GDM Flashcards
A 34-year-old female is currently 16 weeks pregnant. You’re collecting the patient’s health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient’s risk for developing gestational diabetes?
A. 34-years-old
B. 16 weeks pregnant
C. Gravida 5, para 4
D. BMI 28
E. Hypertension
F. Depression
G. Family history of Type 2 diabetes
The answers are A, C, D, and G. Remember from the lecture we talked about the risk factors for gestational diabetes. To help you remember the risk factors think of the word “MOMMA”. Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes).
When do most patients tend to develop gestational diabetes during pregnancy?
A. usually during the 1-3 month of pregnancy
B. usually during the 2-3 month of pregnancy
C. usually during the 1-2 trimester of pregnancy
D. usually during the 2-3 trimester of pregnancy
The answer is D. Gestational diabetes is a form of diabetes that develops during pregnancy, usually during 2nd or 3rd trimester.
You’re providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin:
A. “Insulin is a type of cell that provides glucose to the body from the blood.”
B. “Insulin is a hormone secreted by the beta cells of the pancreas.”
C. “Insulin influences cells by causing them to uptake glucose from the blood.”
D. “Insulin is a protein that helps carry glucose into the cell for energy.”
The answers are B and C. Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.
A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition?
A. 1 hour glucose tolerance test
B. 24 hour urine collection
C. Hemoglobin A1C
D. 3 hour glucose tolerance test
The answer is D. If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.
A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You’re educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes?
A. “Once I deliver the baby, it will go away, and I will not need any further testing.”
B. “It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals.”
C. “There are no risks or complications related to gestational diabetes other than hyperglycemia.”
D. “I’m at risk for delivering a baby that is too small for its gestational age due to this condition.”
The answer is B. This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.
Fill-in the blank: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is _____________. This is majorly influenced by hormones such as estrogen, progesterone, _______________ and _______________.
A. high; prolactin and human chorionic gonadotropin (hCG)
B. low; estriol and human placental lactogen (hPL)
C. high; human chorionic gonadotropin (hCG) and cortisol
D. low; human placental lactogen (hPL) and cortisol
The answer is D. The statement should read: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is LOW. This is majorly influenced by hormones such as estrogen, progesterone, HUMAN PLACENTAL LACTOGEN (hPL) and CORTISOL.
Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic?
A. Blood glucose 55 mg/dL
B. Blood glucose 82 mg/dL
C. Blood glucose 148 mg/dL
D. Blood glucose 325 mg/dL
The answer is B. Euglycemic means “normal” blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL…Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic.
A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply:
A. Blood glucose 129 mg/dL
B. Blood pressure 190/102
C. Proteinuria
D. Linea nigra
E. Negative glycosuria
The answers are B and C. Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria…meaning there is glucose leaking in the urine).
A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician’s order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician?
A. “It burns when I urinate.”
B. “My back is hurting.”
C. “I feel tired.”
D. “I feel the baby kick about 10 times an hour.”
The answer is A. Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.
A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply:
A. Hyperglycemia
B. Hypoglycemia
C. Respiratory distress
D. Jaundice
E. Hyperthermia
The answers are B and C. The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn’s risk of respiratory distress at birth.
You’re teaching a pregnant mother with gestational diabetes about the signs and symptoms of hyperglycemia. What are the signs and symptoms you will include in your education to the patient? Select all that apply:
A. Sweating
B. Confusion
C. Frequent hunger
D. Polydipsia
E. Anxiety
F. Frequent urination
The answers are C, D, and F. Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of HYPOglycemia (low blood glucose).
When are most pregnant patients tested for gestational diabetes?
A. 6-12 weeks gestation
B. 12-20 weeks gestation
C. 24-28 weeks gestation
D. 34-36 week gestation
The answer is C: 24-28 weeks gestation
A patient completes a one hour glucose tolerance test. The patient’s result is 190 mg/dL. As the nurse you know that the next step in the patient’s care is to?
A. Continue monitoring pregnancy, the test is normal
B. Reassess blood glucose in 2 weeks
C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test
D. Provide education to the patient about how to manage gestational diabetes during pregnancy
The answer is C. A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes.
A patient has a 3 hour glucose tolerance test performed. The results are the following: Fasting 94 mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour 130 mg/dL. Identify which results are abnormal: Select all that apply:
A. Fasting result
B. 1 hour result
C. 2 hour result
D. 3 hour result
The answers are B and C. Abnormal results for a 3 hour glucose tolerance test are: Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL
You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of ______________ 1 hour after a meal.
A. <70 mg/dL
B. <250 mg/dL
C. >160 mg/dL
D. <140 mg/dL
The answer is D: <140 mg/dL
