Chapter 12: Maternal nutrition

Question 1

1. A 22-year-old patient who is pregnant with a single fetus has a preconception body mass index (BMI) of 24. When they were seen in the clinic at 14 weeks of gestation, they had gained 2 kg since conception. How would the nurse interpret this?
   a. This weight gain indicates gestational hypertension.
   b. This weight gain indicates that the patient’s infant is at risk for intrauterine
   growth restriction (IUGR).
   c. This weight gain cannot be evaluated until the patient has been observed for
   several more weeks.
   d. The patient’s weight gain is appropriate for this stage of pregnancy.

Answer 1

ANS: D
The patient’s weight gain is appropriate for this stage of pregnancy is an accurate statement. This patient’s BMI is in the normal range. During the first trimester, the average total weight gain is only 1 to 2 kg. Although weight gain does indicate possible gestational hypertension, it is not a definitive diagnosis. The desirable weight gain during pregnancy varies among patients. The primary factor to consider in making a weight gain recommendation is the appropriateness of the pre-pregnancy weight for the patient’s height. A commonly used method of evaluating the appropriateness of weight for height is the BMI. This patient has gained the appropriate amount of weight for their size at this point in their pregnancy. Although weight gain does indicate risk for IUGR, it does not apply to this patient.

Question 2

A nurse would teach a pregnant patient that which meal 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, dried apricots, and prunes
d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea

Answer 2

ANS: 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 group are all good sources of iron. In addition, the vitamin C in dried apricots aids absorption. Dairy products and tea are not sources of iron.

Question 3

What might a nurse suggest when teaching a patient about reducing the severity of nausea caused by morning sickness?
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 teeth immediately after eating.
d. Keep windows closed if possible.

Answer 3

ANS: A
Interestingly, some patients can tolerate tart or salty foods when they are nauseous. 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. Fresh air can decrease nausea.

Question 4

A nurse would have the most concern with a pregnant woman whose diet consists almost entirely of whole-grain breads and cereals, fruits, and vegetables?
a. Calcium
b. Protein
c. Vitamin B12
d. Folic acid

Answer 4

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.

Question 5

5. What should a nurse advise a pregnant woman who is experiencing nausea and vomiting?
   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 1 to 2 hours).
   c. Increase intake of high-fat foods to keep the stomach full and coated.
   d. Limit fluid intake throughout the day.

Answer 5

ANS: B
Eating small, frequent meals is a correct suggestion for a patient experiencing nausea and vomiting. A pregnant patient experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated but should compensate by drinking fluids at other times. A pregnant patient experiencing nausea and vomiting should reduce their intake of fried and other fatty foods.

Question 6

6. Which should a nurse teach a pregnant patient who is still playing tennis at 32 weeks of gestation, regarding nutrition?
   a. Increase fluid intake before, during, and after exercise.
   b. Include extra protein sources, such as peanut butter, in your diet.
   c. Eat salty foods to replace lost sodium.
   d. Eat easily digested sources of carbohydrate.

Answer 6

ANS: A
Liberal amounts of fluid should be consumed before, during, and after exercise to avoid dehydration, because dehydration can trigger premature labour. The patient’s calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

Question 7

7. Which statement made by a pregnant patient would lead a nurse to believe that the patient might have a lactose intolerance?
   a. “I always have heartburn after I drink milk.”
   b. “If I drink more than a cup of milk, I feel bloated and have abdominal cramps.”
   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.”

Answer 7

ANS: B
Abdominal cramps and bloating are consistent with lactose intolerance. 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.

Question 8

8. A nurse should teach a pregnant patient that consuming more of which food will increase calcium intake?
   a. Fresh apricots
   b. Canned clams
   c. Spaghetti with meat sauce
   d. Canned sardines

Answer 8

ANS: D
Sardines are rich in calcium. Fresh apricots, canned clams, and spaghetti with meat sauce are not high in calcium.

Question 9

9. A 27-year-old pregnant patient with a preconception body mass index (BMI) of 18.0. A nurse would provide education that which weight would be within the normal range for their total recommended weight gain during pregnancy?
   a. 21 kg
   b. 19 kg
   c. 14 kg
   d. 12 kg

Answer 9

ANS: C
This patient has an underweight BMI and should gain 12.5 to 18 kg during pregnancy. A weight gain of 21 kg would be unhealthy for most pregnant patients. A weight gain of 19 kg is slightly above the range of weight this patient should gain in their pregnancy. A weight gain of 12 kg is below the range of weight this patient should gain in their pregnancy.

Question 10

10. A patient in week 34 of pregnancy reports that they are very uncomfortable because of heartburn. What should the nurse suggest to the patient?
    a. Substitute other calcium sources for milk in their diet.
    b. Lie down after each meal.
    c. Reduce the amount of fibre they consume.
    d. Eat five small meals daily.

Answer 10

ANS: D
Eating small, frequent meals may help with heartburn, nausea, and vomiting. Substituting other calcium sources for milk, lying down after eating, and reducing fibre intake are inappropriate dietary suggestions for all pregnant patients and do not alleviate heartburn

Question 11

11. A patient has come to the clinic for preconception counselling because they want to start trying to get pregnant in 3 months. Which information should a nurse provide to this patient?
    a. Discontinue all contraception now.
    b. Lose weight so that you can gain more during pregnancy.
    c. Continue taking any medications you have been taking regularly.
    d. Make sure that you include adequate folic acid in your diet.

Answer 11

ANS: D
A healthy diet before conception is the best way to ensure that adequate nutrients are available for the developing fetus. A patient’s folate or folic acid intake is of particular concern in the preconception period. Neural tube defects are more common in infants of mother with a poor folic acid intake. Depending on the type of contraception used, discontinuing all contraception may not be an accurate statement. Losing weight is not appropriate advice. Depending on the type of medication the patient is taking, continuing its use may not be an accurate statement.

Question 12

12. What would a nurse would teach a pregnant patient regarding the best time to take iron supplements?
    a. On a full stomach
    b. At bedtime
    c. After eating a meal
    d. With milk

Answer 12

ANS: B
Patients should be instructed to take iron supplements at bedtime. Iron supplements are best absorbed if they are taken when the stomach is empty. 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.

Question 13

13. A nurse is aware what condition are infants born to patients with an inadequate weight gain during pregnancy at higher risk of experiencing?
    a. Spina bifida
    b. Intrauterine growth restriction (IUGR)
    c. Diabetes mellitus
    d. Down syndrome

Answer 13

ANS: B
Both normal-weight and underweight patients with inadequate weight gain have an increased risk of giving birth to an infant with adverse effects on growth and development such as IUGR. Spina bifida, diabetes mellitus, and Down syndrome are not associated with inadequate maternal weight gain.

Question 14

14. After a nurse completes nutritional counselling for a pregnant patient, which information from the patient would indicate that they understand the role of protein in their 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

Answer 14

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.

Question 15

15. A nurse is aware that pregnant adolescents are at high risk for, related to their lower body mass indices (BMIs) and “fad” dieting practices?
    a. Obesity
    b. Diabetes
    c. Low-birth-weight babies
    d. High-birth-weight babies

Answer 15

ANS: C
Adolescents tend to have lower BMIs because they are still developing and may follow unsafe nutritional practices. In addition, the fetus and still-growing mother may compete for nutrients. These factors, along with inadequate weight gain, lend themselves to a higher incidence of low-birth-weight babies. Maternal obesity and diabetes, and high birth weight of babies are conditions associated with higher BMIs.

Question 16

16. Why is maternal nutritional status an especially significant factor that may influence the outcome of pregnancy?
    a. It is very difficult to adjust because of people’s ingrained eating habits.
    b. It is an important preventive measure for a variety of problems.
    c. Society loves obsessing about weight and diets.
    d. A patient’s preconception weight becomes irrelevant.

Answer 16

ANS: B
Maternal nutritional status is a significant factor because it is potentially alterable and because good nutrition before and during pregnancy can help prevent a variety of problems. Nutritional status draws much attention for its all-around effect on a healthy pregnancy and birth. We cannot assume that it is very difficult to adjust because of ingrained habits. The statement that society loves obsessing about weight and diets does not apply to all pregnant patients and is not important related to pregnancy outcomes. A patient’s preconception weight should be her desirable body weight before pregnancy, therefore, it is not relevant.

Question 17

17. Which statement about acronyms in nutrition is accurate?
    a. Dietary reference intakes (DRIs) consist of recommended dietary allowances
    (RDAs), adequate intakes (AIs), and upper limits (ULs).
    b. RDAs are the same as ULs, except with better data.
    c. AIs offer guidelines for avoiding excessive amounts of nutrients.
    d. DRI’s refer to green, leafy vegetables; whole grains; and fruit.

Answer 17

ANS: 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. DRIs include a wide variety of nutrients and food components; they are divided into age, sex, and life-stage categories (e.g., infancy, pregnancy, and lactation). Green, leafy vegetables; whole grains; and fruit are important, but they are not the whole nutritional story.

Question 18

18. What should a nurse be aware of with regard to protein in the diet of pregnant patients?
    a. Many protein-rich foods are also good sources of calcium, iron, and B vitamins.
    b. Many patients 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 pregnant patients on
    macrobiotic diets.

Answer 18

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

Question 19

19. A nurse would provide which nutritional recommendation about fluids during pregnancy?
    a. A pregnant patient’s daily intake should be about 3 litres.
    b. Coffee should be limited to no more than two cups, but tea and cocoa can be
    consumed without worry.
    c. All artificial sweeteners are safe for pregnant patients.
    d. Water with fluoride is especially encouraged because it reduces the child’s risk of
    tooth decay.

Answer 19

ANS: C
The recommended daily intake of liquid is 2.2 litres. Water, milk, decaffeinated tea, and juices are good sources, although pregnant women should limit their intake of fruit juice, as it can be high in calories and therefore lead to extra weight gain. Artificial sweeteners, including aspartame, have no ill effects on the normal mother or fetus. However, mothers with phenylketonuria should avoid aspartame. No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay. However, it still helps the mother.

Question 20

20. Which minerals and vitamins usually are recommended to supplement a pregnant patient’s diet?
    a. Fat-soluble vitamins A and D
    b. Water-soluble vitamins C and B6
    c. Iron and folate
    d. Calcium and zinc

Answer 20

ANS: C
Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important to the health of the fetus. 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.

Question 21

21. Which vitamins or minerals can lead to congenital malformations of the fetus if taken in excess by the pregnant patient?
    a. Zinc
    b. Vitamin D
    c. Folic acid
    d. Vitamin A

Answer 21

ANS: D
Zinc, vitamin D, and folic acid are vital to good maternity and fetal health and are highly unlikely to be consumed in excess. Vitamin A taken in excess causes a number of problems. An analogue of vitamin A appears in prescribed acne medications, which must not be taken during pregnancy.

Question 22

22. While taking a diet history, the nurse might be told that the expectant mother has cravings for ice chips, cornstarch, and baking soda. What is the term for this behaviour?
    a. Pre-eclampsia
    b. Pyrosis
    c. Pica
    d. Purging

Answer 22

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

Question 23

23. What should a nurse teach a pregnant patient about getting enough iron in their diet?
    a. Milk, coffee, and tea aid iron absorption if consumed at the same time as iron.
    b. Iron absorption is inhibited by a diet rich in vitamin C.
    c. Eating green leafy vegetables will ensure an adequate iron intake.
    d. Constipation is common with iron supplements.

Answer 23

ANS: D
Constipation can be a problem. Milk, coffee and tea inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. A plant-based diet will not provide enough iron for a pregnant person.

Question 24

24. The major source of nutrients in the diet of a pregnant person should be composed of
    a. simple sugars.
    b. fats.
    c. fibre.
    d. complex carbohydrates.

Answer 24

ANS: D
Complex carbohydrates supply the pregnant patient with vitamins, minerals, and fibre. The most common simple carbohydrate is table sugar, which is a source of energy but does not provide any nutrients. Fats provide 9 kcal in each gram, in contrast to carbohydrates and proteins, which provide only 4 kcal in each gram. Fibre is supplied primarily by complex carbohydrates.

Question 25

25. A pregnant patient’s diet may not meet their need for folates. A good source of this nutrient is
    a. chicken.
    b. cheese.
    c. potatoes.
    d. green leafy vegetables.

Answer 25

ANS: D
Sources of folates include green leafy vegetables, whole grains, fruits, liver, dried peas, and beans. Chicken and cheese are excellent sources of protein but are poor in folates. Potatoes contain carbohydrates and vitamins and minerals but are poor in folates.

Question 26

26. When providing care to the prenatal patient, a nurse understands that pica is defined as
    a. intolerance of milk products.
    b. iron deficiency anemia.
    c. ingestion of nonfood substances.
    d. episodes of anorexia and vomiting.

Answer 26

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

Question 27

27. The most important reason for evaluating the pattern of weight gain in pregnancy is to
    a. prevent excessive adipose tissue deposits.
    b. identify potential nutritional problems or complications of pregnancy.
    c. assess the need to limit caloric intake in obese patient.
    d. determine cultural influences on the patient’s diet.

Answer 27

ANS: B
Maternal and fetal risks in pregnancy are increased when the mother is significantly overweight. Excessive adipose tissue may occur with excess weight gain; however, this is not the reason for monitoring the weight gain pattern. It is important to monitor the pattern of weight gain to identify complications. The pattern of weight gain is not influenced by cultural influences.

Question 28

1. While completing the physical assessment of a pregnant patient, a nurse can evaluate the patient’s nutritional status by observing a number of physical signs. Which signs would indicate that the patient has unmet nutritional needs? (Select all that apply.)
   a. Loss of vibratory sense
   b. Bright, clear, shiny eyes
   c. Tender calves
   d. Spoon-shaped nails
   e. Reddish pink mucous membranes
   f. Surface papillae present on tongue

Answer 28

ANS: A, C, D
The malnourished pregnant woman may display loss of vibratory sense, tender calves, and spoon-shaped nails. Bright, clear shiny eyes are a sign of good nutrition. Reddish pink mucous membranes is a normal finding in those with good nutrition, and the tongue should have surface papillae and not be smooth.

Question 29

2. Which will a nurse teach a pregnant patient regarding the prevention of foodborne illness? (Select all that apply.)
   a. Clean all kitchen utensils with a 15-mL ratio of bleach to 750 mL water followed
   by a water rinse.
   b. Refrigerate perishable food at 4C or lower.
   c. Leftovers can be safely consumed up to 1 week after they were originally cooked.
   d. Never defrost food at room temperature.
   e. It is not safe to consume Brie and Camembert cheese.
   f. It is safe to consume raw eggs as long as they are blended well.

Answer 29

Foodborne illness can be prevented by refrigerating perishable food at 4C or lower, never defrosting food at room temperature, and avoiding any unpasteurized milk product such as Brie or Camembert cheese. Utensils should be cleaned with a bleach-to-water ratio, but 15 mL is too high; the correct ratio is 5 mL bleach to 750 mL water, followed by a clear water rinse. Leftovers should be consumed within 2 to 3 days. Raw eggs should not be consumed.

Question 30

3. A nurse would teach a pregnant person that which fish is considered safe to consume while pregnant? (Select all that apply.)
   a. Shark
   b. Canned tuna
   c. Shrimp
   d. Pollock
   e. Swordfish
   f. Marlin

Answer 30

ANS: B, C, D
As a precaution the pregnant woman should avoid eating fresh or frozen tuna, shark, swordfish, escolar, and marlin. High levels of mercury can harm the developing nervous system of the fetus. It is essential for the nurse to assist the woman in understanding the differences between numerous sources of this product. A pregnant woman can eat canned tuna. It is a common misconception that fish caught in local waterways are the safest. Commercially caught fish that are low in mercury include salmon, shrimp, pollock, and catfish.

Question 31

1. A newly pregnant patient visits their provider’s office for the first prenatal appointment. To estimate accurate weight gain throughout the pregnancy, a nurse will be evaluating the appropriateness of weight for height using the body mass index (BMI). The patient weighs 51 kg and is 1.57 m tall. The BMI is .

Answer 31

20.7
BMI = weight divided by height squared. BMI = 51 kg/(1.57 m)2, or 20.7. Prepregnant BMI can be classified into the following categories: <18.5, underweight or low; 18.5 to 24.9, normal; 25 to 29.9 overweight or high; and >30, obese.