What is the main reason why a woman who is older than 35 years may have difficulty achieving pregnancy?

Choice A reason: Eating three larger meals a day is not recommended for hyperemesis gravidarum, as it may increase the nausea and vomiting. Instead, the nurse should advise the woman to eat small, frequent meals throughout the day.

Choice B reason: Ice cream may stay down better than other foods, as it is cold, bland, and soothing. The nurse should encourage the woman to try foods that are appealing to her and avoid foods that trigger nausea.

Choice C reason: Eating what sounds good to the woman even if her meals are not well-balanced is acceptable for hyperemesis gravidarum, as the priority is to maintain hydration and nutrition. The nurse should reassure the woman that she can resume a balanced diet once her symptoms improve.

Choice D reason: Avoiding ginger tea or sweet drinks is not necessary for hyperemesis gravidarum, as some women may find them helpful in reducing nausea. The nurse should suggest the woman to experiment with different beverages and see what works for her.

Choice E reason: Eating a high-protein snack at bedtime is beneficial for hyperemesis gravidarum, as it can prevent low blood sugar levels and morning sickness. The nurse should recommend the woman to have a protein-rich food, such as cheese, yogurt, nuts, or eggs, before going to bed.

Choice A reason: Genetic changes and anomalies are not the most dangerous effect, as they are rare and not directly caused by smoking. Smoking can increase the risk of some birth defects, such as cleft lip and cleft palate, but these are not genetic changes and can be corrected by surgery. Smoking can also cause chromosomal abnormalities in the eggs, but these usually result in miscarriage or stillbirth, not live births.

Choice B reason:Maternal smoking is a significant risk factor for intrauterine growth restriction (IUGR). Nicotine and carbon monoxide from cigarettes reduce oxygen supply to the fetus, leading to lower birth weights and smaller body lengths.

Choice C reason: Fetal addiction to the substance inhaled is not the most dangerous effect, as it is not permanent and can be treated by medication and supportive care. Smoking can expose the fetus to nicotine, carbon monoxide, and other harmful chemicals, which can cross the placenta and affect the fetal brain and nervous system. Smoking can also cause withdrawal symptoms in the newborn, such as irritability, tremors, and difficulty feeding.

Choice D reason:Although prenatal exposure to smoking can affect neurodevelopment and is associated with behavioral issues, extensive central nervous system damage is not the most immediate or dangerous effect. The most critical concern remains intrauterine growth restriction.