Exam 1 - Chapter 29 / REVIEW FOR EXAM 2/3 Flashcards
Preconception counseling is critical in thesafe management of diabetic pregnancies.
Which complication is commonly associated with poor glycemic control before and during early
pregnancy?
a. Frequent episodes of maternal hypoglycemia
b. Congenital anomalies in the fetus
c. Hydramnios
d. Hyperemesis gravidarum
B - Preconception counseling is particularly important since strict metabolic control before
conception and in theearly weeks of gestation is instrumental in decreasing therisk of congenital
anomalies. Frequent episodes of maternal hypoglycemia may occur during thefirst trimester (not
before conception) as a result of hormonal changes and theeffects on insulin production and use.
Hydramnios occurs approximately 10 times more often in diabetic pregnancies than in
nondiabetic pregnancies. Typically, it is observed in thethird trimester of pregnancy.
Hyperemesis gravidarum may exacerbate hypoglycemic events because thedecreased food intake
by themother and glucose transfer to thefetus contribute to hypoglycemia.
During a prenatal visit, thenurse is explaining dietary management to a woman with
pregestational diabetes. Which statement by theclient reassures thenurse that teaching has been
effective?
a. I will need to eat 600 more calories per day because I am pregnant.
b. I can continue with the same diet as before pregnancy as long as it is well balanced.
c. Diet and insulin needs change during pregnancy.
d. I will plan my diet based on the results of urine glucose testing.
C - Diet and insulin needs change during thepregnancy in direct correlation to hormonal changes and
energy needs. In thethird trimester, insulin needs may double or even quadruple. Thediet is
individualized to allow for increased fetal and metabolic requirements, with consideration of
such factors as prepregnancy weight and dietary habits, overall health, ethnic background,
lifestyle, stage of pregnancy, knowledge of nutrition, and insulin therapy
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?
a. Macrosomia
b. Congenital anomalies of the central nervous system
c. Preterm birth
d. Low birth weight
A - Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor glycemic
control during the preconception time frame and into the early weeks of the pregnancy is
associated with congenital anomalies. Preterm labor or birth is more likely to occur with severe
diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or
macrosomia, is the greatest risk factor for this fetus.
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?
a. Deficient fluid volume
b. Imbalanced nutrition: less than body requirements
c. Imbalanced nutrition: more than body requirements
d. Disturbed sleep pattern
B - This clients clinical cues include weight loss, which supports a nursing diagnosis of Imbalanced
nutrition: less than body requirements. No clinical signs or symptoms support a nursing
diagnosis of deficient fluid volume. This client reports weight loss, not weight gain. Although
theclient reports nervousness, themost appropriate nursing diagnosis, based on theclients other
clinical symptoms, is 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?
a. PKU is a recognized cause of preterm labor.
b. The fetus may develop neurologic problems.
c. A pregnant woman is more likely to die without strict dietary control.
d. Women with PKU are usually mentally handicapped and should not reproduce.
B - Children born to women with untreated PKU are more likely to be born with mental retardation,
microcephaly, congenital heart disease, and low birth weight. Maternal PKU has no effect on
labor. Women without dietary control of PKU are more likely to miscarry or bear a child with congenital anomalies. Screening for undiagnosed maternal PKU at the first prenatal visit may be
warranted, especially in individuals with a family history of the disorder, with low intelligence of
an uncertain cause, or who have given birth to microcephalic infants
Thenurse who is caring for a woman hospitalized for hyperemesis gravidarum would
expect theinitial treatment to involve what?
a. Corticosteroids to reduce inflammation
b. Intravenous (IV) therapy to correct fluid and electrolyte imbalances
c. Antiemetic medication, such as pyridoxine, to control nausea and vomiting
d. Enteral nutrition to correct nutritional deficits
B - Initially, thewoman who is unable to down clear liquids by mouth requires IV therapy to correct
fluid and electrolyte imbalances. Corticosteroids have been successfully used to treat refractory
hyperemesis gravidarum, but they are not theexpected initial treatment for this disorder.
Pyridoxine is vitamin B6, not an antiemetic medication. Promethazine, a common antiemetic,
may be prescribed. In severe cases of hyperemesis gravidarum, enteral nutrition via a feeding
tube may be necessary to correct maternal nutritional deprivation but is not theinitial treatment
for this client.
In terms of theincidence and classification of diabetes, which information should thenurse
keep in mind when evaluating clients during their ongoing prenatal appointments?
a. Type 1 diabetes is most common.
b. Type 2 diabetes often goes undiagnosed.
c. GDM means that thewoman will receive insulin treatment until 6 weeks after birth.
d. Type 1 diabetes may become type 2 during pregnancy.
B - Type 2 diabetes often goes undiagnosed because hyperglycemia gradually develops and is often
not severe. Type 2, sometimes called adult-onset diabetes, is themost common type of diabetes.
GDM refers to any degree of glucose intolerance first recognized during pregnancy; insulin may
or may not be needed. People do not go back and forth between type 1 and type 2 diabetes.
A number of metabolic changes occur throughout pregnancy. Which physiologic
adaptation of pregnancy will influence the nurses plan of care?
a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus
secretes its own.
b. Women with insulin-dependent diabetes are prone to hyperglycemia during thefirst
trimester because they are consuming more sugar.
c. During thesecond and third trimesters, pregnancy exerts a diabetogenic effect that ensures
an abundant supply of glucose for thefetus.
d. Maternal insulin requirements steadily decline during pregnancy
C - Pregnant women develop increased insulin resistance during thesecond and third trimesters.
Insulin never crosses theplacenta; thefetus starts making its own around the10th week. As a
result of normal metabolic changes during pregnancy, insulin-dependent women are prone to
hypoglycemia (low levels). Maternal insulin requirements may double or quadruple by theend of
pregnancy
Which statement concerning thecomplication of maternal diabetes is themost accurate?
a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios occurs approximately twice as often in diabetic pregnancies than in
nondiabetic pregnancies.
c. Infections occur about as often and are considered about as serious in both diabetic and
nondiabetic pregnancies.
d. Even mild-to-moderate hypoglycemic episodes can have significant effects on fetal well being.
A - Prompt treatment of DKA is necessary to save thefetus and themother. Hydramnios occurs 10
times more often in diabetic pregnancies. Infections are more common and more serious in
pregnant women with diabetes. Mild-to-moderate hypoglycemic episodes do not appear to have
significant effects on fetal well-being.
Which statement regarding thelaboratory test for glycosylated hemoglobin Alc is correct?
a. Thelaboratory test for glycosylated hemoglobin Alc is performed for all pregnant women,
not only those with or likely to have diabetes
b. This laboratory test is a snapshot of glucose control at themoment.
c. This laboratory test measures thelevels of hemoglobin Alc, which should remain at less
than 7%.
d. This laboratory test is performed on thewomans urine, not her blood.
C - Hemoglobin Alc levels greater than 7% indicate an elevated glucose level during the previous 4
to 6 weeks. This extra laboratory test is for diabetic women and defines glycemic control over
the previous 4 to 6 weeks. Glycosylated hemoglobin level tests are performed on the blood.
A new mother with a thyroid disorder has come for a lactation follow-up appointment.
Which thyroid disorder is a contraindication for breastfeeding?
a. Hyperthyroidism
b. PKU
c. Hypothyroidism
d. Thyroid storm
B - PKU is a cause of mental retardation in infants; mothers with PKU pass on phenylalanine and
therefore should elect not to breastfeed. A woman with either hyperthyroidism or
hypothyroidism would have no particular reason not to breastfeed. A thyroid storm is a
complication of hyperthyroidism and is not a contraindication to breastfeeding.
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 themost appropriate diagnosis at this time?
a. Risk for injury, to thefetus related to birth trauma
b. Deficient knowledge, related to diabetic pregnancy management
c. Deficient knowledge, related to insulin administration
d. Risk for injury, to the mother related to hypoglycemia or hyperglycemia
B - Before a treatment plan is developed or goals for the outcome of care are outlined, this client
must come to an understanding of diabetes and the potential effects on her pregnancy. She
appears more concerned about changes to her social life than adopting a new self-care regimen.
Risk for injury to the fetus related to either placental insufficiency or birth trauma may come later
in the pregnancy. At this time, the client is having difficulty acknowledging the adjustments that
she needs to make to her lifestyle to care for herself during pregnancy. The client may not yet be
on insulin. Insulin requirements increase with gestation. The importance of glycemic control must
be part of health teaching for this client. However, she has not yet acknowledged that changes to
her lifestyle need to be made and may not participate in the plan of care until understanding takes
place.
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?
a. 75 mg/dl before lunch. This is low; better eat now
b. Hypercalcemia
c. Hypobilirubinemia
d. Hypoinsulinemia
A - Theneonate is at highest risk for hypoglycemia because fetal insulin production is accelerated
during pregnancy to metabolize excessive glucose from themother. At birth, thematernal glucose
supply stops and the neonatal insulin exceeds the available glucose, thus leading to hypoglycemia.
Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems
of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, and large
amounts of bilirubin are released into the neonates circulation, with resulting hyperbilirubinemia.
Because fetal insulin production is accelerated during pregnancy, hyperinsulinemia develops in
the neonate.
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?
a. 75 mg/dl before lunch. This is low; better eat now
b. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time.
c. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin.
d. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before
going to sleep
D - 50 mg/dl after waking from a nap is too low. During hours of sleep, glucose levels should not be
less than 60 mg/dl. Snacks before sleeping can be helpful. Thepremeal acceptable range is 60 to
99 mg/dl. Thereadings 1 hour after a meal should be less than 129 mg/dl. Two hours after eating,
thereadings should be less than 120 mg/dl.
Which preexisting factor is known to increase therisk of GDM?
a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of large infant
d. Previous diagnosis of type 2 diabetes mellitus
C - A previous birth of a large infant suggests GDM. Obesity (body mass index [BMI] of 30 or
greater) creates a higher risk for gestational diabetes. A woman younger than 25 years is not
generally at risk for GDM. Theperson with type 2 diabetes mellitus already has diabetes and thus
will continue to have it after pregnancy. Insulin may be required during pregnancy because oral
hypoglycemia drugs are contraindicated during pregnancy
