Preview Extract
Chapter 12
1) The prenatal clinic nurse is caring for a 15-year-old primiparous patient at 8 weeks’
gestation. The patient is 64 inches tall and weighs 115 pounds. The patient asks the nurse
why she is supposed to gain so much weight. What is the best response by the nurse?
1. “Gaining 25–35 pounds is recommended for healthy fetal growth.”
2. “It’s what your certified nurse–midwife recommended for you.”
3. “Inadequate weight gain delays lactation after delivery.”
4. “Weight gain is important to assure that you get enough vitamins.”
Answer: 3
Rationale 1:
For an appropriate weight woman, 25–35 pounds of weight gain is recommended for optimal
fetal growth and development.
Rationale 2:
Although this statement might be true, the patient has asked a “why” question that should be
directly answered.
Rationale 3:
Inadequate weight gain can lead to decreased fetal growth and development.
Rationale 4:
Vitamin intake is related to the types of food consumed, not to caloric intake. Because this
patient is 15, her diet is probably not optimal, and her intake of empty calories or junk food
might make up the majority of her calorie intake.
2) The nurse is preparing an antenatal nutrition class for pregnant women. Which material
should be included in the teaching?
1. Dietary protein can only be obtained through consuming dairy, meat, and eggs.
2. During pregnancy, consumption of oily fish should be avoided.
3. Iron absorption is generally higher for vegetable products than for animal products.
4. Nutritional iodine requirements generally can be met through intake of iodized salt.
Answer: 4
Rationale 1:
Excluding dairy, meat, and eggs, adequate dietary protein can be obtained by consuming a
varied diet with adequate caloric intake and plant-based proteins.
Rationale 2:
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.
Rationale 3:
Iron absorption is generally higher for animal products than for vegetable products.
Rationale 4:
Intake of iodized salt generally provides the recommended intake of iodine.
3) The nurse is presenting a preconception counseling class. The nurse instructs the
participants that niacin intake should increase during pregnancy to promote metabolic
coenzyme activity. The nurse would know that teaching has been effective if a patient
suggests which of the following foods as a source of niacin?
1. Fish
2. Apples
3. Broccoli
4. Milk
Answer: 1
Rationale 1:
Dietary sources of niacin include meats, fish, and enriched grains.
Rationale 2:
Apples will provide sources of other vitamins; however, they do not contain significant
niacin.
Rationale 3:
Broccoli will provide sources of other vitamins; however, it does not contain significant
niacin.
Rationale 4:
Milk will provide sources of other vitamins; however, it does not contain significant niacin.
4) The nurse evaluates the diet of a pregnant patient and finds that it is low in zinc. The nurse
knows that zinc intake should increase during pregnancy to promote protein metabolism.
Which of the following foods should the nurse suggest in order to increase intake of zinc?
1. Shellfish
2. Bananas
3. Yogurt
4. Cabbage
Answer: 1
Rationale 1:
Zinc is found in greatest concentration in meats and meat by-products. Enriched grains also
tend to be high in zinc.
Rationale 2:
Bananas are high in other nutrients but do not have significant levels of zinc.
Rationale 3:
Yogurt is high in other nutrients but does not have significant levels of zinc.
Rationale 4:
Cabbage is high in other nutrients but does not have significant levels of zinc.
5) The nurse is providing nutritional counseling for a postpartum patient with a hemoglobin
of 8.0. Which statement indicates that additional teaching is necessary?
1. “My iron is low, but it will increase as I take iron supplements.”
2. “I need to increase food sources that contain iron.”
3. “If I drink lots of milk, I will increase my iron level faster.”
4. “I might feel less energetic and tire more easily while my iron is low.”
Answer: 3
Rationale 1:
Iron supplements are indicated with anemia. This patient’s hemoglobin level is 8.0; lower
than 10 is considered anemia during pregnancy. Taking iron will increase hemoglobin.
Rationale 2:
Anemia requires additional iron. Many foods, such as red meat, will provide iron. Increasing
iron-rich foods will improve anemia.
Rationale 3:
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.
Rationale 4:
Hemoglobin carries oxygen; when the hemoglobin level is low, the muscles are not
adequately oxygenated, especially during activity, and fatigue results.
6) The breastfeeding mother is concerned that her milk production has decreased. The nurse
knows that further patient teaching is needed based on which statement?
1. “I am drinking a minimum of 8–10 glasses of liquid a day.”
2. “I have started cutting back on my protein intake.”
3. “At least three times a day, I am drinking a glass of milk.”
4. “I try to take a nap in the morning and afternoon when the baby is sleeping.”
Answer: 2
Rationale 1:
The breastfeeding mother must consume a minimum of 8–10 glasses of liquid per day.
Rationale 2:
The decreased intake of protein will decrease milk production.
Rationale 3:
The breastfeeding mother must increase her protein and calcium intake.
Rationale 4:
It has also been found that adequate rest is necessary for the body to maintain its production
of milk.
7) The nurse is conducting a postpartum home visit. The patient has been home for a week
and is formula feeding her infant. Which statement by the patient indicates that she
understands the teaching?
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
Rationale 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 pre-pregnancy levels for
other nutrients.
Rationale 2:
Weight loss goals of 1 to 2 lb. (0.45 to 0.9 kg)/week are usually suggested for mothers who
formula feed.
Rationale 3:
The woman should diet only under the guidance of her primary healthcare provider.
Rationale 4:
After birth, the formula-feeding mother’s dietary requirements return to pre-pregnancy levels.
8) The nurse is planning an educational session for pregnant vegans. What information
should the nurse include?
1. Eating beans and rice provides complete protein needs.
2. Soy is not a good source of protein for vegans.
3. Rice contains a high level of vitamin B12.
4. Vegan diets are high in iron.
Answer: 1
Rationale 1:
Neither rice nor beans and other legumes contain complete protein requirements on their
own. However, consuming both in a meal or in a day provides for complete protein needs.
Rationale 2:
Soy is a very good source of protein and calcium and is safe during pregnancy.
Rationale 3:
Rice contains very low amounts of vitamin B12. Four servings of vitamin B12 per day are
recommended during pregnancy.
Rationale 4:
Vegan diets are low in iron, and pregnant vegans often experience anemia.
9) A pregnant patient who is a lacto-ovo vegetarian asks the nurse to help her plan a diet that
includes adequate protein intake. What instruction should the nurse give?
1. “Because you don't eat meat, eggs, or dairy products, it's important to eat adequate plantbased proteins.”
2. “To improve protein absorption, avoid simultaneous intake of animal protein and plant
protein.”
3. “Following a lacto-ovo vegetarian diet will require you to take a daily supplement of
vitamin B12.”
4. “In addition to eggs and dairy products, beans, peanut butter, and soy milk can be effective
sources of plant-based proteins.”
Answer: 4
Rationale 1:
While lacto-ovo vegetarians do not eat meat, they do eat eggs, milk, and dairy products.
Rationale 2:
Plant protein quality can be improved if it is consumed with certain animal proteins.
Rationale 3:
Vegan diets, in which no animal products are consumed, often require daily supplementation
of vitamin B12.
Rationale 4:
A diet that includes plant proteins such as beans and rice, peanut butter on whole-grain bread,
and whole-grain cereal with soymilk, helps ensure the expectant mother obtains all the
essential amino acids.
10) Which patient statement on cultural or religious influences on nutrition requires
intervention?
1. “My grandmother makes sure I eat a serving of greens each day.”
2. “I avoid milk and meat at meals because I am Jewish.”
3. “My auntie sent me clay from the south to eat every day.”
4. “Because I am Muslim, I do not ever eat any pork products.”
Answer: 3
Rationale 1:
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.
Rationale 2:
A kosher diet involves avoiding pork and shellfish and not eating dairy and meat at the same
meal.
Rationale 3:
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.
Rationale 4:
Dietary restrictions in the Muslim tradition include avoidance of pork. Because other meats
are eaten, the patient is not at risk for protein or iron deficiency.
11) The nurse is working with a pregnant 14-year-old. The patient confides that she's
concerned she may be struggling with bulimia nervosa. Which nursing observation best
supports the patient's statement?
1. The patient is of normal weight for her height and reports binge eating followed by
purging.
2. Despite being extremely underweight, the patient describes herself as being fat.
3. The patient reports dietary cravings for soil and clay.
4. In terms of food variety and quantity, the patient's diet is extremely restrictive.
Answer: 1
Rationale 1:
Bulimia is characterized by binge eating and purging, and individuals with bulimia nervosa
often maintain normal or near-normal weight for their height.
Rationale 2:
Anorexia nervosa is an eating disorder characterized by an extreme fear of weight gain and
fat, and it incorporates a self-perception of being overweight even when the individual is
extremely underweight.
Rationale 3:
Dietary cravings for and consumption of nonnutritive substances is consistent with pica.
Rationale 4:
The dietary intake of individuals with anorexia nervosa is very restrictive in both variety and
quantity.
12) When preparing nutritional instruction, which of the following pregnant patients would
the nurse consider highest priority?
1. 40-year-old gravida 2
2. 22-year-old primigravida
3. 35-year-old gravida 4
4. 15-year-old nulligravida
Answer: 4
Rationale 1:
The 40-year-old has completed her growth cycle, and her body can focus on diverting the
nutritional needs to the fetus.
Rationale 2:
The 22-year-old has completed her growth cycle, and her body can focus on diverting the
nutritional needs to the fetus.
Rationale 3:
The 35-year-old has completed her growth cycle, and her body can focus on diverting the
nutritional needs to the fetus.
Rationale 4:
Adolescent patients typically are still in their own growth cycle. Suddenly, they have to
supply nutrition for themselves and the fetus. This places them at greatest risk for
malnutrition.
13) Which statement is best to include when teaching a pregnant adolescent about nutritional
needs of pregnancy?
1. “It is important eat iron-rich foods like meat every day.”
2. “Calcium and milk aren’t needed until the third trimester.”
3. “Folic acid intake is the key to having a healthy baby.”
4. “You just need to pay attention to what you eat now.”
Answer: 1
Rationale 1:
Adolescents often have an iron intake that is inadequate for pregnancy. Giving specific
examples are most helpful when giving nutritional information.
Rationale 2:
Calcium is needed throughout pregnancy and should be consumed daily.
Rationale 3:
Although folic acid is important during pregnancy to prevent neural tube defects, and for
lactation, there is not one single nutritional element responsible for having a healthy baby.
Rationale 4:
This response is too vague to be helpful. Adolescents will need specific information to
improve nutrition during pregnancy.
14) The school nurse is planning a class about nutrition for pregnant teens. The nurse knows
that several of the pregnant teenage patients have been diagnosed with iron-deficiency
anemia. Which should the nurse encourage the teens to consume more of in order to increase
iron absorption?
1. Gatorade
2. Orange juice
3. Milk
4. Green tea
Answer: 2
Rationale 1:
Gatorade does not contain vitamin C.
Rationale 2:
Vitamin C is found in citrus fruits and juices and is known to enhance the absorption of iron
from meat and non-meat sources.
Rationale 3:
Milk does not contain vitamin C.
Rationale 4:
Green tea does not contain vitamin C.
15) The nurse is working with a pregnant teen. In order to accurately assess the teen’s
nutritional intake, the nurse should:
1. Assess laboratory values.
2. Ask her to complete a 24-hour dietary recall.
3. Observe for clinical signs of malnutrition.
4. Ask about her cooking facilities.
Answer: 2
Rationale 1:
Laboratory values only provide information about the nutritional status of the patient.
Rationale 2:
A 24-hour recall is the only method listed that assesses the patient’s food intake.
Rationale 3:
Clinical signs of malnutrition only provide information about the nutritional status of the
patient.
Rationale 4:
Cooking facilities might not be related to food intake.
16) The nurse is leading a session on nutrition for newly delivered women. Which statement
indicates that teaching has been effective?
1. “Because I am breastfeeding, I need a low calcium intake.”
2. “Breastfeeding requires that I eat lots of protein daily.
3. “Since I am bottle-feeding, I don’t have to eat vegetables.”
4. “Bottle-feeding moms like me require a high sodium intake.”
Answer: 2
Rationale 1:
Breastfeeding requires an increase of 1,000 mg per day of calcium—the same amount of
calcium that is recommended during pregnancy.
Rationale 2:
Breastfeeding patients should consume 65 g of protein daily during the first six months of
breastfeeding and 62 g daily during the second six months. Protein is a major ingredient in
breast milk.
Rationale 3:
Although vitamin intake is not directly related to bottle-feeding, good nutritional habits are
important to form while bottle-feeding, because in the future, the baby will be eating what the
mother eats.
Rationale 4:
Sodium intake is not increased during bottle-feeding.
17) The nurse is preparing a prenatal class about infant feeding methods. The maternal
nutritional requirements for breastfeeding and formula-feeding will be discussed. What
statement should the nurse include?
1. “Breastfeeding requires a continued high intake of protein and calcium.”
2. “Formula-feeding mothers should protect their health with a lot of calcium.”
3. “Producing breast milk requires calories, but any source of food is fine.”
4. “Formula-feeding mothers need a high protein intake to avoid fatigue.”
Answer: 1
Rationale 1:
Lactation requires calories, along with increased protein and calcium intake.
Rationale 2:
Formula-feeding mothers do not need additional nutrients.
Rationale 3:
Although any food source would provide the additional calories, these needs are best met by
using increased protein intake as the source for the required additional calories to support
milk production.
Rationale 4:
Formula-feeding moms do not need additional nutrients.
18) The nurse is observing the meal selections of a group of pregnant and postpartal patients.
One meal consists of a cup of skim milk, soy burger on a bun, baked beans, 8 ounces of
water, four carrot sticks, and a mixed fresh fruit cup. For which patient is this meal the best
choice?
1. 27-year-old primip, 8 weeks’ gestation, Hgb 11.0
2. 30-year-old multip two days postpartum, bottle-feeding
3. 15-year-old primip, one day postpartum, breastfeeding
4. 20-year-old multip, 32 weeks’ gestation, reports fatigue.
Answer: 3
Rationale 1:
This patient needs a high-iron diet. The meal described is high in calcium and protein, but
low in iron.
Rationale 2:
The meal described is high in calcium and protein. This meal would be more than adequate
for a bottle-feeding patient, but it is better suited to a breastfeeding patient.
Rationale 3:
This is the best patient for this meal. Because the patient is an adolescent, she needs a highprotein diet, and because she is breastfeeding, she needs a high-calcium diet. The meal
described is high in calcium and protein: milk, soy, and beans all are sources of protein, while
milk and soy are good sources of calcium.
Rationale 4:
The high protein and calcium of the described meal are good during pregnancy, but the report
of fatigue could indicate a low hemoglobin level that requires additional assessment prior to
recommending a specific diet.
Test Bank for Contemporary Maternal-Newborn Nursing
Patricia W Ladewig, Marcia L London, Michele Davidson
9780133429862, 9780134257020
