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?

Choice A rationale Nausea, commonly known as "morning sickness," is a very common and normal physiological response during the first trimester of pregnancy, often attributed to hormonal changes, particularly rising levels of human chorionic gonadotropin (hCG) and estrogen. While uncomfortable, it does not typically indicate a need for a registered dietitian referral unless it leads to significant weight loss or hyperemesis gravidarum. Choice B rationale A 4.5 kg (10 lb) weight gain by 12 weeks of gestation is considered excessive for the first trimester. The recommended weight gain during the first trimester is typically 0.5 to 2 kg (1 to 4.5 lb). Such rapid weight gain can indicate an imbalanced diet or underlying nutritional issues that warrant evaluation and guidance from a registered dietitian to optimize maternal and fetal health. Choice C rationale Taking a multivitamin daily, especially one formulated for prenatal use, is a positive health behavior during pregnancy. Prenatal vitamins typically contain essential nutrients like folic acid and iron, which are crucial for fetal development and maternal health, reducing the risk of neural tube defects and iron deficiency anemia. This indicates appropriate nutritional supplementation, not a need for referral. Choice D rationale Constipation is a common complaint during pregnancy, often due to hormonal changes, such as increased progesterone, which slows gastrointestinal motility, and pressure from the growing uterus on the bowels. Eating prunes is a natural and effective dietary strategy to manage constipation, as they are a good source of fiber, promoting bowel regularity. This is a healthy coping mechanism and does not necessitate a dietitian referral.