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CHAPTER 11: NUTRITION DURING PREGNANCY AND LACTATION MULTIPLE CHOICE 1. What is a normal weight gain during pregnancy for an underweight woman? a. between 25 and 35 pounds c. at least 40 pounds b. between 28 and 40 pounds d. no more than 35 pounds ANS: B PTS: 1 DIF: A TOP: Weight Gain during Pregnancy 2. How many additional calories a day should a woman consume during the second and third trimesters? a. second trimester an additional 240 calories, third trimester 350 calories b. second trimester an additional 440 calories, third trimester 550 c. second trimester an additional 340 calories, third trimester 450 calories d. no extra calories are needed during pregnancy ANS: C PTS: 1 DIF: A TOP: Weight Gain during Pregnancy 3. Which of the following nutrients does not need to be increased during pregnancy? a. Protein c. iron b. vitamin C d. vitamin A ANS: D PTS: 1 DIF: B TOP: Nutritional Needs during Pregnancy 4. Why is there an increased need for B vitamins during pregnancy? a. for development of red blood cells b. essential for development of infant's bones and teeth c. to provide an increase of hemoglobin d. essential for a fetus’s collagen development ANS: A PTS: 1 DIF: C TOP: Nutritional Needs during Pregnancy 5. _____ is the condition when nausea persists and becomes so severe that it is life-threatening. a. Parenteral gravidarum c. Hyperemesis gravidarum b. Morning sickness d. Binge-purge gravidarum ANS: C PTS: 1 DIF: A TOP: Concerns during Pregnancy 6. What two conditions can be relieved by eating high-fiber foods? a. morning sickness and weight gain c. hypertension and anemia b. hypertension and heartburn d. constipation and hemorrhoids ANS: D PTS: 1 DIF: B TOP: Concerns during Pregnancy 7. How can heartburn be relieved? a. eating three meals a day c. drinking three cups of milk a day b. eating small, frequent meals d. eating up to 25 grams of fiber a day ANS: B PTS: 1 DIF: B TOP: Concerns during Pregnancy 8. _____ is the craving for nonfood substances such as starch or clay.

a. Pico c. Pica b. Anemia d. Picanemia ANS: C PTS: 1 DIF: A TOP: Concerns during Pregnancy 9. Which nutrient is often deficient in women who are diagnosed with megaloblastic anemia? a. vitamin C c. Iron b. folate d. Copper ANS: B PTS: 1 DIF: B TOP: Concerns during Pregnancy 10. The ingestion of alcohol while pregnant can result in _____. a. weight gain c. spontaneous abortions b. hypertension d. fetal alcohol syndrome ANS: D PTS: 1 DIF: A TOP: Concerns during Pregnancy 11. The infant's sucking initiates the release of _____ (a hormone), which causes the ejection of milk into the infant's mouth. a. oxytocin c. Insulin b. aldosterone d. Prolactin ANS: A PTS: 1 DIF: A TOP: Lactation 12. During lactation, approximately how many extra calories are recommended daily? a. 300 c. 500 b. 400 d. 1,000 ANS: C PTS: 1 DIF: A TOP: Lactation 13. Which vitamin, in excess, can cause birth defects? a. vitamin C c. vitamin A b. vitamin E d. vitamin D ANS: C PTS: 1 DIF: B TOP: Nutritional Needs during Pregnancy 14. Which of the following are pregnant adolescents particularly prone to? a. gestational diabetes c. pregnancy-induced hypertension b. weight gain d. abruptio placentae ANS: C PTS: 1 DIF: B TOP: Concerns during Pregnancy 15. What is the approximate number of calories in an ounce of human milk? a. 10 cal c. 30 cal b. 20 cal d. 40 cal ANS: B PTS: 1 DIF: A TOP: Lactation 16. A nursing mother's use of caffeine may cause the following in her infant. a. abnormal growth c. irritability b. blindness d. fatigue ANS: C PTS: 1 DIF: B TOP: Concerns during Pregnancy 17. The U.S. Public Health Service and the March of Dimes recommend that all women of childbearing age take a multivitamin or _____ of folic acid daily.

Heartburn/indigestion: Eat small, frequent meals; avoid spicy or greasy foods; avoid liquids with meals; after eating wait at least one hour before lying down; wait at least two hours before exercising. Excessive weight gain: Eliminate all food items that are not on the MyPyramid; bake, broil, or boil rather than frying; use fruits and custards made with fat-free milk; encourage raw vegetables as snacks; eliminate empty calorie foods. PTS: 1 DIF: C TOP: Concerns during Pregnancy 3. Describe the physiology associated with pregnancy and anemia. Compare iron deficiency anemia and folate deficiency anemia. ANS: Iron deficiency: During pregnancy, the increased volume of blood creates the need for additional iron for the hemoglobin for this blood. If the need is not met by the diet or by iron stores in the body, iron deficiency anemia develops. This is treated by a daily iron supplement. Folate deficiency: A form of megaloblastic anemia that can occur during pregnancy, it is characterized by too few red blood cells and by large, immature red blood cells. The need for folic acid increases dramatically when new red blood cells are being formed. PTS: 1 DIF: C TOP: Concerns during Pregnancy 4. Discuss the concerns that a pregnant teenager will have. ANS: The teen mother is still in need of nurturing herself. Economic needs for financial support. Social need to be a member of the teen group. Psychological need to meet love, belonging, and safety and security needs. To be an active member of a group. Prenatal health care. Infant care. Nutritional counseling to fulfill the nutritional needs of her own body. Nutritional counseling to meet infant’s dietary need. PTS: 1 DIF: B TOP: Pregnancy during Adolescence 5. List the benefits of breast-feeding. ANS: Breast milk contains the right amount of lactose, water, fatty acids, and amino acids for brain development, growth, and digestion. No infant would be allergic to the mother’s milk; however, there may be a reaction to something the mother eats. Human milk has 100 ingredients not found in formula. Breast-fed infants have a lower incidence of ear infections, diarrhea, allergies, and hospital admissions. It is a source of antibodies to diseases such as pneumonia, bronchitis, influenza, German measles, botulism, and staphylococcal infections. Good for jaw development and growth of straight, healthy teeth because it is harder to get milk out of a breast than a bottle. The process creates an emotional attachment between mother and child. It aids in removing excess weight from mother and stimulates return of uterus to prepregnant state. Breast milk is economical, always the right temperature, and readily available. PTS: 1 DIF: B TOP: Lactation 6. Describe the physical characteristics of an infant born with fetal alcohol syndrome. ANS: Physical characteristics may include a small head, short eye slits, a flat midface, and a thin upper lip. There is usually a growth deficiency, placing the child in the lowest 10th of age norms. PTS: 1 DIF: B TOP: Concerns during Pregnancy

MODIFIED TRUE/FALSE 1. It is recommended that pregnant women should always drink an additional six ounces of regular fortified milk per day. _________________________ ANS: F, two servings (16 ounces) of fat-free milk PTS: 1 DIF: B TOP: Fulfillment of Nutritional Needs during Pregnancy 2. During pregnancy, the mother needs additional calories, vitamins, and minerals. It is advisable for the mother to take extra amounts of all vitamins and minerals. _________________________ ANS: F, not advisable PTS: 1 DIF: B TOP: Fulfillment of Nutritional Needs during Pregnancy 3. Nausea associated with pregnancy, or morning sickness, is a benign condition . _________________________ ANS: F, could be life-threatening PTS: 1 DIF: B TOP: Concerns during Pregnancy 4. Smoking during pregnancy may affect the intellectual and behavioral development of the fetus as it grows up. _________________________ ANS: T PTS: 1 DIF: B TOP: Concerns during Pregnancy 5. Women with smaller-sized breasts will be unable to produce enough milk to satisfy an infant. _________________________ ANS: F, will be able PTS: 1 DIF: B TOP: Lactation 6. Research has shown that a lack of an intake of folate during pregnancy may result in neural tube defects for the baby. _________________________ ANS: F, prepregnancy PTS: 1 DIF: B TOP: Nutritional Needs during Prepregnancy 7. During pregnancy, most of the weight gain occurs during the first trimester of pregnancy. ___________________ ANS: F, second and third PTS: 1 DIF: B TOP: Weight Gain during Pregnancy 8. A pregnant adolescent should gain the same weight as a mature woman of the same size. _____________________

ANS: “Studies have shown that if you choose nutrient-dense foods, you will gradually lose the weight. There may be a significant weight loss in the first month of lactation.” PTS: 1 DIF: B TOP: Lactation 5. “Will I have to stop drinking coffee if I breast-feed?” ANS: “Excessive consumption of caffeine during lactation may cause irritability and wakefulness in the infant.” PTS: 1 DIF: B TOP: Lactation 6. “Are there other important contraindications to breast-feeding that I need to know?” ANS: “Alcohol reduces the amount of milk produced. Caffeine causes irritability and wakefulness in the infant. Women who smoke produce less milk. Smoking exerts harmful effects on infants and mothers. Women who test positive for HIV should not breast-feed their infants. Breast-feeding mothers should not take oral contraceptives. It reduces the volume and the protein content of the milk. Other drugs may affect the infant and should be evaluated by the physician.” PTS: 1 DIF: B TOP: Lactation 7. “Tell me why I should breast-feed.” ANS: “An infant grows faster the first year than at any other time. Their growth reflects their nutritional well-being. Breast milk excels as a source of nutrients for the young infant. With the exception of vitamin D and fluoride, breast milk provides all the nutrients a healthy infant needs for the first four to six months of life. Breast milk offers the infant protection against infection from viruses, bacteria, and other pathogens that cannot be achieved any other way. Breast-fed children are less likely to develop stomach and intestinal disorders and middle ear infections, and are less likely to develop wheezing.” PTS: 1 DIF: C TOP: Lactation 8. Ms. Jayce states, “Well, you have given me a lot of information to think about. I will continue to think about this. If my labor is not very difficult, I’ll probably be able to make up my mind then.” What is the appropriate response from the nurse? ANS: “Ms. Jayce, I have only given you some general information about breast-feeding. There are some predelivery preparations you must make. I am going to refer you to a lactation specialist who can prepare you for successful lactation, if that is your choice.” PTS: 1 DIF: B TOP: Lactation You are assigned to complete nutritional assessments of pregnant women at a family planning clinic. After the examinations and interviews are completed, you will meet with the women as a group to answer questions or to begin prenatal education. You will need to identify the women who are at nutritional risk during pregnancy. 9. List risk indicators for which to be alert.

ANS: Women who ordinarily consume an inadequate diet; are lactose intolerant; are carrying multiple fetuses; smoke cigarettes or use other tobacco; use alcohol or illegal drugs; are underweight or overweight; gain excess weight; have an insufficient weight gain; lack nutritional knowledge; are economically deprived (poverty); are adolescents or teenagers; have a preexisting chronic illness; have had frequent pregnancies; have low hemoglobin and hematocrit. PTS: 1 DIF: B TOP: Care Planning 10. Identify the components of a nutritional assessment. ANS: Review of the health records; physical exam; laboratory analyses; interview to determine usual food and beverage intake, food allergies or intolerances, usual medications taken, adequacy of income to determine availability of food, medical history, cultural influences on dietary intake (religious or ethical), presence of any nutrition-related discomforts of pregnancy (morning sickness, constipation, heartburn, etcetera), presence of or history of eating disorders, and obstetric or gynecological factors that impact the nutritional status PTS: 1 DIF: C TOP: Care Planning 11. Identify some common nutrition-related outcomes. ANS: The woman will achieve an appropriate weight gain during pregnancy; consume appropriate nutrients; use nursing measures to cope with nutrition-related discomforts; avoid consuming alcohol, illegal drugs, caffeine, and tobacco; prepare for successful breast-feeding or bottle-feeding. PTS: 1 DIF: B TOP: Care Planning 12. Describe the role of the nurse versus that of the registered dietitian in prenatal dietary education. ANS: The nurse can adequately educate the mother in making food choices and meal planning during pregnancy and lactation. Registered dietitians, however, may need to educate women in planning dietary modifications for women on special therapeutic diets. The registered dietitian can also calculate the patients specific calorie needs during the pregnancy based on height, weight, age, activity, weight gain needed by trimester, etc. PTS: 1 DIF: C TOP: Care Planning 13. Several women in the group are members of varied cultures. Identify potential dietary problems associated with the different cultures. ANS: Chinese: Use of large amounts of grease in cooking; limited use of milk and milk products; diet often low in protein and calories; use of soy sauce, which is high in sodium. Polish: Sodium in pork, sausage, and pickles; limited fruits and raw vegetables; large consumption of sweets; and a tendency to overcook vegetables. Italian: Tendency to overcook vegetables; limited use of grains; high use of olive oil; and insufficient servings from milk groups. Hispanic: Limited meats, milk, and milk products; average use of sugar; and large amounts of grease or lard.