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TEST BANK FOR MATERNITY NURSING
REVISED REPRINT 8TH EDITION BY
LOWDERMILK
Chapter 08: maternal and fetal nutrition
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 woman’s
infant is at risk f growth restriction (IUGR).
c. This weight gain cannot be evaluated until the woman has been observed for several
more weeks.
d. The woman’s weight gain is 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 wo 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 t 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 woman’s
BMI is in the norma During the first trimester, the average total weight gain is only 1 to 2.5 kg.
DIF
:
Cognitive Level: Analysis
REF: 243
OBJ: Client Needs: Health Promotion and Maintenance
Process: Assessment
TOP: Nursing
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: Comprehension
REF: 241
OBJ: Client Needs: Physiologic Integrity TOP:
Nursing Process: Planning
3. Which nutrient’s recommended dietary allowance (RD 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: Knowledge
REF: 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: Comprehension
REF: 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 af
b. “If I drink more than a cup have abdominal cramps and b
c. “Drinking milk usually make in hives.”
d. “Sometimes I notice that I 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: Application REF: 247 OBJ: Client Needs: Physiologic
Integrity TOP: Nursing Process: Assessment
6. A pregnant woman’s diet history indicates that she 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: Comprehension REF: 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 woman’s t 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: Comprehension
REF: 243
OBJ: Client Needs: Health Promotion and Maintenance
Process: Planning
TOP: Nursing
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: Comprehension REF: 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 contracept
b. “Lose weight so that you ca during pregnancy.”
c. “You may take any medicatio been taking regularly.”
d. “Make sure that you include 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
woman’s folate or akefolicisof aci 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: Application
REF: 240
OBJ: Client Needs: Health Promotion and Maintenance Process: Planning
TOP: Nursing
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: Application REF: 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: Application REF: 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: Knowledge
REF: 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: Knowledge REF: 241
OBJ: Client Needs: Physiologic Integrity TOP:
Nursing Process: Planning
14. Which nutritional recommendation about fluids is accurate?
a. A woman’s daily intake shou 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 reduc 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: Comprehension REF: 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: Comprehension REF: 249
OBJ: Client Needs: Health Promotion and Maintenance Process: Planning
TOP: Nursing
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: Knowledge REF: 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: Knowledge
REF: 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: Comprehension
REF: 245
OBJ: Client Needs: Health Promotion and Maintenance
Process: Planning
TOP: Nursing
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 patient’s nutr 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: Analysis
REF: 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