Exam 1 - Chapter 15

Question 1

Which nutrients recommended dietary allowance (RDA) is higher during lactation than 
during pregnancy?
a. Energy (kcal)
b. Iron
c. Vitamin A
d. Folic acid

Answer 1

A - Nutrient needs for energyprotein, calcium, iodine, zinc, B vitamins, and vitamin Cremain higher
during lactation than during pregnancy. The need for iron is not higher during lactation than
during 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 of
pregnancy

Question 2

A pregnant womans diet consists almost entirely of whole grain breads and cereals, fruits,
and vegetables. Which dietary requirement is the nurse most concerned about?
a. Calcium
b. Protein
c. Vitamin B12
d. Folic acid

Answer 2

C - A pregnant womans 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, a pregnant womans 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 attributable to her dietary
restrictions. Folic acid needs can be met by enriched bread products.

Question 3

Which statement made by a lactating woman leads the nurse to believe that the client
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.

Answer 3

B - Lactose intolerance, which is an inability to digest milk sugar because of a lack of the enzyme
lactose in the small intestine, is a problem that interferes with milk consumption. 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 who breaks out in hives after consuming milk is more likely to have a milk
allergy and should be advised to simply brush her teeth after consuming dairy products.

Question 4

A client states that she does not drink milk. Which foods should the nurse encourage this
woman to consume in greater amounts to increase her calcium intake?
a. Fresh apricots
b. Canned clams
c. Spaghetti with meat sauce
d. Canned sardines

Answer 4

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

Question 5

A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. What
is this clients total recommended weight gain during pregnancy?
a. 20 kg (44 lb)
b. 16 kg (35 lb)
c. 12.5 kg (27.5 lb)
d. 10 kg (22 lb)

Answer 5

C - This woman has a normal BMI and should gain 11.5 to 16 kg during her pregnancy. A weight
gain of 20 kg (44 lb) is unhealthy for most women; a weight gain of 16 kg (35 lb) is at the high
end of the range of weight this woman should gain in her pregnancy;

Question 6

A woman has come to the clinic for preconception counseling because she wants to start
trying to get pregnant. Which guidance should she expect to receive?
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 regularly taking.
d. Make sure you include adequate folic acid in your diet

Answer 6

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 that she has been using, discontinuing
all contraception at this time may not be appropriate. Advising this client to lose weight now so
that she can gain more during pregnancy is also not appropriate advice. Depending on the type of
medications the woman is taking, continuing to take them regularly may not be appropriate

Question 7

To prevent gastrointestinal (GI) upset, when should a pregnant client be instructed to take
the recommended iron supplements?
a. On a full stomach
b. At bedtime
c. After eating a meal
d. With milk

Answer 7

B - Iron supplements taken at bedtime may reduce GI upset and should be taken at bedtime if
abdominal discomfort occurs when iron supplements are taken between meals. Iron supplements
are best absorbed if they are taken when the stomach is empty. Bran, tea, coffee, milk, and eggs
may reduce absorption

Question 8

After the nurse completes nutritional counseling for a pregnant woman, she asks the
client to repeat the instructions to assess the clients understanding. Which statement indicates
that the client 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

Answer 8

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 the amniotic fluid. Iron intake prevents anemia. Calcium
intake is needed for fetal bone and tooth development. Glycemic control is needed in those with
diabetes; protein is one nutritional factor to consider for glycemic control but not the primary
role of protein intake.

Question 9

Pregnant adolescents are at greater risk for decreased BMI and fad dieting with which 
condition?
a. Obesity
b. Gestational diabetes
c. Low-birth-weight babies
d. High-birth-weight babies

Answer 9

C - Adolescents tend to have lower BMIs. In addition, the fetus and the 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 teenager has type 1 diabetes, an adolescent with a low BMI is less likely to
develop gestational diabetes. High-birth-weight or large-for-gestational age (LGA) babies are
most often associated with gestational diabetes.

Question 10

Maternal nutritional status is an especially significant factor of the many that influence
the outcome of pregnancy. Why is this the case?
a. Maternal nutritional status is extremely difficult to adjust because of an individuals
ingrained eating habits.
b. Adequate nutrition 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.

Answer 10

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 benefit 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.

Question 11

With regard to weight gain during pregnancy, the nurse should be aware of which
important information?
a. In pregnancy, 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 women of normal weight.
c. Women with inadequate weight gain have an increased risk of delivering a preterm infant
with intrauterine growth restriction (IUGR).
d. Greater than expected weight gain during pregnancy is almost always attributable to oldfashioned overeating.

Answer 11

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 women of normal weight to give birth to a child with
major congenital defects. Overeating is only one of several likely causes

Question 12

Which nutritional recommendation regarding 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

Answer 12

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 consumed 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. Although no evidence indicates that prenatal fluoride consumption reduces
childhood tooth decay, fluoride still helps the mother

Question 13

Which minerals and vitamins are usually recommended as a supplement in a pregnant 
clients diet?
a. Fat-soluble vitamins A and D
b. Water-soluble vitamins C and B6
c. Iron and folate
d. Calcium and zinc

Answer 13

C - Iron should generally be supplemented, and folic acid supplements are often needed because
folate is so important in pregnancy. Fat-soluble vitamins should be supplemented as a medical
prescription, as vitamin D might be for lactose-intolerant women.

Question 14

Which vitamins or minerals may 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

Answer 14

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, vitamin D, and
folic acid are all vital to good maternity and fetal health and are highly unlikely to be consumed
in excess.

Question 15

While obtaining a diet history, the nurse might be told that the expectant mother has
cravings for ice chips, cornstarch, and baking soda. Which nutritional problem does this behavior
indicate?
a. Preeclampsia
b. Pyrosis
c. Pica
d. Purging

Answer 15

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 of preeclampsia include increasing hypertension, proteinuria, and
hemoconcentration. Pyrosis is a burning sensation in the epigastric region, otherwise known as
heartburn. Purging refers to self-induced vomiting after consuming large quantities of food.

Question 16

Assessment of a womans nutritional status includes a diet history, medication regimen,
physical examination, and relevant laboratory tests. Which finding might require consultation to
a higher level of care?
a. Oral contraceptive use may interfere with the absorption of iron.
b. Illnesses that have created nutritional deficits, such as 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. Testing for diabetes is the only nutrition-related laboratory test most pregnant women
need

Answer 16

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 can 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.

Question 17

Which guidance might the nurse provide for a client with severe morning sickness?

a. Trying lemonade and potato chips
b. Drinking plenty of fluids early in the day
c. Immediately brushing her teeth after eating
d. Never snacking before bedtime

Answer 17

A - Interestingly, some women can tolerate tart or salty foods when they are nauseated. Lemonade
and potato chips are an ideal combination. The woman should avoid drinking too much when
nausea is most likely, but she should increase her 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.

Question 18

Many clients are concerned about the increased levels of mercury in fish and may be
reluctant to include this source of nutrients in their diet. What is the best advice for the nurse to
provide?
a. Canned white tuna is a preferred choice.
b. Shark, swordfish, and mackerel should be avoided.
c. Fish caught in local waterways is the safest.
d. Salmon and shrimp contain high levels of mercury.

Answer 18

B - As a precaution, the pregnant client should avoid eating shark, swordfish, and mackerel, as well
as the less common tilefish.

Question 19

Nutrition 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 client, the nurse is able to evaluate the clients nutritional status by observing a
number of physical signs. Which physical sign indicates to the nurse that the client has unmet
nutritional needs?
a. Normal heart rate, rhythm, and blood pressure
b. Bright, clear, and shiny eyes
c. Alert and responsive with good endurance
d. Edema, tender calves, and tingling

Answer 19

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,
edema in the lower extremities may also be a common physical finding during the third
trimester. Completing a thorough health history and physical assessment and requesting further
laboratory testing, if indicated, are essential for the nurse.

Question 20

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. Which
recommendation would the nurse make for this particular client after a tennis match?
a. Drink several glasses of fluid.
b. Eat extra protein sources such as peanut butter.
c. Enjoy salty foods to replace lost sodium.
d. Consume easily digested sources of carbohydrate.

Answer 20

A - If no medical or obstetric problems contraindicate physical activity, then pregnant women should
get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed
before, during, and after exercise because dehydration can trigger premature labor. The womans
caloric intake should be sufficient to meet the increased needs of pregnancy and the demands of
exercise.

Question 21

A woman in the 34th week of pregnancy reports that she is very uncomfortable because
of heartburn. Which recommendation would be appropriate for this client?
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.

Answer 21

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

Question 22

Which information regarding protein in the diet of a pregnant woman is most helpful to
the client?
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.

Answer 22

A - Good sources for protein, such as meat, milk, eggs, and cheese, have a lot of calcium and iron.
Most women 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 23

A client states that she plans to breastfeed her newborn infant. What guidance would be
useful for this new mother?
a. The mothers intake of vitamin C, zinc, and protein can now be lower than during
pregnancy.
b. Caffeine consumed by the mother accumulates in the infant, who may be unusually active
and wakeful.
c. Critical iron and folic acid levels must be maintained.
d. Lactating women can go back to their prepregnant caloric intake.

Answer 23

B - A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein
levels need to be moderately higher during lactation than during pregnancy. The
recommendations for iron and folic acid are lower during lactation. Lactating women should
consume approximately 500 kcal more than their prepregnancy intake, at least 1800 kcal daily
overall

Question 24

The labor and delivery nurse is preparing a client who is severely obese (bariatric) for an
elective cesarean birth. Which piece of specialized equipment will not likely be needed when
providing care for this pregnant woman?
a. Extra-long surgical instruments
b. Wide surgical table
c. Temporal thermometer
d. Increased diameter blood pressure cuf

Answer 24

C - Obstetricians today are seeing an increasing number of morbidly obese pregnant women
weighing 400, 500, and 600 pounds. To manage their conditions and to meet their logistical
needs, a new medical subspecialty,bariatric obstetrics, has arisen. Extra-wide blood pressure
cuffs, scales that can accommodate up to 880 pounds, and extra-wide surgical tables designed to
hold the weight of these women are used. Special techniques for ultrasound examination and
longer surgical instruments for cesarean birth are also required. A temporal thermometer can be
used for a pregnant client of any size.

Question 25

Which pregnant woman should strictly follow weight gain recommendations during
pregnancy?
a. Pregnant with twins
b. In early adolescence
c. Shorter than 62 inches or 157 cm
d. Was 20 pounds overweight before pregnancy

Answer 25

D - A weight gain of 5 to 9 kg will provide sufficient nutrients for the fetus. Overweight and obese
women should be advised to lose weight before conception to achieve the best pregnancy
outcomes. A higher weight gain in twin gestations may help prevent low birth weights.
Adolescents need to gain weight toward the higher acceptable range, which provides for their
own growth, as well as for fetal growth. In the past, women of short stature were advised to
restrict their weight gain; however, evidence to support these guidelines has not been found.

Question 26

The major source of nutrients in the diet of a pregnant woman should be composed of 
what?
a. Simple sugars
b. Fats
c. Fiber
d. Complex carbohydrates

Answer 26

D - Complex carbohydrates supply the pregnant woman with vitamins, minerals, and fiber. 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. Fiber is primarily supplied by complex carbohydrates.

Question 27

A pregnant womans diet may not meet her increased need for folates. Which food is a 
rich source of this nutrient?
a. Chicken
b. Cheese
c. Potatoes
d. Green leafy vegetables

Answer 27

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 sources for folates.

Question 28

If a clients normal prepregnancy diet contains 45 g of protein daily, how many more
grams of protein should she consume per day during pregnancy?
a. 5
b. 10
c. 25
d. 30

Answer 28

C - The recommended intake of protein for the pregnant woman is 70 g. Therefore, additional
protein intakes of 5, 10, or 15 g would be inadequate to meet protein needs during pregnancy. A
protein intake of 30 g is more than would be necessary and would add extra calories.

Question 29

Which action is the first priority for the nurse who is assessing the influence of culture on
a clients diet?
a. Evaluate the clients weight gain during pregnancy.
b. Assess the socioeconomic status of the client.
c. Discuss the four food groups with the client.
d. Identify the food preferences and methods of food preparation common to the clients
culture.

Answer 29

D - Understanding the clients food preferences and how she prepares food wstitlhl eassi nurse
in
determining whether the clients culture is adversely affecting her nutritional intake. An
evaluation of a clients weight gain during pregnancy should be included for all clients, not only
for clients from different cultural backgrounds. Tonhoemsoi cisotaetcus of the client may
alter the nutritional intake but not the cultural influence. Teaching the food groups to the client
should come after assessing her food preferences.

Question 30

The nurse has formulated a diagnosis of Imbalanced nutrition: Less than body
requirements
for the client. Which goal is most appropriate for this client to obtain?
a. Gain a total of 30 pounds.
b. Consistently take daily supplements.
c. Decrease her intake of snack foods.
d. Increase her intake of complex carbohydrates.

Answer 30

A - A weight gain of 30 pounds is one indication that the client has gained a sufficient amount for
the nutritional needs of pregnancy. A daily supplement is not the best goal for this client and
does not meet the basic need of proper nutrition during pregnancy

Question 31

Which action is the highest priority for the nurse when educating a pregnant adolescent?
a. Emphasize the need to eliminate common teenage snack foods because they are high in
fat and sodium.
b. Determine the weight gain needed to meet adolescent growth, and add 35 pounds.
c. Suggest that she not eat at fast-food restaurants to avoid foods of poor nutritional value.
d. Realize that most adolescents are unwilling to make dietary changes during pregnancy

Answer 31

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

Question 32

Most women with uncomplicated pregnancies can use the nurse as their primary source
for nutritional information. However, the nurse or midwife may need to refer a client to a registered dietitian for in-depth nutritional counseling. Which conditions would require such a
consultation? (Select all that apply.)
a. Preexisting or gestational illness such as diabetes
b. Ethnic or cultural food patterns
c. Obesity
d. Vegetarian diets
e. Multifetal pregnancy

Answer 32

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, the client with a preexisting or
gestational illness 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.