test bank for maternity nursing revised reprint 8th ... · the desirable weight gain during...

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TEST BANK FOR MATERNITY NURSING

REVISED REPRINT 8TH EDITION BY

LOWDERMILK

Chapter 08: maternal and fetal nutrition

MULTIPLE CHOICE

1. A 22-year-old woman pregnant with a single fetus has a preconception

body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks

of gestation, she had gained 1.8 kg (4 lb) since conception. How would the

nurse interpret this?

a. This weight gain indicates possible gestational hypertension.

b. This weight gain indicates that the woman’s

infant is at risk f growth restriction (IUGR).

c. This weight gain cannot be evaluated until the woman has been observed for several

more weeks.

d. The woman’s weight gain is for this stage of pregnancy.

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ANS: D

Feedback

A Although this is an accurate statement, it does

not apply to this patient. The desirable weight

gain during pregnancy varies among women.

The primary factor to consider in making a

weight gain recommendation is the

appropriateness of the pre-pregnancy weight for

the wo height. A commonly used method of

evaluating the appropriateness of weight

for height is the BMI. This woman has

gained the appropriate amount of weight

for her size at this point in her pregnancy.

B Although this is an accurate statement, it does

not apply to this patient. The desirable weight

gain during pregnancy varies among women.

The primary factor to consider in making a

weight gain recommendation is the

appropriateness of the pre-pregnancy weight

for t height. A commonly used method of

evaluating the appropriateness of weight

for height is the BMI. This woman has

gained the appropriate amount of weight

for her size at this point in her pregnancy.

C Weight gain should take place throughout

the pregnancy. The optimal rate of weight

gain depends on the stage of the pregnancy.

D This is an accurate statement. This woman’s

BMI is in the norma During the first trimester, the average total weight gain is only 1 to 2.5 kg.

DIF

:

Cognitive Level: Analysis

REF: 243

OBJ: Client Needs: Health Promotion and Maintenance

Process: Assessment

TOP: Nursing

2. Which of the following meals 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, ambrosia (orange sections, coconut, and pecans), and prunes

d. Red beans and rice, cornbread, mixed greens, and decaffeinated tea

ANS: C

Feedback

A 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.

Dairy products are not a source of iron.

B 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.

Dairy products are not a source of iron.

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

meal are all good sources of iron. In

addition, the vitamin C in ambrosia (orange

sections) aids absorption.

D 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. Tea is not a

source of iron. DIF

:

Cognitive Level: Comprehension

REF: 241

OBJ: Client Needs: Physiologic Integrity TOP:

Nursing Process: Planning

3. Which nutrient’s recommended dietary allowance (RD lactation than during pregnancy?

a. Energy (kcal)

b. Iron

c. Vitamin A

d. Folic acid ANS: A

Feedback

A Needs for energy, protein, calcium, iodine,

zinc, the B vitamins, and vitamin C remain

greater during lactation than during

pregnancy.

B Needs for energy, protein, calcium, iodine,



pregnancy.

C Needs for energy, protein, calcium, iodine,



pregnancy.

D Needs for energy, protein, calcium, iodine,



pregnancy. DIF

:

Cognitive Level: Knowledge

REF: 252



4. A pregnant woman experiencing nausea and vomiting should:

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 2 to 3 hours).

c. Increase her intake of high-fat foods to keep the stomach full and coated.

d. Limit fluid intake throughout the day.

ANS: B

Feedback

A A pregnant woman experiencing nausea and

vomiting should avoid consuming fluids

early in the day or when nauseated.

B This is a correct suggestion for a woman

experiencing nausea and vomiting.

C A pregnant woman experiencing nausea

and vomiting should reduce her intake of fried and other fatty foods.

D A pregnant woman experiencing nausea

and vomiting should avoid consuming

fluids early in the morning or when

nauseated but should compensate by

drinking fluids at other times. DIF

:


REF: 259



5. Which statement made by a lactating woman would lead the nurse to believe that the woman might have lactose intolerance?

a. “I always have heartburn af

b. “If I drink more than a cup have abdominal cramps and b

c. “Drinking milk usually make in hives.”

d. “Sometimes I notice that I after I drink a cup of milk

ANS: B

Feedback

A 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.

B These symptoms are consistent with lactose intolerance.

C One problem that can interfere with milk








amounts of milk without symptoms.

D One problem that can interfere with milk








amounts of milk without symptoms. DIF: Cognitive Level: Application REF: 247 OBJ: Client Needs: Physiologic

Integrity TOP: Nursing Process: Assessment

6. A pregnant woman’s diet history indicates that she of foods. The nurse would encourage this woman to consume more of which food to increase her calcium intake?

a. Fresh apricots

b. Canned clams

c. Spaghetti with meat sauce

d. Canned sardines ANS: D

Feedback

A Apricots are not high in calcium.

B Canned clams are not high in calcium.

C Spaghetti with meat sauce is not high in calcium.

D Sardines are rich in calcium. DIF: Cognitive Level: Comprehension REF: 248 OBJ: Client Needs: Physiologic

Integrity TOP: Nursing Process: Planning

7. A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 18.0. The nurse knows that this woman’s t weight gain during pregnancy should be at least:

a. 20 kg (44 lb).

b. 16 kg (35 lb).

c. 12.5 kg (27.5 lb).

d. 10 kg (22 lb). ANS: C

Feedback

A This weight gain would be unhealthy for

most women. This woman has a normal

BMI and should gain 11.5 to 16 kg during

pregnancy.

B This is the high end of the range of weight

this woman should gain in her pregnancy.

C This woman has a normal BMI and should

gain 11.5 to 16 kg during pregnancy.

D This weight gain would be appropriate for

an obese woman. This woman has a normal

BMI, which indicates that her weight is

average. DIF

:


REF: 243


Process: Planning

TOP: Nursing

8. A woman in week 34 of pregnancy reports that she is very uncomfortable because of heartburn. The nurse would suggest that the woman:

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. ANS: D

Feedback

A Eliminating milk in the diet is an

inappropriate dietary suggestion for all

pregnant women, and it does not alleviate

heartburn.

B Lying down after meals may actually

increase the symptoms of heartburn.

C Reducing the amount of dietary fiber consumed is not likely to alleviate heartburn.

D Eating small, frequent meals may help with heartburn, nausea, and vomiting.

DIF: Cognitive Level: Comprehension REF: 259 OBJ: Client Needs: Physiologic

Integrity TOP: Nursing Process: Planning

9. A woman has come to the clinic for preconception counseling because she

wants to start trying to get pregnant in 3 months. She can expect the

following advice:

a. “Discontinue all contracept

b. “Lose weight so that you ca during pregnancy.”

c. “You may take any medicatio been taking regularly.”

d. “Make sure that you include acid in your diet.”

ANS: D

Feedback

A Depending on the type of contraception

used, this may not be an accurate statement.

B This statement is not appropriate advice.

C Depending on the type of medication the woman is taking, this may not be an

accurate statement.

D A healthy diet before conception is the best

way to ensure that adequate nutrients are

available for the developing fetus. A

woman’s folate or akefolicisof aci particular

concern in the periconception period. Neural

tube defects are more common in infants of

women with a poor folic acid intake.

DIF

:

Cognitive Level: Application

REF: 240

OBJ: Client Needs: Health Promotion and Maintenance Process: Planning

TOP: Nursing

10. To prevent gastrointestinal upset, patients should be instructed to take iron supplements:

a. On a full stomach.

b. At bedtime.

c. After eating a meal.

d. With milk. ANS: B

Feedback

A Iron supplements are best absorbed if they

are taken when the stomach is empty. Iron

can be taken at bedtime if abdominal

discomfort occurs when it is taken between

meals.

B Taking the iron supplement at bedtime is helpful in reducing gastrointestinal discomfort.

C Iron supplements are best absorbed if they

are taken when the stomach is empty. Iron

can be taken at bedtime if abdominal

discomfort occurs when it is taken between

meals.

D Iron supplements are best absorbed if they

are taken when the stomach is empty. Bran,

tea, coffee, milk, and eggs may reduce

absorption. DIF: Cognitive Level: Application REF: 247 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

11. Pregnant adolescents are at high risk for _____ because of lower body mass indices (BMIs) and “fad” dieting.

a. Obesity

b. Diabetes

c. Low-birth-weight babies

d. High-birth-weight babies ANS: C

Feedback

A Obesity is associated with higher BMIs.

Adolescents typically have a lower BMI

because they are still developing and they

may follow unsafe nutritional practices.

B Diabetes is associated with higher BMIs,

or obesity. Adolescents typically have a

lower BMI because they are still

developing and they may follow unsafe

nutritional practices.

C Adolescents tend to have lower BMIs. In

addition, the fetus and 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.

D High-birth-weight babies are frequently

associated with women who have

gestational diabetes or obesity. Adolescents

typically have a lower BMI, because they

are still developing and they may follow

unsafe nutritional practices. DIF: Cognitive Level: Application REF: 252 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment, Diagnosis

12. Which statement about acronyms in nutrition is accurate?

a. Dietary reference intakes (DRIs) consist of

RDAs, adequate intakes (AIs), and upper limits (ULs).

b. Recommended dietary allowances (RDAs) are the same as ULs, except with better data.

c. AIs offer guidelines for avoiding excessive amounts of nutrients.

d. They all refer to green, leafy vegetables; whole grains; and fruit.

ANS: A

Feedback

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. Green,

leafy vegetables; whole grains; and fruit are

important, but they are not the whole

nutritional story.

B DRIs consist of RDAs, AIs, and ULs. AIs








nutritional story.

C DRIs consist of RDAs, AIs, and ULs. AIs








nutritional story.

D DRIs consist of RDAs, AIs, and ULs. AIs








nutritional story. DIF

:


REF: 240


Nursing Process: Assessment

13. With regard to protein in the diet of pregnant women, nurses should be aware that:

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.

ANS: A

Feedback

A Good protein sources such as meat, milk,

eggs, and cheese have a lot of calcium and iron.

B Most women already eat a high-protein

diet and do not need to increase their intake.

C Protein is sufficiently important that

specific servings of meat and dairy are recommended.

D High-protein supplements are not

recommended because they have been

associated with an increased incidence of

preterm births. DIF: Cognitive Level: Knowledge REF: 241



14. Which nutritional recommendation about fluids is accurate?

a. A woman’s daily intake shou 10 glasses (2.3 L) 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 reduc risk of tooth decay.

ANS: A

Feedback

A Eight to 10 glasses is the standard for

fluids; however, they should be the right fluids.

B All beverages containing caffeine, including

tea, cocoa, and some soft drinks, should be

avoided or drunk only in limited amounts.

C Artificial sweeteners, including aspartame,

have no ill effects on the normal mother or

fetus. However, mothers with

phenylketonuria should avoid aspartame.

D No evidence indicates that prenatal

fluoride consumption reduces childhood

tooth decay. However, it still helps the

mother. DIF: Cognitive Level: Comprehension REF: 245 OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

15. Which vitamins or minerals can 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 ANS: D

Feedback

A Zinc is vital to good maternity and fetal

health but is highly unlikely to be consumed in excess.

B Vitamin D is vital to good maternity and fetal health but is highly unlikely to be

consumed in excess.

C Folic acid is vital to good maternity and fetal health but is highly unlikely to be

consumed in excess.

D Vitamin A taken in excess causes a number

of problems. An analog of vitamin A appears

in prescribed acne medications,

which must not be taken during pregnancy.

DIF

:

Cognitive Level: Comprehension REF: 249

OBJ: Client Needs: Health Promotion and Maintenance Process: Planning

TOP: Nursing

16. While taking a diet history, the nurse might be told that the

expectant mother has cravings for ice chips, cornstarch, and baking

soda. This represents a nutritional problem known as:

a. Preeclampsia.

b. Pyrosis.

c. Pica.

d. Purging. ANS: C

Feedback

A Preeclampsia is a complication of

pregnancy.

B Pyrosis is more commonly known as heartburn.

C The consumption of foods low in nutritional value or of nonfood substances (e.g., dirt,

laundry starch) is called pica.

D Purging consists of self-induced vomiting. DIF: Cognitive Level: Knowledge REF: 251 OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing

Process: Diagnosis

17. To help a woman reduce the severity of nausea caused by morning sickness, the nurse might suggest that she:

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 her teeth immediately after eating.

d. Never snack before bedtime.

ANS: A

Feedback

A Interestingly, some women can tolerate tart or salty foods when they are nauseous.

B 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.

C The woman should avoid brushing her teeth immediately after eating.

D A small snack of cereal and milk or yogurt before bedtime may help the stomach in the morning.

DIF

:


REF: 259



18. Three servings of milk, yogurt, or cheese plus two servings of meat,

poultry, or fish will adequately supply the recommended amount of protein

for the pregnant woman. Many patients 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 patient in

determining which fish is safe to consume would include:

a. Canned white tuna is a preferred choice.

b. Avoid shark, swordfish, and mackerel.

c. Fish caught in local waterways are the safest.

d. Salmon and shrimp contain high levels of mercury.

ANS: B

Feedback

A High levels of mercury can harm the

developing nervous system of the fetus. It is

essential for the nurse to assist the patient in

understanding the differences between

numerous sources of this product. A

pregnant patient can eat as much as 12

ounces a week of canned light tuna; however, canned white,

albacore, or tuna steaks contain higher

levels of mercury and should be limited to no more than 6 ounces per week.

B As a precaution, the pregnant patient

should avoid eating all of these and the

less common tilefish. Additional

information on levels of mercury in

commercially caught fish is available at

www.cfsan.fda.gov.

C This is a common misconception. 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. If no information

is available, these fish sources should be

avoided or limited to less than 6 ounces or be

the only fish consumed that week.

D Commercially caught fish that are low in

mercury include salmon, shrimp, pollock,

or catfish. The pregnant patient may eat up

to 12 ounces per week. DIF

:


REF: 245


Process: Planning

TOP: Nursing

19. Nutrition is one of the most significant factors in influencing the outcome of a

pregnancy. It 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 patient, the nurse can evaluate the patient’s nutr observing a

number of physical signs. Which sign would indicate that

the patient has unmet nutritional needs?

a. Normal heart rate, rhythm, and blood pressure

b. Bright, clear, shiny eyes

c. Alert, responsive, and good endurance

d. Edema, tender calves, and tingling ANS: D

Feedback

A The malnourished pregnant patient may

display rapid heart rate, abnormal rhythm,

enlarged heart, and elevated blood pressure.

B A patient receiving adequate nutrition will

have bright, shiny eyes with no sores and

moist, pink membranes. Pale or red

membranes, dryness, infection, dull

appearance of the cornea, or blue sclerae are

all signs of poor nutrition.

C This patient is well nourished. Cachexia,

listlessness, and tiring easily would be indications of poor nutritional status.

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, it may

also be a common physical finding during

the third trimester. It is essential that the

nurse complete a thorough health history

and physical assessment and request further

laboratory testing if indicated. DIF

:

Cognitive Level: Analysis

REF: 256


Nursing Process: Assessment

MULTIPLE RESPONSE

1. Most women with uncomplicated pregnancies can use the nurse as their

primary source for nutritional information. The nurse or midwife should

refer a patient to a registered dietitian for in-depth nutritional counseling

when which of the following exist(s)? (Choose all that apply.)

a. Preexisting or gestational illness such as

diabetes

b. Ethnic or cultural food patterns

c. Obesity

d. Vegetarian diets

test bank for maternity nursing revised reprint 8th ... · the desirable weight gain during...

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