Chapter 29 – Endocrine and Metabolic Disorders-( Test Questions ) Flashcards
Preconception counseling is critical in the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?
Congenital anomalies in the fetus
During a prenatal visit, the nurse is explaining dietary management to a woman with pregestational diabetes. Which statement by the client reassures the nurse that teaching has been effective?
Diet and insulin needs change during pregnancy.
Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the client mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. This fetus is at the greatest risk for which condition?
Macrosomia
A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks. She appears thin and somewhat nervous. She reports that she eats a well-balanced diet, although her weight is 5 pounds less than it was at her last visit. The results of laboratory studies confirm that she has a hyperthyroid condition. Based on the available data, the nurse formulates a plan of care. Which nursing diagnosis is most appropriate for the client at this time?
Imbalanced nutrition: less than body requirements
A client with maternal phenylketonuria (PKU) has come to the obstetrical clinic to begin prenatal care. Why would this preexisting condition result in the need for closer monitoring during pregnancy?
The fetus may develop neurologic problems.
The nurse who is caring for a woman hospitalized for hyperemesis gravidarum would expect the initial treatment to involve what?
Intravenous (IV) therapy to correct fluid and electrolyte imbalances
In terms of the incidence and classification of diabetes, which information should the nurse keep in mind when evaluating clients during their ongoing prenatal appointments?
Type 2 diabetes often goes undiagnosed.
A number of metabolic changes occur throughout pregnancy. Which physiologic adaptation of pregnancy will influence the nurse’s plan of care?
During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
What is the most accurate statement concerning the complication of maternal diabetes?
Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
Which statement regarding the laboratory test for glycosylated hemoglobin Alc is correct?
This laboratory test measures the levels of hemoglobin A1c, which should remain at less than 7%.
A new mother with a thyroid disorder has come for a lactation follow-up appointment. Which thyroid disorder is a contraindication for breastfeeding?
PKU
An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes. She attends her centering appointment accompanied by one of her girlfriends. This young woman appears more concerned about how her pregnancy will affect her social life than her recent diagnosis of diabetes. A number of nursing diagnoses are applicable to assist in planning adequate care. What is the most appropriate diagnosis at this time?
Risk for injury, to the mother related to hypoglycemia or hyperglycemia
A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?
50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.
Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
Hypoglycemia
Which preexisting factor is known to increase the risk of GDM?
Previous birth of large infant
Which physiologic alteration of pregnancy most significantly affects glucose metabolism?
Placental hormones are antagonistic to insulin, thus resulting in insulin resistance.
To manage her diabetes appropriately and to ensure a good fetal outcome, how would the pregnant woman with diabetes alter her diet?
Eat her meals and snacks on a fixed schedule.
A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is a thyroid storm, which may occur in response to stress such as infection, birth, or surgery. What are the signs and symptoms of this emergency disorder? (Select all that apply.)
Fever, Restlessness
Hypothyroidism occurs in 2 to 3 pregnancies per 1000. Because severe hypothyroidism is associated with infertility and miscarriage, it is not often seen in pregnancy. Regardless of this fact, the nurse should be aware of the characteristic symptoms of hypothyroidism. Which do they include? (Select all that apply.)
Lethargy d. Decrease in exercise capacity e. Cold intolerance
Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both. Over time, diabetes causes significant changes in the microvascular and macrovascular circulations. What do these complications include? (Select all that apply.)
a. Atherosclerosis b. Retinopathy d. Nephropathy e. Neuropathy
Achieving and maintaining euglycemia are the primary goals of medical therapy for the pregnant woman with diabetes. These goals are achieved through a combination of diet, insulin, exercise, and blood glucose monitoring. The target blood glucose levels 1 hour after a meal should be _____________.
ANS: 110 to 129 mg/dl
