A nurse is reinforcing teaching about appropriate exercises during pregnancy with a client who is at 24 weeks of gestation. Which of the following statements indicates a need for additional teaching?

Choice A reason:

A prior vaginal delivery is not a contraindication for VBAC. In fact, it is a positive predictor of success for VBAC, as it indicates that the woman has a proven pelvis and can tolerate labor.

Choice B reason:

The gestation of 42 weeks is not a contraindication for VBAC. However, it is associated with an increased risk of stillbirth while awaiting spontaneous labor, which should be balanced against the risks of induction of labor or elective repeat cesarean.

Choice C reason:

Maternal obesity is a relative contraindication for VBAC. It is associated with a lower success rate of VBAC, a higher risk of uterine rupture, and a higher risk of maternal and neonatal complications. The decision to attempt VBAC in obese women should be made on a case-by-case basis by a senior obstetrician.

Choice D reason:

One prior cesarean delivery is not a contraindication for VBAC. Most women who have had one prior lower segment cesarean delivery are eligible for VBAC, as the risk of uterine rupture is low (0.5%) and the success rate is high (72-75%).

Choice E reason:

A macrosomic fetus is a relative contraindication for VBAC. It is associated with a lower success rate of VBAC, a higher risk of uterine rupture, and a higher risk of shoulder dystocia and birth trauma. The decision to attempt VBAC in women with suspected macrosomia should be made on a case-by-case basis by a senior obstetrician.

Choice A reason:

Eating leafy green vegetables is a good way to increase iron intake, as they are rich in iron and other nutrients. Iron is needed to produce hemoglobin, the protein that carries oxygen in red blood cells. Iron deficiency anemia occurs when there is not enough iron to make hemoglobin, resulting in low red blood cell count and low oxygen delivery to the tissues.

Leafy green vegetables such as broccoli, kale, turnip greens, and collard greens are among the best sources of iron from plants.

Choice B reason:

Taking calcium supplements is not helpful for iron deficiency anemia, as calcium can interfere with iron absorption. Calcium binds to iron in the intestine and prevents it from being absorbed into the bloodstream. Therefore, calcium supplements should not be taken at the same time as iron supplements or iron-rich foods. Calcium is important for bone health, but it does not affect hemoglobin production or red blood cell count.

Choice C reason:

Consuming two glasses of prune juice daily is not advisable for iron deficiency anemia, as prune juice has a laxative effect and can cause diarrhea. Diarrhea can lead to dehydration and loss of nutrients, including iron. Prune juice also contains oxalates, which are compounds that can reduce iron absorption by forming insoluble complexes with iron in the intestine. Prune juice does contain some iron, but not enough to compensate for its negative effects on iron status.

Choice D reason:

Consuming raw sushi is not recommended for iron deficiency anemia, as raw fish can contain parasites or bacteria that can cause infections. Infections can increase inflammation and blood loss, which can worsen iron deficiency anemia. Raw fish also contains phytates, which are substances that can inhibit iron absorption by binding to iron in the intestine. Raw fish does provide some iron, but it is not a reliable or safe source of iron for people with iron deficiency anemia. : Iron deficiency anemia - Diagnosis & treatment - Mayo Clinic. : Iron- Deficiency Anemia - Hematology.org.