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Lowdermilk: Maternity & Women's 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
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning
2.
a.
b.
c.
d.

REF: 310

Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than
during pregnancy?
Energy (kcal)
Iron
Vitamin A
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
Mosby items and derived items © 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

A woman with lactose intolerance is more likely to experience bloating and cramping. Milk consumption may cause abdominal cramping. Which statement made by a lactating woman leads the nurse to believe that the woman might have lactose intolerance? “I always have heartburn after I drink milk. d. and vegetables. Folic acid needs can be met by enriched bread products. 2007. an affiliate of Elsevier Inc. A client that breaks out in hives after consuming milk is more likely to have a milk allergy. 14-2 A pregnant woman’s diet consists almost entirely of whole grain breads and cereals. The nurse should be more concerned with the woman’s intake of vitamin B12 due to her dietary restrictions. although many lactose-intolerant individuals can tolerate small amounts of milk without symptoms. which is the inability to digest milk sugar because of a lack of the enzyme lactose in the small intestine. this diet is deficient in vitamin B12. Depending on the woman’s food choices. DIF: Cognitive Level: Knowledge REF: 326 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment 4. .” “Sometimes I notice that I have bad breath after I drink a cup of milk. bloating. this diet may be adequate in calcium. Protein needs can be sufficiently met by a vegetarian diet. b. Because vitamin B12 is found in foods of animal origin. a. c. DIF: Cognitive Level: Application REF: 316 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment Mosby items and derived items © 2012. I usually have abdominal cramps and bloating. d.” “If I drink more than a cup of milk. b. a. not heartburn. 2006 by Mosby. and diarrhea in such people. c. The nurse is most concerned about this woman’s intake of: Calcium Protein Vitamin B12 Folic acid ANS: C This diet is consistent with that followed by a strict vegetarian (vegan). fruits. Inc.” ANS: B One problem that can interfere with milk consumption is lactose intolerance. This woman should be advised to simply brush her teeth after consuming dairy products.” “Drinking milk usually makes me break out in hives.. Vegans consume only plant products.Test Bank 3.

b. This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy. an affiliate of Elsevier Inc. The nurse encourages this woman to consume more of which food in order to increase her calcium intake? Fresh apricots Canned clams Spaghetti with meat sauce Canned sardines ANS: D Sardines are rich in calcium. 2006 by Mosby. c. b. Canned clams are not high in calcium. a. Spaghetti with meat sauce is not high in calcium. c. Fresh apricots are not high in calcium. REF: 317 A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. 2007. A woman has come to the clinic for preconception counseling because she wants to start trying to get pregnant in 3 months. a.5 lb) 10 kg (22 lb) ANS: C This woman has a normal BMI and should gain 11.. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning 6. She can expect the following advice: a. A weight gain of 16 kg (35 lb) is the high end of the range of weight this woman should gain in her pregnancy. Inc. 14-3 A pregnant woman’s diet history indicates that she likes the following. This woman has a normal BMI.5 to 16 kg during pregnancy. d.Test Bank 5. The nurse knows that this woman’s total recommended weight gain during pregnancy should be at least: 20 kg (44 lb) 16 kg (35 lb) 12. DIF: Cognitive Level: Comprehension REF: 311 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning 7. . A weight gain of 10 kg (22 lb) is appropriate for an obese woman. A weight gain of 20 kg (44 lb) is unhealthy for most women.” Mosby items and derived items © 2012. d. “Discontinue all contraception now.5 kg (27. which indicates that her weight is average.

Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals. coffee. 308" OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning 8. “Eating protein will make my baby have strong teeth after he is born. 2007. and eggs may reduce absorption. it may not be appropriate to discontinue all contraception at this time. Iron can be taken at bedtime if abdominal discomfort occurs when it is taken between meals.. clients should be instructed to take iron supplements: On a full stomach At bedtime After eating a meal With milk ANS: B Taking iron supplements at bedtime may reduce GI upset.” ANS: D A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. Which statement indicates that she understands the role of protein in her pregnancy? a. “Eating protein will prevent me from becoming anemic. an affiliate of Elsevier Inc. To prevent gastrointestinal (GI) upset. Depending on the type of medications the woman is taking. “You may take any medications you have been taking regularly. “Protein will help my baby grow. DIF: Cognitive Level: Application REF: 325 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning 9. “Lose weight so that you can gain more during pregnancy. DIF: Cognitive Level: Application REF: "307. b. Iron supplements are best absorbed if they are taken when the stomach is empty. tea. c.” b. . you ask her to repeat your instructions so that you can assess her understanding of the instructions given. Bran. Neural tube defects are more common in infants of women with a poor folic acid intake.Test Bank 14-4 b. milk. “Make sure you include adequate folic acid in your diet. Iron supplements are best absorbed if they are not taken on a full stomach. Inc. Depending on the type of contraception used. A woman’s folate or folic acid intake is of particular concern in the periconception period.” d.” Mosby items and derived items © 2012. it may not be appropriate for her to continue taking them regularly. a.” c. Advising the client to lose weight now so that she can gain more during pregnancy is not appropriate advice. 2006 by Mosby. d.” c. After you complete your nutritional counseling for a pregnant woman.

Calcium intake is needed for fetal bone and tooth development. an affiliate of Elsevier Inc. an adolescent with a low BMI is less likely to develop gestational diabetes. “Eating protein will prevent me from being diabetic. and the formation of amniotic fluid. It is an important preventive measure for a variety of problems c. the fetus and still growing mother appear to compete for nutrients. the increase in the maternal blood volume. High-birth-weight or large for gestational age (LGA) babies are most often associated with gestational diabetes. These factors. DIF: Cognitive Level: Application REF: 319 OBJ: Client Needs: Health Promotion and Maintenance TOP: "Nursing Process: Assessment. Pregnant adolescents are at high risk for _______________ due to lower body mass indexes (BMIs) and “fad” dieting. the enlargement of the uterus. a. Low-birth-weight babies d. An adequate protein intake is essential to meeting the increasing demands of pregnancy. It is very difficult to adjust because of people’s ingrained eating habits b. Obesity b. Glycemic control is needed in diabetics. lend themselves to a higher incidence of low-birth-weight babies. Unless the teen has type 1 diabetes. Inc. 2007. A woman’s preconception weight becomes irrelevant Mosby items and derived items © 2012. but this is not the primary role of protein intake. protein is one nutritional factor to consider. Diagnosis" 11.. DIF: Cognitive Level: Application REF: 313 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation 10. Women love obsessing about their weight and diets d. Obesity is associated with a higher than normal BMI. 2006 by Mosby.” ANS: A Protein is the nutritional element basic to growth. along with inadequate weight gain. Gestational diabetes c. These demands arise from the rapid growth of the fetus. High-birth-weight babies ANS: C Adolescents tend to have lower BMIs. Maternal nutritional status is an especially significant factor of the many that influence the outcome of pregnancy because: a. This is often associated with obesity. Iron intake prevents anemia. mammary glands. . Additionally. and placenta.Test Bank 14-5 d.

Women with inadequate weight gain have an increased risk of delivering an infant with intrauterine growth restriction (IUGR) d. only aspartame has not been associated with any maternity health concerns. Inc. 2006 by Mosby. Obese women may have their health concerns. Which nutritional recommendation about fluids is accurate? a. A woman’s daily intake should be six to eight glasses of water. With regard to weight gain during pregnancy. but their risk of giving birth to a child with major congenital defects is the same as with normal-weight women c. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Evaluation REF: 307 12. Mosby items and derived items © 2012. The primary factor in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman’s height. milk. Of the artificial sweeteners. Coffee should be limited to no more than 2 cups. Obese women are twice as likely as normal-weight women to give birth to a child with major congenital defects. 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. In this case. Greater than expected weight gain during pregnancy is almost always due to oldfashioned overeating ANS: C IUGR is associated with women with inadequate weight gain. the woman’s height is not a factor in determining her target weight b. DIF: Cognitive Level: Knowledge REF: 309 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis 13. Overeating is only one of several likely causes. b. Pregnancy is not the time to begin a weight loss diet. but tea and cocoa can be consumed without worry.. Clients and their caregivers should still be concerned with appropriate weight gain. c. and/or juice.Test Bank 14-6 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. 2007. . maternity nurses should know that: a. an affiliate of Elsevier Inc.

should be avoided or should be drunk only in limited amounts. including tea.. Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the mother? a. ANS: A Six to eight glasses is still the standard for fluids. Vitamin A Mosby items and derived items © 2012. mothers with phenylketonuria (PKU) should avoid aspartame. However.Test Bank 14-7 d. however. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. it still helps the mother. they should be the right fluids. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning REF: 314 14. Folic acid d. Fat-soluble vitamins A and D b. Artificial sweeteners. DIF: Cognitive Level: Application REF: "315. Calcium and zinc ANS: C Iron generally should be supplemented. Most women get enough calcium. Which minerals and vitamins usually are recommended to supplement a pregnant woman’s diet? a. Iron and folate d. including aspartame. 2006 by Mosby. an affiliate of Elsevier Inc. as vitamin D might be for lactose-intolerant women. Vitamin D c. and some soft drinks. Fat-soluble vitamins should be supplemented as a medical prescription. vitamin B6 is prescribed only if the woman has a very poor diet. 318" OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning 15. . Water with fluoride is especially encouraged because it reduces the child’s risk of tooth decay. However. Zinc b. Inc. have no ill effects on the normal mother or fetus. Zinc sometimes is supplemented. All beverages containing caffeine. cocoa. Water-soluble vitamin C sometimes is consumed in excess naturally. and folic acid supplements often are needed because folate is so important. 2007. Water-soluble vitamins C and B6 c.

2007. Preeclampsia b. Inc. proteinuria. which must not be taken during pregnancy. laundry starch) is called pica. cornstarch. Pyrosis c. DIF: Cognitive Level: Comprehension REF: 317 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning 16. Assessment of a woman’s nutritional status includes a diet history. medication regimen. otherwise known as heartburn. and baking soda. such as phenylketonuria (PKU). physical examination. A maternity nurse performing such an assessment should be aware that: a. Pica d. 2006 by Mosby.. Vitamin D is vital to good maternity and fetal health and is highly unlikely to be consumed in excess. Illnesses that have created nutritional deficits.g. may require nutritional care before conception c. . The woman’s socioeconomic status and educational level are not relevant to her Mosby items and derived items © 2012. 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. Purging ANS: C The consumption of foods low in nutritional value or of nonfood substances (e. While taking a diet history the nurse might be told that the expectant mother has cravings for ice chips. Characteristics include increasing hypertension. dirt. This represents a nutritional problem known as: a.. Folic acid is vital to good maternity and fetal health and is highly unlikely to be consumed in excess. an affiliate of Elsevier Inc.Test Bank 14-8 ANS: D If taken in excess. Zinc is vital to good maternity and fetal health and is highly unlikely to be consumed in excess. Oral contraceptive use may interfere with the absorption of iron b. Preeclampsia is a vasospastic disease process encountered after 20 weeks of gestation. and hemoconcentration. and relevant laboratory tests. vitamin A causes a number of problems. An analog of vitamin A appears in prescribed acne medications. A burning sensation in the epigastric region is pyrosis.

Salmon and shrimp contain high levels of mercury Mosby items and derived items © 2012. 2006 by Mosby. A woman’s finances affect her access to good nutrition. such as lemonade. The woman should avoid drinking too much when nausea is most likely. Three servings of milk. they are the province of the social worker d. Inc. Canned white tuna is a preferred choice b. Drink plenty of fluids early in the day c. her education (or lack thereof) can influence the nurse’s teaching decisions. The woman should avoid brushing her teeth immediately after eating. 2007. poultry. A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning. Oral contraceptive use may interfere with the absorption of folic acid. . yogurt. the nurse might suggest that she: a. The only nutrition-related laboratory test most pregnant women need is testing for diabetes ANS: B A registered dietitian can help with therapeutic diets. or fish will adequately supply the recommended amount of protein for the pregnant woman. some women can tolerate tart or salty foods when they are nauseated..Test Bank 14-9 examination. or salty foods. swordfish. but she should be sure to make up the fluid levels later in the day when she feels better. Avoid shark. such as potato chips b. Never snack before bedtime ANS: A Interestingly. To help a woman reduce the severity of nausea caused by morning sickness. Brush her teeth immediately after eating d. DIF: Cognitive Level: Knowledge REF: 326 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning 19. Fish caught in local waterways is the safest d. Iron deficiency can appear if placement of an intrauterine device (IUD) results in blood loss. Try a tart food or drink. an affiliate of Elsevier Inc. 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. or cheese plus two servings of meat. 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. and mackerel c.

and blood pressure b. DIF: Cognitive Level: Comprehension REF: 314 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning 20. Bright. Alert. and elevated blood pressure. shrimp. A pregnant client may eat as much as 12 ounces a week of canned light tuna. . If she presented as listless. infection. albacore. cachectic. Nutrition is alterable and an important preventive measure for a variety of potential problems such as low birth weight and prematurity. these fish sources should be avoided. clear. Which sign indicates that the client has unmet nutritional needs? a. and tingling ANS: D The physiologic changes of pregnancy may complicate the interpretation of physical findings. This client is well nourished. Normal heart rate. Lower extremity edema often occurs when caloric and protein deficiencies are present. The pregnant client may eat up to 12 ounces per week. It is essential for the nurse to assist the client in understanding the differences between numerous sources of this product. limited to less than 6 ounces. the nurse can evaluate the client’s nutritional status by observing a number of physical signs. 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. dull appearance of the cornea. 2006 by Mosby. dryness..fda. Additional information on levels of mercury in commercially caught fish is available at www. Nutrition is one of the most significant factors in influencing the outcome of a pregnancy.cfsan. Pale or red membranes. however. If no information is available. Edema. The malnourished pregnant client may display rapid heart rate. High levels of mercury can harm the developing nervous system of the fetus. easily fatigued. 2007. and request further laboratory testing if indicated. shiny eyes c. While completing the physical assessment of the pregnant client. an affiliate of Elsevier Inc. DIF: Cognitive Level: Analysis REF: 323 Mosby items and derived items © 2012. abnormal rhythm.gov. or blue sclerae are signs of poor nutrition. tender calves. or tuna steaks contain higher levels of mercury and should be limited to no more than 6 ounces per week. shiny eyes with no sores and moist. the pregnant client should avoid eating all of these as well as the less common tilefish. responsive. Inc. pollock. enlarged heart. or the only fish consumed that week. Commercially caught fish that is low in mercury includes salmon. canned white. it may also be a common physical finding during the third trimester. however. and tired this would be an indication of poor nutritional status.Test Bank 14-10 ANS: B As a precaution. or catfish. and good endurance d. A client receiving adequate nutrition will have bright. rhythm. It is essential that the nurse complete a thorough health history and physical assessment. pink membranes.

c. a client with a body mass index (BMI) in the obese range should gain at least 7 kg to ensure a healthy outcome. Most women with uncomplicated pregnancies can use the nurse as their primary source for nutritional information. DIF: Cognitive Level: Application REF: 321 OBJ: "Client Needs: Physiologic Integrity. Very strict vegetarians (vegans) who consume only plant products may also require vitamin B and mineral supplementation. Calculate the body mass index (BMI) for a woman who is 65 cm tall and weighs 115 lb. a. Physiologic Adaptation" TOP: Nursing Process: Implementation COMPLETION 1. 2007. Inc. This client may well require indepth counseling on optimum food choices.. 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 vegetarian client needs to have her dietary intake carefully assessed to ensure that the optimum combination of amino acids and protein intake is achieved. an affiliate of Elsevier Inc. B. D The nurse should be especially aware that conditions such as diabetes can require in-depth dietary planning and evaluation.Test Bank 14-11 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment MULTIPLE RESPONSE 1. 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. b. C. this client would benefit from a referral to a dietitian. BMI = Weight in kg divided by height in meters squared DIF: Cognitive Level: Analysis REF: 309 Mosby items and derived items © 2012. To prevent issues with hypoglycemia and hyperglycemia as well as an increased risk for perinatal morbidity and mortality. 2006 by Mosby. These pregnant women include those with: Preexisting or gestational illness such as diabetes Ethnic or cultural food patterns Obesity Vegetarian diets ANS: A. According to the Institute of Medicine. d. The obese pregnant client may be under the misapprehension that because of her excess weight that little or no weight gain is necessary. There are times when the nurse or midwife should refer a client to a registered dietitian for in-depth nutritional counseling.

and life-stage categories. Inc. These recommendations for daily nutritional intakes meet the needs of approximately 75% to 80% of the healthy population.Test Bank 14-12 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment 2. Extra-wide blood pressure cuffs. A new medical subspecialty referred to as ____________ obstetrics has subsequently arisen. an affiliate of Elsevier Inc. and scales that can safely hold the weight of these clients are necessary to deliver safe care. Dietary Reference Intakes (DRIs) have been established for the people of the United States and Canada. They are divided into age.. DIF: Cognitive Level: Knowledge REF: 308 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment Mosby items and derived items © 2012. 2006 by Mosby. surgical tables. the subspecialty of bariatric obstetrics has been developed. Is this statement true or false? ANS: F The DRIs apply to almost all (97% to 99%) of the healthy members of the population. Obstetricians today are seeing more morbidly obese pregnant women (those that weigh 400 lb or greater). . sex. DIF: Cognitive Level: Comprehension OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning REF: 312 TRUE/FALSE 1. 2007. ANS: Bariatric To best manage the conditions of these women and to meet their logistical needs. Special techniques for ultrasound and longer surgical instruments are also required.