Maternal And Child Nursing Care 5th Edition By London – Test Bank
Chapter 11 Maternal Nutrition
1) A 15-year-old primipara at 8 weeks’ gestation who is 64 inches tall and weighs 115 pounds asks why she is supposed to gain so much weight. What is the best response by the nurse?
1. “Inadequate weight gain delays lactation after delivery.”
2. “It’s what your certified nurse–midwife recommended for you.”
3. “Weight gain is important to assure that you get enough vitamins.”
4. “Gaining 25 to 35 pounds is recommended for healthy fetal growth.”
Answer: 4
Explanation:
1. Inadequate weight gain can lead to decreased fetal growth and development.
2. Although this statement might be true, the client has asked a “why” question that should be directly answered.
3. Vitamin intake is related to the types of food consumed, not to caloric intake. Because this client is 15, her diet is probably not optimal, and her intake of empty calories or junk food might make up the majority of her caloric intake.
4. Adolescents who become pregnant less than 4 years after menarche are at risk because of their physiologic and anatomic immaturity. They are more likely than older adolescents to still be growing, which can affect the fetus’s development.
Page Ref: 229
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Implementation/Teaching/Learning
Learning Outcome: 11.6 Compare recommendations for weight gain and nutrient intakes in the pregnant adolescent with those for the mature pregnant adult.
MNL Learning Outcome: 2.4.4. Evaluate the nutritional needs of the pregnant adolescent.
2) The nurse is preparing an antenatal nutrition class for pregnant women. Which material should be included in the teaching?
1. During pregnancy, consumption of oily fish should be avoided.
2. Dietary protein can only be obtained through consuming dairy, meat, and eggs.
3. Nutritional iodine requirements generally can be met through intake of iodized salt.
4. Iron absorption is generally higher for vegetable products than for animal products.
Answer: 3
Explanation:
1. Oily fish provide the best source of docosahexaenoic acid (DHA), which may reduce the risk of preterm birth, preeclampsia, low birth weight, and enhance fetal and infant brain development.
2. Excluding dairy, meat, and eggs, adequate dietary protein can be obtained by consuming a varied diet with adequate caloric intake and plant-based proteins.
3. Intake of iodized salt generally provides the recommended intake of iodine.
4. Iron absorption is generally higher for animal products than for vegetable products.
Page Ref: 223
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Planning/Teaching/Learning
Learning Outcome: 11.2 Explain the significance of specific nutrients in the diet of the pregnant woman.
MNL Learning Outcome: 2.5.1. Recognize nutritional requirements specific to pregnancy.
3) The nurse instructs on the importance of niacin during a preconception counseling class. Which food item selected by a participant indicates that teaching about the sources of niacin has been effective?
1. Fish
2. Milk
3. Apples
4. Broccoli
Answer: 1
Explanation:
1. Dietary sources of niacin include meats, fish, and enriched grains.
2. Milk will provide sources of other vitamins; however, it does not contain significant niacin.
3. Apples will provide sources of other vitamins; however, they do not contain significant niacin.
4. Broccoli will provide sources of other vitamins; however, it does not contain significant niacin.
Page Ref: 225
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Evaluation/Teaching/Learning
Learning Outcome: 11.2 Explain the significance of specific nutrients in the diet of the pregnant woman.
MNL Learning Outcome: 2.5.1. Recognize nutritional requirements specific to pregnancy.
4) It has been identified that a pregnant client’s diet is low in zinc. Which food should the nurse suggest to increase intake of this mineral?
1. Yogurt
2. Bananas
3. Cabbage
4. Shellfish
Answer: 4
Explanation:
1. Yogurt is high in other nutrients but does not have significant levels of zinc.
2. Bananas are high in other nutrients but do not have significant levels of zinc.
3. Cabbage is high in other nutrients but does not have significant levels of zinc.
4. Zinc is found in greatest concentration in meats and meat by-products. Enriched grains also tend to be high in zinc.
Page Ref: 223
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Implementation/Teaching/Learning
Learning Outcome: 11.2 Explain the significance of specific nutrients in the diet of the pregnant woman.
MNL Learning Outcome: 2.5.1. Recognize nutritional requirements specific to pregnancy.
5) The nurse is providing nutritional counseling for a postpartum client with a hemoglobin of 8. Which statement indicates that additional teaching is necessary?
1. “I need to increase food sources that contain iron.”
2. “If I drink lots of milk, I will increase my iron level faster.”
3. “My iron is low, but it will increase as I take iron supplements.”
4. “I might feel less energetic and tire more easily while my iron is low.”
Answer: 2
Explanation:
1. Anemia requires additional iron. Many foods, such as red meat, will provide iron. Increasing iron-rich foods will improve anemia.
2. Milk does not contain iron; it contains calcium. Increased calcium intake will not increase hemoglobin levels. Further, iron should not be taken with milk, as the iron will not be absorbed.
3. Iron supplements are indicated with anemia. This client’s hemoglobin level is 8; lower than 10 is considered anemia during pregnancy. Taking iron will increase hemoglobin.
4. Hemoglobin carries oxygen; when the hemoglobin level is low, the muscles are not adequately oxygenated, especially during activity, and fatigue results.
Page Ref: 223
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Evaluation/Teaching/Learning
Learning Outcome: 11.3 Compare nutritional needs during pregnancy, the postpartum period, and lactation with nonpregnant requirements.
MNL Learning Outcome: 5.2.2. Apply strategies to promote maternal well-being after birth including nutrition, rest, and activity.
6) The nurse reviews nutritional requirements with a breastfeeding mother who is concerned that her milk production has decreased. Which statement indicates that further teaching is required?
1. “I have started cutting back on my protein intake.”
2. “At least 3 times a day, I drink a glass of milk.”
3. “I am drinking a minimum of 8 to 10 glasses of liquid a day.”
4. “I try to take a nap in the morning and afternoon when the baby is sleeping.”
Answer: 1
Explanation:
1. It is especially important for the breastfeeding mother to consume sufficient calories because inadequate caloric intake can reduce milk volume. The decreased intake of protein represents a decrease in calories, which will decrease milk production.
2. The breastfeeding mother must increase her protein and calcium intake.
3. The breastfeeding mother must consume a minimum of 8 to 10 glasses of liquid per day.
4. It has also been found that adequate rest is necessary for the body to maintain its production of milk.
Page Ref: 232
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Evaluation/Teaching/Learning
Learning Outcome: 11.8 Compare nutritional counseling issues for breastfeeding and formula-feeding mothers.
MNL Learning Outcome: 2.5.4. Compare nutritional needs of the breastfeeding mother versus the formula feeding mother.
7) The nurse is conducting a postpartum visit to a client who is formula-feeding her infant. Which client statement indicates that teaching about weight maintenance has been effective?
1. “I have increased my caloric intake by 600 calories per day.”
2. “My dietician has set my weight loss goal at 1 to 2 pounds per week.”
3. “Instead of making another doctor’s appointment, I started a diet that my best friend recommended.”
4. “My daily regimen includes taking extra vitamin A, vitamin C, and thiamine in order to meet my body’s increased need for nutrients after pregnancy.”
Answer: 2
Explanation:
1. If the mother has a good understanding of nutritional principles, it is sufficient to advise her to reduce her daily caloric intake by about 300 kcal and to return to prepregnancy levels for other nutrients.
2. Weight loss goals of 1 to 2 pounds (0.45 to 0.9 kg)/week are usually suggested for mothers who formula-feed.
3. The woman should diet only under the guidance of her primary healthcare provider.
4. After birth, the formula-feeding mother’s dietary requirements return to prepregnancy levels.
Page Ref: 232
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Evaluation/Teaching/Learning
Learning Outcome: 11.8 Compare nutritional counseling issues for breastfeeding and formula-feeding mothers.
MNL Learning Outcome: 2.5.4. Compare nutritional needs of the breastfeeding mother versus the formula feeding mother.
8) The nurse is planning an educational session for pregnant clients who are vegans. What information should the nurse include?
1. Vegan diets are high in iron.
2. Rice contains a high level of vitamin B12.
3. Soy is not a good source of protein for vegans.
4. Eating beans and rice provides complete protein needs.
Answer: 4
Explanation:
1. Vegan diets are low in iron, and pregnant vegans often experience anemia.
2. Rice does not contain vitamin B12.
3. Soy is a very good source of protein and calcium and is safe during pregnancy.
4. Complete proteins can be obtained by eating different types of plant-based proteins such as beans and rice.
Page Ref: 226
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Planning/Teaching/Learning
Learning Outcome: 11.4 Plan adequate prenatal vegetarian diets based on the nutritional requirements of pregnancy.
MNL Learning Outcome: 2.5.3. Describe factors that present nutritional concerns during pregnancy.
9) A pregnant client who is a lacto-ovo vegetarian asks for help planning a diet that includes adequate protein intake. What instruction should the nurse give?
1. “To improve protein absorption, avoid simultaneous intake of animal protein and plant protein.”
2. “Following a lacto-ovo vegetarian diet will require you to take a daily supplement of vitamin B12.”
3. “Because you don’t eat meat, eggs, or dairy products, it’s important to eat adequate plant-based proteins.”
4. “In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective sources of plant-based proteins.”
Answer: 4
Explanation:
1. Plant protein quality can be improved if it is consumed with certain animal proteins.
2. Vegan diets, in which no animal products are consumed, often require daily supplementation of vitamin B12.
3. While lacto-ovo vegetarians do not eat meat, they do eat eggs, milk, and dairy products.
4. A diet that includes plant proteins, such as beans and rice, peanut butter on whole-grain bread, and whole-grain cereal with soy milk, helps ensure the expectant mother obtains all the essential amino acids.
Page Ref: 226
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: IX.7. Provide appropriate client teaching that reflects developmental stage, age, culture, spirituality, client preferences, and health literacy considerations to foster client engagement in their care │ NLN Competencies: Relationship Centered Care; Practice; learn cooperatively, facilitate the learning of others│ Nursing/Integrated Concepts: Implementation/Teaching/Learning
Learning Outcome: 11.4 Plan adequate prenatal vegetarian diets based on the nutritional requirements of pregnancy.
MNL Learning Outcome: 2.5.3. Describe factors that present nutritional concerns during pregnancy.
10) Which client statement on cultural or religious influences on nutrition requires intervention?
1. “I avoid milk and meat at meals because I am Jewish.”
2. “My auntie sent me clay from the south to eat every day.”
3. “Because I am Muslim, I do not ever eat any pork products.”
4. “My grandmother makes sure I eat a serving of greens each day.”
Answer: 2
Explanation:
1. A kosher diet involves avoiding pork and shellfish and not eating dairy and meat at the same meal.
2. Eating clay is pica. The clay, being a type of soil, can be contaminated with hazardous substances and should be avoided. Some African Americans, especially those from the South, practice clay-eating pica.
3. Dietary restrictions in the Muslim tradition include avoidance of pork. Because other meats are eaten, the client is not at risk for protein or iron deficiency.
4. Greens, such as collard greens and spinach, have high amounts of folic acid and are healthy foods to eat during pregnancy. Women from the southern United States often eat greens.
Page Ref: 229
Cognitive Level: Analyzing
Client Need/Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of client centered care │ AACN Essential Competencies: VII.7. Collaborate with other healthcare professionals and clients to provide spiritually and culturally appropriate health promotion and disease and injury prevention interventions │ NLN Competencies: Relationship Centered Care; Knowledge; Health care approaches of other disciplines and other cultures│ Nursing/Integrated Concepts: Assessment/Culture and Spirituality
Learning Outcome: 11.5 Explain the ways in which various physical, psychosocial, and cultural factors can affect nutritional intake and status in the nursing management of pregnant women.
MNL Learning Outcome: 2.2.3. Recognize maternal cultural and spirituality factors that affect pregnancy.
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