Preexisting or gestational illness such as diabetes

b.

Ethnic or cultural food patterns

c.

Obesity

d.

Vegetarian diets

ANS: A, B, C, D

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 as well as an increased risk for perinatal morbidity and mortality, this client 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 are met. The obese pregnant client 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 client with a body mass index (BMI) in the obese range should gain at least 7 kg to ensure a healthy outcome. This client may well require in-depth counseling on optimum food choices. The vegetarian client 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.

DIF: Cognitive Level: Application REF: 321

OBJ: Client Needs: Physiologic Integrity, Physiologic Adaptation

TOP: Nursing Process: Implementation

COMPLETION

1. Calculate the body mass index (BMI) for a woman who is 65 cm tall and weighs 115 lb.

ANS:

BMI 16

A commonly used method of evaluating the appropriateness of weight for height is the BMI, which is calculated by the following formula.

BMI = Weight in kg divided by height in meters squared

DIF: Cognitive Level: Analysis REF: 309

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. Obstetricians today are seeing more morbidly obese pregnant women (those that weigh 400 lb or greater). A new medical subspecialty referred to as ____________ obstetrics has subsequently arisen.

ANS:

Bariatric

To best manage the conditions of these women and to meet their logistical needs, the subspecialty of bariatric obstetrics has been developed. Extra-wide blood pressure cuffs, surgical tables, and scales that can safely hold the weight of these clients are necessary to deliver safe care. Special techniques for ultrasound and longer surgical instruments are also required.

DIF: Cognitive Level: Comprehension REF: 312

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

TRUE/FALSE

1. Dietary Reference Intakes (DRIs) have been established for the people of the United States and Canada. These recommendations for daily nutritional intakes meet the needs of approximately 75% to 80% of the healthy population. Is this statement true or false?

ANS: F

The DRIs apply to almost all (97% to 99%) of the healthy members of the population. They are divided into age, sex, and life-stage categories.

DIF: Cognitive Level: Knowledge REF: 308

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

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