Lowdermilk: Maternity & Women's Health Care, 10th Edition

Lowdermilk: Maternity & Women's Health Care, 10th Edition
Chapter 14: Maternal and Fetal Nutrition

Test Bank
MULTIPLE CHOICE
1. Which meal provides 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
Foods 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. Additionally, the vitamin C in ambrosia (orange sections) aids absorption.
Although there is protein in the cheese sandwich, absorbable iron is not provided.
Oatmeal, toast with jelly, and dairy products are poor sources of iron.
Tea does not contain iron. Although the legumes have some iron, this is not the optimal
choice.
DIF: Cognitive Level: Comprehension
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Planning
2.
a.
b.
c.
d.
REF: 310
Which nutrients recommended dietary allowance (RDA) is higher during lactation than
during pregnancy?
Energy (kcal)
Iron
Vitamin A
Folic acid
ANS: A
Needs for energy, protein, calcium, iodine, zinc, the B vitamins, and vitamin C remain
greater than nonpregnant needs.
The need for iron is not higher during lactation than 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.
DIF: Cognitive Level: Knowledge

REF: 319
Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank
3.
a.
b.
c.
d.
14-2
A pregnant womans diet consists almost entirely of whole grain breads and cereals,
fruits, and vegetables. The nurse is most concerned about this womans intake of:
Calcium
Protein
Vitamin B12
Folic acid
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.
Depending on the womans food choices, this 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 due to her
dietary restrictions. Folic acid needs can be met by enriched bread products.
REF: 326
TOP: Nursing Process: Assessment
4.
a.
b.
c.
d.
Which statement made by a lactating woman leads the nurse to believe that the woman
might have lactose intolerance?
I always have heartburn after I drink milk.
If I drink more than a cup of milk, I usually have abdominal cramps and bloating.
Drinking milk usually makes me break out in hives.
Sometimes I notice that I have bad breath after I drink a cup of milk.
ANS: B
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.
A woman with lactose intolerance is more likely to experience bloating and cramping, not
heartburn.
A client that breaks out in hives after consuming milk is more likely to have a milk allergy.
This woman should be advised to simply brush her teeth after consuming dairy products.
DIF: Cognitive Level: Application

REF: 316
Test Bank
5.
a.
b.
c.
d.
14-3
A pregnant womans diet history indicates that she likes the following. The nurse
encourages this woman to consume more of which food in order to increase her calcium
intake?
Fresh apricots
Canned clams
Spaghetti with meat sauce
Canned sardines
ANS: D
Sardines are rich in calcium.
Fresh apricots are not high in calcium.
Canned clams are not high in calcium.
Spaghetti with meat sauce is not high in calcium.
6.
a.
b.
c.
d.
REF: 317
A 27-year-old pregnant woman had a preconceptual body mass index (BMI) of 19. The
nurse knows that this womans total recommended weight gain during pregnancy should
be at least:
20 kg (44 lb)
16 kg (35 lb)
12.5 kg (27.5 lb)
10 kg (22 lb)
ANS: C
This woman has a normal BMI and should gain 11.5 to 16 kg during pregnancy.
A weight gain of 20 kg (44 lb) is unhealthy for most women. This woman has a normal BMI
and should gain 11.5 to 16 kg during pregnancy.
A weight gain of 16 kg (35 lb) is the high end of the range of weight this woman should gain
in her pregnancy.
A weight gain of 10 kg (22 lb) is appropriate for an obese woman. This woman has a normal
BMI, which indicates that her weight is average.
REF: 311
OBJ: Client Needs: Health Promotion and Maintenance
7.
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 contraception now.
Test Bank
14-4
b. Lose weight so that you can gain more during pregnancy.

c. You may take any medications you have been taking regularly.
d. Make sure you include adequate folic acid in your diet.
ANS: 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 used, it may not be appropriate to discontinue all
contraception at this time.
Advising the client to lose weight now so that she can gain more during pregnancy is not
appropriate advice.
Depending on the type of medications the woman is taking, it may not be appropriate for her
to continue taking them regularly.
REF: "307, 308"
8.
a.
b.
c.
d.
To prevent gastrointestinal (GI) upset, clients should be instructed to take iron

supplements:
On a full stomach
At bedtime
After eating a meal
With milk
ANS: B
Taking iron supplements at bedtime may reduce GI upset.
Iron supplements are best absorbed if they are not taken on a full stomach.
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.
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.
REF: 325
9.
After you complete your nutritional counseling for a pregnant woman, you ask her to
repeat your instructions so that you can assess her understanding of the instructions
given. Which statement indicates that she 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.
Test Bank
14-5
d. Eating protein will prevent me from being diabetic.

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.
REF: 313
TOP: Nursing Process: Evaluation
10. Pregnant adolescents are at high risk for _______________ due to lower body mass
indexes (BMIs) and fad dieting.
a. Obesity
b. Gestational diabetes
c. Low-birth-weight babies
d. High-birth-weight babies
ANS: C
Adolescents tend to have lower BMIs. Additionally, 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.
Obesity is associated with a higher than normal BMI.
Unless the teen has type 1 diabetes, an adolescent with a low BMI is less likely to develop
gestational diabetes. This is often associated with obesity.
High-birth-weight or large for gestational age (LGA) babies are most often associated with
gestational diabetes.
REF: 319
TOP: "Nursing Process: Assessment, Diagnosis"
11. Maternal nutritional status is an especially significant factor of the many that influence
the outcome of pregnancy because:
a. It is very difficult to adjust because of peoples ingrained eating habits
b. It 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
Test Bank
14-6
ANS: 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 be of benefit to 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.
TOP: Nursing Process: Evaluation
REF: 307
12. With regard to weight gain during pregnancy, maternity nurses should know that:
a. In this case, 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 normal-weight women
c. Women with inadequate weight gain have an increased risk of delivering an infant
with intrauterine growth restriction (IUGR)
d. Greater than expected weight gain during pregnancy is almost always due to oldfashioned overeating
ANS: 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 normal-weight women to give birth to a child with major
congenital defects.
Overeating is only one of several likely causes.
REF: 309
TOP: Nursing Process: Diagnosis
13. Which nutritional recommendation about 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.
Test Bank
14-7
d. Water with fluoride is especially encouraged because it reduces the childs risk of
tooth decay.
ANS: 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 drunk 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.
No evidence indicates that prenatal fluoride consumption reduces childhood tooth decay.
However, it still helps the mother.
REF: 314
14. Which minerals and vitamins usually are recommended to supplement a pregnant
womans diet?
a. Fat-soluble vitamins A and D
b. Water-soluble vitamins C and B6
c. Iron and folate
d. Calcium and zinc
ANS: C
Iron generally should be supplemented, and folic acid supplements often are needed because
folate is so important.
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.
REF: "315, 318"
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
Test Bank
14-8
ANS: 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 is vital to good maternity and fetal health and is highly unlikely to be consumed in
excess.
Vitamin D is vital to good maternity and fetal health and is highly unlikely to be consumed in
excess.
Folic acid is vital to good maternity and fetal health and is highly unlikely to be consumed in
excess.
REF: 317
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
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 include increasing hypertension, proteinuria, and hemoconcentration.
A burning sensation in the epigastric region is pyrosis, otherwise known as heartburn.
Purging refers to self-induced vomiting after consuming large quantities of food.
REF: 318
TOP: Nursing Process: Diagnosis
17. Assessment of a womans nutritional status includes a diet history, medication regimen,
physical examination, and relevant laboratory tests. A maternity nurse performing such
an assessment should be aware that:
a. Oral contraceptive use may interfere with the absorption of iron
b. Illnesses that have created nutritional deficits, such as phenylketonuria (PKU), may
require nutritional care before conception
c. The womans socioeconomic status and educational level are not relevant to her
Test Bank
14-9
examination; they are the province of the social worker

d. The only nutrition-related laboratory test most pregnant women need is testing for
diabetes
ANS: 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 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.
REF: 321
18. 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
Interestingly, some women can tolerate tart or salty foods when they are nauseated.
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.
A small snack of cereal and milk or yogurt before bedtime may help the stomach in the
morning.
REF: 326
19. 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
clients 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 client
in determining which fish is safe to consume includes:
a. Canned white tuna is a preferred choice
b. Avoid shark, swordfish, and mackerel
c. Fish caught in local waterways is the safest
d. Salmon and shrimp contain high levels of mercury
Test Bank
14-10
ANS: B
As a precaution, the pregnant client should avoid eating all of these as well as the less
common tilefish. Additional information on levels of mercury in commercially caught fish is
available at www.cfsan.fda.gov.
High levels of mercury can harm the developing nervous system of the fetus. It is essential
for the nurse to assist the client in understanding the differences between numerous sources
of this product. A pregnant client may 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.
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, limited to less than 6 ounces, or the only fish
consumed that week.
Commercially caught fish that is low in mercury includes salmon, shrimp, pollock, or catfish.
The pregnant client may eat up to 12 ounces per week.
REF: 314
20. Nutrition is one of the most significant factors in influencing the outcome of a
pregnancy. Nutrition is alterable and an 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 can evaluate the clients nutritional
status by observing a number of physical signs. Which sign indicates that the client 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
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.
The malnourished pregnant client may display rapid heart rate, abnormal rhythm, enlarged
heart, and elevated blood pressure.
A client 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 signs of poor nutrition.
This client is well nourished. If she presented as listless, cachectic, easily fatigued, and tired
this would be an indication of poor nutritional status.
DIF: Cognitive Level: Analysis
REF: 323
Test Bank
14-11

MULTIPLE RESPONSE
1.
a.
b.
c.
d.
Most women with uncomplicated pregnancies can use the nurse as their primary source
for nutritional information. There are times when the nurse or midwife should refer a
client to a registered dietitian for in-depth nutritional counseling. These pregnant women
include those with:
Preexisting or gestational illness such as diabetes
Ethnic or cultural food patterns
Obesity
Vegetarian diets
ANS: 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, this client 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. The obese pregnant client may be under the
misapprehension that because of her excess weight that little or no weight gain is necessary.
According to the Institute of Medicine, a client with a body mass index (BMI) in the obese
range should gain at least 7 kg to ensure a healthy outcome. This client may well require indepth counseling on optimum food choices. The vegetarian client needs to have her dietary
intake carefully assessed to ensure that the optimum combination of amino acids and protein
intake is achieved. Very strict vegetarians (vegans) who consume only plant products may
also require vitamin B and mineral supplementation.

REF: 321
OBJ: "Client Needs: Physiologic Integrity, Physiologic Adaptation"
TOP: Nursing Process: Implementation
COMPLETION
1.
Calculate the body mass index (BMI) for a woman who is 65 cm tall and weighs 115 lb.
ANS:
BMI 16
A commonly used method of evaluating the appropriateness of weight for height is the BMI,
which is calculated by the following formula.
BMI = Weight in kg divided by height in meters squared
DIF: Cognitive Level: Analysis
REF: 309
Test Bank
14-12

2.
Obstetricians today are seeing more morbidly obese pregnant women (those that weigh
400 lb or greater). A new medical subspecialty referred to as ____________ obstetrics
has subsequently arisen.
ANS:
Bariatric
To best manage the conditions of these women and to meet their logistical needs, the
subspecialty of bariatric obstetrics has been developed. Extra-wide blood pressure cuffs,
surgical tables, and scales that can safely hold the weight of these clients are necessary to
deliver safe care. Special techniques for ultrasound and longer surgical instruments are also
required.
REF: 312
TRUE/FALSE
1.
Dietary Reference Intakes (DRIs) have been established for the people of the United
States and Canada. These recommendations for daily nutritional intakes meet the needs
of approximately 75% to 80% of the healthy population. Is this statement true or false?
ANS: F
The DRIs apply to almost all (97% to 99%) of the healthy members of the population. They
are divided into age, sex, and life-stage categories.
REF: 308

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Lowdermilk: Maternity & Women's Health Care, 10th Edition

Chapter 14: Maternal and Fetal Nutrition

DIF: Cognitive Level: Knowledge

DIF: Cognitive Level: Application

b. Lose weight so that you can gain more during pregnancy.

To prevent gastrointestinal (GI) upset, clients should be instructed to take iron

d. Eating protein will prevent me from being diabetic.

13. Which nutritional recommendation about fluids is accurate?

examination; they are the province of the social worker

OBJ: Client Needs: Physiologic Integrity

DIF: Cognitive Level: Application

OBJ: Client Needs: Health Promotion and Maintenance

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