A nurse is performing a nutritional assessment for a client during their first prenatal visit at 12 weeks of gestation. Which of the following findings indicates that the client should be referred to a registered dietician?
The client reports that they take a multivitamin daily.
The client reports a 4.5 kg (10 lb) weight gain since their positive pregnancy test.
The client reports that they are nauseous most mornings.
The client reports that they eat prunes to help manage their constipation.
The Correct Answer is B
Choice A rationale
Taking a multivitamin daily is generally recommended during pregnancy to ensure the mother and baby receive necessary nutrients. It does not indicate a need for referral to a dietitian.
Choice B rationale
A weight gain of 4.5 kg (10 lb) since a positive pregnancy test could be a concern depending on the timeframe. If this weight gain occurred rapidly, it could indicate issues such as fluid retention or inadequate nutrition, which would warrant a referral to a dietitian.
Choice C rationale
Nausea, particularly in the morning, is a common symptom of early pregnancy often referred to as “morning sickness”. It does not typically require dietary intervention unless it is severe (hyperemesis gravidarum), leading to weight loss and dehydration.
Choice D rationale
Eating prunes is a natural method to manage constipation, a common issue during pregnancy due to hormonal changes that slow digestion. This choice does not indicate a need for a dietitian referral.
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Correct Answer is D
Explanation
Choice A rationale
Turning a baby’s car seat forward when they are 1 year old is not recommended. According to the American Academy of Pediatrics, children should ride in a rear-facing car seat as long as possible, until they reach the highest weight or height allowed by their seat. This is because rear-facing car seats provide the best protection for the baby’s head, neck, and spine in a crash.
Choice B rationale
While it’s important to keep a baby warm in the car seat, using a sleep sack is not the safest option. Bulky outerwear and blankets can interfere with the tightness of the harness, which can compromise the safety of the baby. Instead, it’s recommended to dress the baby in lighter layers and place a warm blanket over them and the harness.
Choice C rationale
A car seat challenge test, also known as a car seat trial, is usually performed on babies who were born preterm, not at full term. This test checks whether the baby can sit in a car seat safely without any breathing problems or other complications. Since the newborn in question was delivered at 38 weeks of gestation, which is considered full term, a car seat challenge test is not typically required.
Choice D rationale
The car seat should indeed be positioned at a 45-degree angle. This angle is especially important for newborns and infants who are rear-facing, as it helps to support their head and prevent it from falling forward.
Correct Answer is C
Explanation
The first action the nurse should take when caring for a client who has bladder distention following a vaginal birth is to assist the client to the bathroom. Bladder distention can occur after birth due to the pressure on the bladder during labour and birth.
Encouraging the client to empty her bladder will relieve the distention and promote comfort.
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