Diabetes in Pregnancy EAQ

In which obstetric complication should the nurse be alert for while providing care to a pregnant pt with DM? a. hydramnios b. preeclampsia c. hypoglycemia d. monilial vaginitis e. brachial plexus palsy

a,b,c,d,

What does the nurse tell a pregnant pt. with diabetes who asks about dietary management during pregnancy? a."Eat meals at the same time everyday." b. "You need a large carbohydrate snack at bedtime." c. If you skip a meal, you should have a large snack." d. "you need to stay away from any aerobic exercise." e. "Remember to have more whole grains in your diet."

a,b,e

The pregnant pt with diabetes is prescribed aerobic exercise with resistance training, arm exercises, and a recumbent exercise bicycle. What does the nurse instruct the pt to ensure optimal benefit from t he exercise? a. "Do the prescribed exercises after meals" b. "Stop the exercises if you have uterine contractions" c. "Perform aerobic exercises for 10 min. every day" d. "increase exercise if there are signs of hypoglycemia" e. "Check glucose levels before, during, and after exercise."

a,b,e.

Which conditions are common in infants born to mothers with diabetes mellitus? a. Hypoglycemia b. Marfan syndrome c. Cephalhematoma d. Shoulder dystocia e. Brachial plexus palsy

a,c,d,e Brachial plexus palsy and cephalhematoma may occur in the child as a result of a difficult vaginal birth. The brachial plexus is a group of nerves that originate from the spinal cord. A cechalhematoma is a hemorrhage of blood between the skull and the perisosteum. Shoulder dystocia is a risk associated with diabetic pregnancy because the infancts born to women with diabetes tend to be disproportionate increase in shoulder, trunk, and chest size. Hypoglycemia is a risk if the pt does not control her bg during last half of pregnancy.

Which nursing interventions does the nurse implement when assessing a patient with gestational diabetes? a. tells the pt to follow a diabetic diet b. explains the importance of exercising daily c. demonstrates how to monitor blood glucose levels d. tells the pt not to take any oral hypoglycemics e. explains the effect of diabetes on the pregnancy and fetus

a,c,e

The nurse is teaching a woman with gestational diabetes the technique to inject insulin. What should the nurse include in the teaching session? a. Inject insulin slowly b. aspirate before injecting c. clean injection site with alcohol d. after injection, cover site with sterile gauze e. insert needle at a 45-90 degree angle.

a,d,e

What does the nurse tell the pt with gestational diabetes about the prescribed nonstress test (NST)? a. "The test is used to evaluate the fetus's well-being." b. "The test is used to evaluate the weight of the fetus." c. "The test is used to evaluate fetal cardiac anomalies" d. "The test is used to evaluate defects in the neural tube"

a.

Which action does the nurse take to determine whether the carbohydrate intake is inadequate in a pregnant pt with diabetes? a. Monitor for urine ketones b. Evaluate the nonstress test results c. Determine the degree of glycosuria. d. Schedule a baseline fetal sonogram.

a. If a patient with diabetes does not take in enough carbs, the body resorts to breaking down fats for energy. The by-product of fat metabolism is ketones. Therefore the nurse monitors the urine for ketones. The amount of ketones in the urine helps detect inadequate carb intake.

The nurse is reviewing the medical record of a pregnant pt with diabetes mellitus and notices the pt has poor glycemic control throughout the early weeks of pregnancy. What does the nurse infer that the pt may be at risk for? a. Miscarriage b. ketoacidosis c. polyhydramnios d. fetal macrosomia

a. Metabolic changes in the early weeks of pregnancy change the insulin and glucose levels in the body. This may result in poor glycemic control and may increase the chance of miscarriage. Polyhydramnios may occur in the third trimester of pregnancy because of hyperglycemia. There is an increased chance of fetal macrosomia if there is poor glycemic control in the later weeks of pregnancy. Ketoacidosis occurs during the second or third trimester if the maternal metabolism is stressed by illness or infection.

What are maternal and neonatal risks associated with gestational diabetes mellitus? a. Maternal preeclampsia and fetal macrosomia b. Maternal placenta previa and fetal prematurity c. Maternal hyperemesis and neonatal low birth weight d. Maternal premature rupture of membranes and neonatal sepsis

a. Women with gestational diabetes have twice the risk of developing hypertensive disorders such as preeclampsia, and the baby usually has macrosomia. Premature rupture of membranes and neonatal sepsis are not risks associated with gestational diabetes.

What are the metabolic changes associated with pregnancy? a. Maternal insulin requirements increase during the first trimester b. Maternal production of insulin increases during the first trimester c. There is enough glucose for the fetus during the second trimester d. Fasting blood glucose levels will decrease during the first trimester e. The pt's tolerance to glucose increases in the second trimester

b,c,d In the first trimester, an increase in estrogen and progesterone production stimulate the beta cells in the pancreas to increase insulin production. The beta cells also increase peripheral use of glucose and, in turn, decrease the overall blood glucose levels. This reduces fasting glucose levels by approximately 10%. During the second and third trimester, hormonal changes increase insulin resistance and ensure abundant supply of glucose for the fetus. The body develops insulin resistance as a glucose-sparing mechanism. In the second trimester, hormonal changes decrease tolerance to glucose. Maternal insulin requirements increases from 18 to 24 weeks of gestation, not in the first trimester

A pt with gestational diabetes tells the nurse, "I'm extremely worried that my child will be diabetic, too." Which actions does the nurse take to alleviate the pt's anxiety? a. Evaluate test results to assess fetal growth b. Use therapeutic communication with the pt. c. Listen to the feelings and concerns of the pt. d. provide factual information of risks to the pt. e. ask the pt to share any fears with the nurse.

b,c,d,e

Which tests does the nurse evaluate to determine the health status of a pt. with diabetes in the first few weeks of pregnancy? a. Nonstress fetal test b. Thyroid function test c. Urinalysis and culture d. 24-hour urine collection e. Glycosylated hemoglobin A1c

b,c,d,e

When a pregnant women with diabetes experiences hypoglycemia while hospitalized, what should the nurse have the woman do? a. eat a candy bar b. eat six saltine crackers or drink 8 oz of milk c. drink 4 oz of orange juice followed by 8 oz of milk d. Drink 8 oz of orange juice with 2 tsp of sugar added

b. Crackers provide carbohydrate in the form of polysaccharides. A candy bar provides only monosaccharides. Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain it to normal levels. Orange juice and sugar will increase the blood sugar but not provide a slow-burning carbohydrate to sustain the blood sugar

Diabetes in pregnancy puts the fetus at risk in several ways. Whate should nurses be aware of? a. At birth, the neonate of a diabetic mother is no longer at any greater risk. b. The most important cause of prenatal loss in diabetic pregnancy is congenital malformations. c. With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. d. Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring.

b. The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. Congenital malformations account for 30-50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern.

The nurse is teaching a pt with diabetes mellitus about ways to prevent infant morbidity. What is the most important aspect to include? a. "you must avoid exercise after meals" b. "Fetal growth needs to be checked monthly" c. "your bg levels must be in control" d. "you need to adhere to a strict ketogenic diet"

c. A strict control of glucose levels in a mother with diabetes prevents infant morbidity. This is because an increase in the glucose levels will not provide the adequate insulin required for fetal growth.

Which condition should the nurse be alert for after administering terbutaline (Brethine) to a pregnant pt with diabetes mellitus? a. infection b. dyspnea c. ketoacidosis e. hypoglycemia

c. Terbutaline is a beta mimetic drug administered for tocolysis to stop preterm labor. It may lead to hyperglycemia and cause ketoacidosis in the pregnant pt.

A pregnant women at 28 weeks of gestation has been diagnosed with gestational diabetes (GDM). What does the nurse caring for this woman demonstrate? a. Glucose levels are monitored by testing urine 4 times a day at bedtime b. Dietary modifications and insulin are both required for adequate treatment. c. Oral hypoglycemic agents should not be used if the woman is reluctant to give herself insulin d. Dietary management involves distributing nutrient requirements over three meals and two or three snacks.

d. Small frequent meals over a 24 hour period help decrease the risk for hypoglycemia and ketoacidosis.