Altered Glucose Metabolism During Pregnancy
Which statement made by a woman diagnosed with gestational diabetes indicates to the nurse that the teaching about dietary practices was effective? "If I feel like the baby's not moving a lot, I drink soda." "I have been eating three small meals and two snacks every day." "If I run out of insulin, I can use my husband's metformin once a day until I can get to the pharmacy." "I know my baby needs healthy foods to grow, so I have been eating extra fruit and breads."
"I have been eating three small meals and two snacks every day." Calories should be distributed among three meals and two or more snacks.
A primigravida Hispanic patient asks why she needs to be screened for gestational diabetes when she is not a diabetic. Which response by the nurse is appropriate? "Many patients with gestational diabetes show no symptoms. It is an important way to help you have a healthy pregnancy." "We test all patients for diabetes because today's diet makes you more likely to get diabetes." "Your race makes you more likely to develop gestational diabetes, so we are screening you just in case." "Because this is your first pregnancy, we don't know what to expect, so we are going to test you just in case."
"Many patients with gestational diabetes show no symptoms. It is an important way to help you have a healthy pregnancy." Most patients with gestational diabetes are asymptomatic. For this reason, universal screening is best practice to promote the best pregnancy outcomes.
A patient with gestational diabetes experiences rupture of membranes at 36 weeks gestation. Which patient teaching statement regarding this condition is accurate? "Rupture of membranes is more common in women with gestational diabetes because of the excess amounts of glucose in your urine." "Rupture of membranes at this time in your pregnancy is normal and sometimes happens before labor begins." "Your membranes likely ruptured because of excess ketones in your blood." "Preterm rupture of membranes is more common in women with gestational diabetes, and it might be related to overdistention of your uterus."
"Preterm rupture of membranes is more common in women with gestational diabetes, and it might be related to overdistention of your uterus." It is thought that the cause of increased incidence of preterm rupture of membranes in gestational diabetics is overdistention of the uterus.
Which patient teaching statement regarding potential newborn complications resulting from uncontrolled diabetes is accurate? "Gestational diabetes leads to hyperbilirubinemia because of the breakdown of excess glucose in utero." "The fetus compensates for lack of oxygen in utero by making additional erythrocytes. When these are broken down after birth, it can lead to jaundice and hyperbilirubinemia." "Hyperinsulinemia in the fetus can impair cortisol production, which has been shown to lead to hyperbilirubinemia." "Hypoglycemia after birth leads to increased bilirubin levels in the neonate."
"The fetus compensates for lack of oxygen in utero by making additional erythrocytes. When these are broken down after birth, it can lead to jaundice and hyperbilirubinemia." Hyperbilirubinemia is caused by elevated levels of bilirubin, which is a by-product of the breakdown of erythrocytes.
Which patient teaching statement regarding the long-term effect of gestational diabetes is accurate? "Up to 70% of women may go on to develop type 2 diabetes mellitus." "Many women who develop gestational diabetes will require insulin after delivery for the rest of their lives." "Once you are diagnosed with gestational diabetes, every subsequent pregnancy will also be complicated by gestational diabetes." "You may need to periodically check your glucose levels after delivery to make sure your gestational diabetes has gone away."
"Up to 70% of women may go on to develop type 2 diabetes mellitus." Women who have gestational diabetes have a significantly increased risk for developing type 2 diabetes later in life.
When teaching a patient with a body mass index (BMI) of 20 about recently prescribed subcutaneous insulin, which statement is correct? "You will need to insert the needle at a 45-degree angle to ensure it is delivered to the subcutaneous tissue." "If you need to deliver more than 0.5 mL of insulin, you will need to use two injection sites." "If you use the no-pinch method, you should use an 8-mm needle." "Gently massage the injection site with sterile gauze after administration to ensure the medication is absorbed."
"You will need to insert the needle at a 45-degree angle to ensure it is delivered to the subcutaneous tissue." This patient has a very low BMI and likely minimal subcutaneous tissue. Entering at a 45-degree angle will ensure the medication is delivered into subcutaneous tissue and not muscle.
Match the type of diabetes with its characterization. 1. Lack of insulin secretion 2. Insulin resistance 3. Early gluconeogenesis a. Type 2 diabetes mellitus b. Gestational diabetes mellitus c. Type 1 diabetes mellitus
1. c 2. a 3. b
Gestational diabetes may cause congenital abnormalities in the fetus. Match the congenital malformation with its definition. 1. Fetal size greater than 4000 g 2. Malformations in heart structures 3. Abnormal closure of spinal cord 4. Malformation of lower spine and lower extremities a. Caudal regression syndrome b. Cardiac defects c. Neural tube defects d. Microcephaly e. Macrosomia
1. e 2. b 3. c 4. a
The nurse is preparing to educate a woman with an abnormal 1-hour glucose tolerance test. Which additional diagnostic test would the nurse anticipate the health care provider to order? Fasting glucose test Hemoglobin A1C test Repeat finger-stick glucose test 3-hour glucose tolerance test
3-hour glucose tolerance test The oral 3-hour glucose tolerance test follows a failed 1-hour glucose tolerance test to confirm the diagnosis of gestational diabetes.
Which characteristic describes the cause of type 1 diabetes mellitus? Inability of the body's cells to store glucose as glucagon Inability of the body's cells to use glucose Complete or partial inability of the body to produce insulin Early gluconeogenesis
Complete or partial inability of the body to produce insulin Type 1 diabetes mellitus is characterized by the beta cells in the pancreas being unable to produce sufficient insulin to maintain euglycemia.
Which condition is related to the increased risk for respiratory distress in neonates born to mothers with gestational diabetes? Hyperinsulinemia after birth Recurrent fetal hypoxia and subsequent increased production of erythrocytes Decreased fetal cortisol levels and therefore insufficient surfactant Decreased maternal magnesium levels
Decreased fetal cortisol levels and therefore insufficient surfactant Surfactant helps the alveoli function properly after birth and promotes adequate ventilation in the newborn. When surfactant is insufficient, ventilation may be impaired.
Which form of diabetes has two subgroups: one type that is controlled with diet, and another type that is controlled by medication? Gestational diabetes mellitus Type 1 diabetes mellitus Type 2 diabetes mellitus Community-acquired diabetes mellitus
Gestational diabetes mellitus Gestational diabetes mellitus is a condition that is brought on by pregnancy and resolves after pregnancy. It has subclassifications including GDMA1 (diet controlled) and GDMA2 (requiring medication).
Which statements are true regarding hyperglycemia? Select all that apply. Glucose levels in the blood may be elevated, but at the cellular level glucose may be low with some forms of diabetes. In gestational diabetes, hyperglycemia always leads to polydipsia. The body attempts to dilute the glucose load, resulting in polyuria. Glycosuria can occur. Glucose is stored in the pancreas when hyperglycemia occurs.
Glucose levels in the blood may be elevated, but at the cellular level glucose may be low with some forms of diabetes. Glucose may be low at the cellular level with hyperglycemia when there is insulin resistance or decreased insulin production. The body attempts to dilute the glucose load, resulting in polyuria. With hyperglycemia, the body will try to compensate for the high glucose level using the renal system. Glycosuria can occur. As the body compensates for hyperglycemia, more glucose may be spilled into the urine for excretion.
Which factors increase a woman's risk for developing gestational diabetes? Select all that apply. History of migraines High blood pressure Advanced maternal age Family history of heart disease Family history of type 2 diabetes mellitus Middle Eastern descent
High blood pressure Hypertension is associated with an increased incidence of gestational diabetes. Advanced maternal age Women over 35 years of age have a higher incidence of gestational diabetes. Family history of type 2 diabetes mellitus Women with a family history of type 2 diabetes mellitus are more likely to develop diabetes during pregnancy.
Which factors associated with gestational diabetes may predispose the pregnant woman to spontaneous abortion in the first trimester? Select all that apply. Ketosis Glucosuria Hypoglycemia Hyperglycemia Uterine distention
Ketosis Untreated ketoacidosis may predispose the mother with diabetes to spontaneous abortion and can lead to maternal death. Hypoglycemia Abnormally low, or hypoglycemic, blood glucose levels may predispose the mother with diabetes to spontaneous abortion. Hyperglycemia Abnormally high, or hyperglycemic, blood glucose levels may predispose the mother with diabetes to spontaneous abortion.
A woman with gestational diabetes who is at 34 weeks gestation voices concern regarding fetal compromise related to her diagnosis of gestational diabetes. Which recommendation would the nurse make to the woman to monitor for potential fetal complications? Assess blood sugar once daily. Purchase a handheld Doppler. Increase the amount of juice and fruit in her diet. Lie down and count the number of kicks felt in an hour.
Lie down and count the number of kicks felt in an hour. Fetal kick counts allow the woman to monitor fetal movement and have been shown to decrease the overall rate of stillbirth.
The nurse assessing for hypoglycemia in a neonate would monitor for which symptoms? Select all that apply. Poor feeding Flexion of the arms and legs Hypothermia Tremors Bluish hands and feet Rooting
Poor feeding Poor feeding and lack of interest in feeding are signs of hypoglycemia in the neonate and are usually related to lethargy caused by lack of glucose. Hypothermia Hypothermia is a symptom of hypoglycemia. Tremors Tremors may be observed in a newborn that has low blood glucose.
Which would the nurse assess at a routine prenatal visit for a patient that has gestational diabetes? Select all that apply. Presence of bacteria, ketones, protein, and glucose in urine Fetal movement by palpation and patient report Serum calcium levels Blood pressure Fundal height
Presence of bacteria, ketones, protein, and glucose in urine Women with diabetes are at increased risk for urinary tract infection. Additionally, the presence of ketones, glucose, and protein may indicate worsening diabetes or preeclampsia. Fetal movement by palpation and patient report Fetal movement is a reliable indicator of well-being. A patient that reports decreased fetal movement requires further evaluation.
The nurse caring for a pregnant patient with gestational diabetes at 33 weeks gestation assesses the fundal height at 36 cm. Which actions by the nurse are correct regarding this finding? Select all that apply. Assure the patient that the fetus is growing appropriately for its age. Recommend that the health care provider order an ultrasound. Educate the patient on the importance of limiting weight gain for the remainder of the pregnancy. Perform a fetal nonstress test and report the findings to the health care provider. Assist the patient with scheduling a cesarean delivery at 37 weeks.
Recommend that the health care provider order an ultrasound. Recommending that the health care provider order an ultrasound is an appropriate action. Amniotic fluid volume and fetal size should be monitored for this patient. Perform a fetal nonstress test and report the findings to the health care provider. Gestational diabetics require additional fetal surveillance as a result of the high-risk nature of the pregnancy. When assessment findings are abnormal, fetal well-being should be assessed. A nonstress test is part of a biophysical profile and gives the health care provider an insight into fetal well-being.