Dudek Chapter 19: Nutrition for Patients with Diabetes Mellitus

A 35-year-old client is seen for her 2-week postoperative appointment after a suction curettage was performed to evacuate a hydatidiform mole. The nurse explains that the human chorionic gonadotropin (hCG) levels will be reviewed every 2 weeks and teaches about the need for reliable contraception for the next 6 months to a year. The client states, "I'm 35 already. Why do I have to wait that long to get pregnant again?" What is the nurse's best response?

"A contraceptive is used so that a positive pregnancy test resulting from a new pregnancy will not be confused with the increased level of hCG that occurs with a developing malignancy." Because of the risk of choriocarcinoma, the woman receives extensive treatment. Therapy includes baseline chest X-ray to detect lung metastasis, plus a physical exam (including a pelvic exam). Serum B-hCG levels weekly until negative results are obtained three consecutive times, then monthly for 6 to 12 months. The woman is cautioned to avoid pregnancy during this time because the increasing B-hCG levels associated with pregnancy would cause confusion as to whether cancer had developed. If after a year B-hCG serum titers are within normal levels, a normal pregnancy can be achieved.

The nurse has just completed teaching a client with diabetes about dietary restrictions necessary to control diabetes complications. The nurse recognizes that the teaching has been successful when the client states which of the following?

"I will eat a diet rich in fruits and vegetables" For people at risk of cardiovascular disease, a diet rich in fruit, vegetables, whole grains, and nuts may lower the risk. People with chronic kidney disease should reduce their protein intake. Hemoglobin A1c must be maintained as close to normal as possible.

The nurse is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply.

"Gestational diabetes mellitus is hyperglycemia that develops during pregnancy, usually around the 24th week of gestation." "Gestational diabetes mellitus increases the risk of preeclampsia, caesarean delivery, and fetal macrosomia." "Gestational diabetes mellitus increases the risk of hypertension." "Screening is not needed if the client is younger than 25 years old and has no personal history of abnormal glucose metabolism." Gestational diabetes increases risks in mother and infant. It increases the risks of preeclampsia, caesarian delivery, and fetal macrosomia and the risk of hypertension and diabetes after pregnancy. As many as 70% of women who develop gestational diabetes will develop type 2 diabetes within 10 years after pregnancy. Usually, gestational diabetes disappears after the infant is born.

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

"I can understand your need to find an answer to what caused this. Let's talk about this further" Talking with the client may assist her to explore her feelings. She and her family may search for a cause for a spontaneous early bleeding so they can plan for future pregnancies. Even with modern technology and medical advances, however, a direct cause cannot usually be determined.

A client with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the client makes which of the following statements?

"I may consume alcohol without food" People with diabetes who choose to drink should limit their intake to one drink per day or less for women and two drinks per day or less for men. Alcohol should be consumed with food to reduce the risk of hypoglycemia.

A nurse is providing discharge teaching for a pregnant client with preeclampsia who will be managed at home on bedrest. The nurse determines that the teaching was successful based on which client statement?

"I need to drink at least 8 glasses of water a day" A client with mild elevation in blood pressure may be placed on bed rest at home. The client is encouraged to rest as much as possible in the lateral recumbent position to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis. The client will be asked to monitor her blood pressure daily (every 4 to 6 hours while awake) and report any increased readings; she will be counseled on taking daily kick counts and report any decrease in fetal movements; and she will see her health care provider weekly for ongoing evaluations. The client should record daily fetal movement counts, and if there is any decrease in movement, she needs to be evaluated by her health care provider that day. A balanced, nutritional diet with no sodium restriction is advised. In addition, the client is encouraged to drink six to eight 8-oz glasses (1.5 to 2 liters) of water daily.

A client with diabetes mellitus has received instructions about sick-day management. Which statement by the client would indicate that the client needs further instructions?

"I should increase the amount of carbohydrate intake" Unless blood glucose levels are higher than 250 mg/dL, the client should eat the usual amount of carbohydrate, dividing it into smaller meals and snacks if necessary.

The nurse is teaching a client who is diagnosed with preeclampsia how to monitor her condition. The nurse determines the client needs more instruction after making which statement?

"If I have changes in my vision I will lie down and rest" Changes in the visual field may indicate the client has moved from preeclampsia to severe preeclampsia and is at risk for developing a seizure due to changes in cerebral blood flow. The client would require immediate assessment and intervention. Gaining weight is not necessarily a sign of worsening preeclampsia. The other choices are instructions which the client may be given to follow.

A pregnant client with preterm premature rupture of the membranes is being discharged home. A nurse is preparing the client's discharge teaching plan. Which instructions would the nurse include? Select all that apply.

"If you notice your belly starting to tighten, call your health care provider." "Check your temperature each day, reporting any increase immediately." Instructions should include monitoring the baby's activity by performing fetal kick counts daily; checking temperature daily and reporting any temperature increases to the health care provider; watching for signs related to the beginning of labor and reporting any tightening of the abdomen or contractions; avoiding any touching or manipulating of the breasts, which could stimulate labor; and taking showers for daily hygiene needs and avoiding sitting in a tub bath.

People with diabetes should avoid the use of fructose as an added sweetener for which of the following reasons?

"It causes adverse effects on serum triglycerides" Fructose causes adverse effects on serum triglycerides and LDL cholesterol.

The nurse's discharge teaching for a client with acute diabetic complications is discussing managing hypoglycemia. The nurse should include which of the following in the client teaching?

"Keep a package of skittles in your pocket at all times" The client should be encouraged to eat 15 g of readily absorbable carbohydrate if blood glucose is ,70 mg/day (see Box 19.7). 16 Skittles candies equal 15 g of readily absorbable carbohydrate, therefore, the nurse is correct to recommend that the client carry this in his pocket at all times. Pure sugars are better than items like chocolate candy bars, which contain fat that slows the gastric emptying time and delays the rise in blood glucose. Lean protein has little or no carbohydrate content. This will not increase blood sugars quickly enough to resolve the hypoglycemia. The client should be encourage to eat a meal within an hour of the hypoglycemic episode, not 4 hours.

A nurse has been assigned to assess a pregnant client for placental abruption (abruptio placentae). For which classic manifestation of this condition should the nurse assess?

"Knife-like" abdominal pain with vaginal bleeding The classic manifestations of abruption placenta are painful dark red vaginal bleeding, "knife-like" abdominal pain, uterine tenderness, contractions, and decreased fetal movement. Painless bright red vaginal bleeding is the clinical manifestation of placenta previa. Generalized vasospasm is the clinical manifestation of preeclampsia and not of abruptio placentae.

The nurse is teaching a prenatal class on potential problems during pregnancy to a group of expectant parents. The risk factors for placental abruption (abruptio placentae) are discussed. Which comment validates accurate learning by the parents?

"Placental abruption is quite painful and I will need to let the doctor know if I begin to have abdominal pain" Placental abruption (abruptio placentae) occurs when there is a spontaneous separation of the placenta from the uterine wall. It can occur anywhere on the placenta and will cause painful, dark red vaginal bleeding. If the abruption is small, the ob/gyn will try to deliver the fetus vaginally. But if severe bleeding occurs or there is fetal distress, a cesarean birth will be performed. Women older than 35 are also at higher risk for developing placental abruption.

A pregnant women calls the clinic to report a small amount of painless vaginal bleeding. What response by the nurse is best?

"Please come in how for evaluation from your healthcare provider" Bleeding during pregnancy is always a deviation from normal and should be evaluated carefully. It may be life-threatening or it may be something that is not a threat to the mother and/or fetus. Regardless, it needs to be evaluated quickly and carefully. Telling the client it may be harmless is a reassuring statement, but does not suggest the need for urgent evaluation. Having the mother lay on her left side and drink water is indicated for cramping.

A client who has been hospitalized with type 2 diabetes is to be discharged. Which tips for eating out should the nurse share?

"Select fresh fruit for dessert" Tips for eating out include the following: Choose unsweetened juice, use oil and vinegar or fresh lemon juice instead of regular salad dressings, order plain roasted meat without gravy or sauce, and select fresh fruit for dessert.

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage. The client looks frightened and confused and states that she does not believe in abortion. Which statement by the nurse is best?

"Unfortunately the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications" The nurse should not inform the client what she must do but supply information about what has happened and teach the client about the treatments that are used to correct the situation. A threatened spontaneous abortion (miscarriage) becomes an imminent (inevitable) miscarriage if uterine contractions and cervical dilation (dilatation) occur. A woman who reports cramping or uterine contractions is asked to seek medical attention. If no fetal heart sounds are detected and an ultrasound reveals an empty uterus or nonviable fetus, her health care provider may perform a dilatation and curettage (D&C) or a dilation and evacuation (D&E) to ensure all products of conception are removed. Be certain the woman has been told the pregnancy was already lost and all procedures, such as suction curettage, are to clear the uterus and prevent further complications such as infection, not to end the pregnancy. This scenario does not involve an abortion (elective termination of pregnancy) or an incomplete miscarriage. A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. An urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant?

A nurse is caring for a client who had hyperlipidemia as a result of low levels of high-density lipoproteins. What suggestion should the nurse offer to increase HDL level?

"have a regular exercise routine" Moderate alcohol consumption, regular exercise, and a low-trans-fat and low-carbohydrate diet can help to raise HDL levels.

A client newly diagnosed with type 1 diabetes asks the nurse when is the best time to inject regular insulin. What should the nurse respond?

30 minutes before eating For optimum effect, regular insulin should be injected 30 minutes before eating.

A client has been diagnosed with a partial molar pregnancy. The nurse is explaining this condition. The nurse knows the teaching was effective when the client states that as a result of an error during fertilization, there are how many chromosomes in her pregnancy?

69 A normal gamete has 23 chromosomes. At fertilization, the sperm fertilizes the ovum, resulting in 23 pairs or 46 chromosomes. In a partial molar pregnancy, two sperm penetrate the ovum, resulting in a total of 69 chromosomes. A pregnancy with 47 chromosomes results in a trisomic condition such as trisomy 21 or trisomy 18.

A nurse is caring for a young woman who is in her 10th week of gestation. She comes into the clinic reporting vaginal bleeding. Which assessment finding best correlates with a diagnosis of hydatidiform mole?

Dark red, "clumpy" vaginal discharge Women with hydatidiform mole ("molar pregnancy") often pass blood clots or watery brown/dark red discharge from the vagina in the first trimester. If a complete molar pregnancy continues into the second trimester undetected, other signs and symptoms appear. The woman often presents with complaints of dark to bright red vaginal bleeding and pelvic pain. Infrequently, she will report passage of grapelike vesicles.

The nurse is caring for an Rh-negative nonimmunized client at 14 weeks' gestation. What information would the nurse provide to the client?

Obtain Rho(D) immune globulin at 28 weeks' gestation. The current recommendation is that every Rh-negative nonimmunized woman receives Rho(D) immune globulin at 28 weeks' gestation and again within 72 hours after giving birth. Consuming a well-balanced nutritional diet and avoiding sexual activity until after 28 weeks will not help to prevent complications of blood incompatibility. Transvaginal ultrasound helps to validate the position of the placenta and will not help to prevent complications of blood incompatibility.

When teaching a client newly diagnosed with type 1 diabetes about exercise, it is important to include which instructions? Select all that apply.

Reduce the insulin dose before planned exercise. Eat a carbohydrate snack before beginning to exercise. Exercise should occur within 2 hours of eating. Stop activity if signs and symptoms of hypoglycemia develop. Reducing the insulin dose before exercising may be the best way to prevent hypoglycemia. Eating a carbohydrate snack before beginning to exercise is advised, especially if the blood glucose level is less than 100 mg/dL. If possible, exercise should occur within 2 hours of eating to prevent hypoglycemia.

Which of the following statements is CORRECT about type 1 and type 2 diabetes?

Type 2 can occur at any age and accounts for 90% to 95% of diagnosed cases of diabetes. Type 2 diabetes, previously referred to as non-insulin-dependent diabetes mellitus or adult-onset diabetes, can occur at any age and accounts for 90% to 95% of diagnosed cases of diabetes. Type 2 diabetes is a slowly progressive disease characterized by a combination of insulin resistance and relative insulin deficiency. Type 1 diabetes, formerly known as insulin-dependent diabetes mellitus or juvenile diabetes, is characterized by the absence of insulin. In type 1 diabetes, there is a relatively abrupt and absolute end to insulin production.

A primipara at 36 weeks' gestation is being monitored in the prenatal clinic for risk of preeclampsia. Which sign or symptom should the nurse prioritize?

a dipstick value of 2+ for protein The increasing amount of protein in the urine is a concern the preeclampsia may be progressing to severe preeclampsia. The woman needs further assessment by the health care provider. Dependent edema may be seen in a majority of pregnant women and is not an indicator of progression from preeclampsia to eclampsia. Weight gain is no longer considered an indicator for the progression of preeclampsia. A systolic blood pressure increase is not the highest priority concern for the nurse, since there is no indication what the baseline blood pressure was.

A client reporting she recently had a positive pregnancy test has reported to the emergency department stating one-sided lower abdominal pain. The health care provider has prescribed a series of tests. Which test will provide the most definitive confirmation of an ectopic pregnancy?

abdominal ultrasound An ectopic pregnancy refers to the implantation of the fertilized egg in a location other than the uterus. Potential sites include the cervix, uterus, abdomen, and fallopian tubes. The confirmation of the ectopic pregnancy can be made by an ultrasound, which would confirm that there was no uterine pregnancy. A quantitative hCG level may be completed in the diagnostic plan. hCG levels in an ectopic pregnancy are traditionally reduced. While this would be an indication, it would not provide a positive confirmation. The qualitative hCG test would provide evidence of a pregnancy, but not the location of the pregnancy. A pelvic exam would be included in the diagnostic plan of care. It would likely show an enlarged uterus and cause potential discomfort to the client but would not be a definitive finding.

A nurse in the maternity triage unit is caring for a client with a suspected ectopic pregnancy. Which nursing intervention should the nurse perform first?

assess the clients vital signs A suspected ectopic pregnancy can put the client at risk for hypovolemic shock. The assessment of vital signs should be performed first, followed by any procedures to maintain the ABCs. Providing emotional support would also occur, as would obtaining a surgical consent, if needed, but these are not first steps.

Which of the following is CORRECT regarding nutrition recommendations for controlling diabetes complications?

both A and B are correct For microvascular complications, the recommendation based on strong evidence is to reduce protein intake to 0.8 to 1.0 g/kg for people with early-stage kidney disease, and the recommendation for CVD is to control hemoglobin A1c as close to normal as possible without significant hypoglycemia.

The nurse is developing a nutrition plan for a client with nephropathy as a complication of type 2 diabetes. Which intervention does the nurse include in the plan?

avoid high protein intake Key components of the diet include managing blood sugar through carbohydrate control, managing blood pressure by decreasing sodium intake, and reducing protein intake.

The guidelines for carbohydrate counting for diabetes mellitus include all of the following EXCEPT:

carbohydrate counting includes unlimited intake of saturated fat and cholesterol Limiting saturated fat and using polyunsaturated fats is encouraged.

The nurse is comforting and listening to a young couple who just suffered a spontaneous abortion (miscarriage). When asked why this happened, which reason should the nurse share as a common cause?

chromosomal abnormality The most common cause for the loss of a fetus in the first trimester is associated with a genetic defect or chromosomal abnormality. There is nothing that can be done and the mother should feel no fault. The nurse needs to encourage the parents to speak with a health care provider for further information and questions related to genetic testing. Early pregnancy loss is not associated with maternal smoking, lack of prenatal care, or the age of the mother.

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor?

chromosomal defects in the uterus Fetal factors are the most common cause of early miscarriages, with chromosomal abnormalities in the fetus being the most common reason. This client fits the criteria for early spontaneous abortion since she was only 10 weeks' pregnant and early miscarriage occurs before 12 weeks.

A woman of 16 weeks' gestation telephones the nurse because she has passed some "berry-like" blood clots and now has continued dark brown vaginal bleeding. Which action would the nurse instruct the woman to do?

come to the health facility with any vaginal material passed This is a typical time in pregnancy for gestational trophoblastic disease to present. Asking the woman to bring any material passed vaginally would be important so the material can be assessed for this.

Type 2 diabetes may go undiagnosed for years. This statement is:

correct Because hyperglycemia develops gradually in type 2 diabetes and is often not severe enough for patients to recognize any of the classic diabetes symptoms, type 2 diabetes may go undiagnosed for years. Many patients will have already developed complications by the time of diagnosis (Ahmad & Crandall, 2010). Many patients will have already developed complications by the time of diagnosis.

People with diabetes should limit their intake of saturated fat and cholesterol because their risk of coronary heart disease is very high. This statement is:

correct People with diabetes are advised to limit their intake of saturated fat to less than 7% of total calories, minimize their intake of trans fat, and consume less than 200 mg of cholesterol daily.

Alcohol is more likely to cause hypoglycemia when consumed without food rather than with food. This statement is:

correct People with diabetes should not drink alcohol because it raises blood glucose levels very quickly. Any alcohol that is consumed should be consumed with food to reduce the risk of nighttime hypoglycemia.

A nurse is caring for a client with poorly controlled type 1 diabetes. The nurse understands that the client may experience acute life-threatening complications caused by a high blood glucose concentration. Which of the following complications should the nurse expect?

diabetic ketoacidosis People with type 1 diabetes are susceptible to diabetic ketoacidosis. Hyperosmolar hyperglycemic nonketotic syndrome occurs most commonly in people with type 2 diabetes.

A woman is being closely monitored and treated for severe preeclampsia with magnesium sulfate. Which finding would alert the nurse to the development of magnesium toxicity in this client?

diminished reflexes Diminished or absent reflexes occur when a client develops magnesium toxicity. Elevated liver enzymes are unrelated to magnesium toxicity and may indicate the development of HELLP syndrome. The onset of seizure activity indicates eclampsia. A serum magnesium level of 6.5 mEq/L would fall within the therapeutic range of 4 to 7 mEq/L.

A client comes to a clinic asking for advice on how to prevent diabetes. What suggestion is BEST for the nurse to give the client? `

eat an adequate intake of high fiber foods A high-fiber diet can slow the absorption of sugar and help to improve blood sugar levels.

A nurse is conducting a refresher program for a group of perinatal nurses. Part of the program involves a discussion of HELLP. The nurse determines that the group needs additional teaching when they identify which aspect as a part of HELLP?

elevated lipoproteins The acronym HELLP represents hemolysis, elevated liver enzymes, and low platelets. This syndrome is a variant of preeclampsia/eclampsia syndrome that occurs in 10% to 20% of clients whose diseases are labeled as severe.

The nurse is assisting in planning a community diabetes prevention program. Which of the following information should the nurse recommend?

engage in heavy physical activity for at least 30 minutes The goal for weight loss is from 5% to 15% of initial weight, with a target of 1 to 2 pounds per week. Moderate physical activity is advised along with an increased intake of fruit, vegetables, and high-fiber foods.

A woman with an incomplete abortion is to receive misoprostol. The woman asks the nurse, "Why am I getting this drug?" The nurse responds to the client, integrating understanding that this drug achieves which effect?

ensures passage of all the products of conception Misoprostol is used to stimulate uterine contractions and evacuate the uterus after an abortion to ensure passage of all the products of conception. Rho(D) immune globulin is used to suppress the immune response and prevent isoimmunization.

A woman at 9 weeks' gestation was unable to control the nausea and vomiting of hyperemesis gravidarum through conservative measures at home. With nausea and vomiting becoming severe, the woman was omitted to the obstetrical unit. Which action should the nurse prioritize?

establish IV for rehydration With severe nausea and vomiting the client may be dehydrated upon coming to hospital for assistance, so establishing an IV line is the priority intervention. This will also allow for hydration, and if needed, the administration of an antiemetic to bypass the gastrointestinal tract. Although the nurse will explain the NPO status to the client (so that vomiting may be brought under control) and the likelihood of being placed on bed rest with bathroom privileges, these teaching are not the priority.

You Selected:

frequent urination Polyphagia, polyuria, polydipsia, and weight loss are cardinal signs of type 1 diabetes mellitus. Other signs include shortened attention span, lowered frustration tolerance, fatigue, dry skin, blurred vision, sores that are slow to heal, and flushed skin.

A nurse is monitoring a client with PROM who is in labor and observes meconium in the amniotic fluid. What does the observation of meconium indicate?

fetal distress related to hypoxia When meconium is present in the amniotic fluid, it typically indicates fetal distress related to hypoxia. Meconium stains the fluid yellow to greenish brown, depending on the amount present. A decreased amount of amniotic fluid reduces the cushioning effect, thereby making cord compression a possibility. A foul odor of amniotic fluid indicates infection. Meconium in the amniotic fluid does not indicate CNS involvement.

A pregnant woman is diagnosed with placental abruption (abruptio placentae). When reviewing the woman's physical assessment in her medical record, which finding would the nurse expect?

firm, ridged uterus on palpation The uterus is firm-to-rigid to the touch with abruptio placentae. It is soft and relaxed with placenta previa. Bleeding associated with abruptio placentae occurs suddenly and is usually dark in color. Bleeding also may not be visible. A gradual onset of symptoms is associated with placenta previa. Fetal distress or absent fetal heart rate may be noted with abruptio placentae. The woman with abruptio placentae usually experiences constant uterine tenderness on palpation.

A woman at 10 weeks' gestation comes to the clinic for an evaluation. Which assessment finding should the nurse prioritize?

fundal height measures 18 cm A fundal height of 18 cm is larger than expected and should be further investigated for gestational trophoblastic disease (hydatidiform mole). One of the presenting signs is the uterus being larger than expected for date. Mild nausea would be a normal finding at 10 weeks' gestation. Blood pressure of 120/84 mm Hg would not be associated with hydatidiform mole and depending on the woman's baseline blood pressure may be within acceptable parameters for her. Bright red spotting might suggest a spontaneous abortion (miscarriage).

A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements?

gestational hypertension Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of preeclampsia, or preexisting hypertension. Placental abruption (abruptio placentae), a separation of the placenta from the uterine wall; placenta previa (placenta covering the cervical os); and preeclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.

A pregnant client has been admitted with reports of brownish vaginal bleeding. On examination, there is an elevated human chorionic gonadotropin (hCG) level, absent fetal heart sounds, and a discrepancy between the uterine size and the gestational age. The nurse interprets these findings to suggest which condition?

gestational trophoblastic disease The client is most likely experiencing gestational trophoblastic disease, or a molar pregnancy. In gestational trophoblastic disease, there is an abnormal proliferation and eventual degeneration of the trophoblastic villi. The signs and symptoms of molar pregnancy include brownish vaginal bleeding, elevated hCG levels, discrepancy between the uterine size and the gestational age, and absent fetal heart sounds. Placental abruption is characterized by premature separation of the placenta. Ectopic pregnancy is a condition where there is implantation of the blastocyst outside the uterus. In placenta previa, the placental attachment is at the lower uterine segment.

A nurse is taking a history of a client at 5 weeks' gestation in the prenatal clinic; however, the client is reporting dark brown vaginal discharge, nausea, and vomiting. Which diagnosis should the nurse suspect?

gestational trophoblastic disease This client has risk factors of a "molar" pregnancy: nausea and vomiting at an early gestational week and dark brown vaginal discharge. The early nausea/vomiting can be due to a high hCG level, which is a sign of gestational trophoblastic disease. There is only one sign/symptom of hyperemesis gravidarum. Placenta previa is marked by bright red bleeding and tends to happen later in gestation. There are no data to support any psychosis at this stage.

Risk factors for type 2 diabetes include all of the following EXCEPT:

greater than 35 years old Risk factors for type 2 diabetes are a family history of diabetes, physical inactivity or exercising less than three times per week, impaired glucose metabolism, a history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Native Americans, Asian Americans, and Pacific Islanders are high-risk ethnic groups. Being greater than 45 years old is considered a risk factor for type 2 diabetes.

A client tells that nurse in the doctor's office that her friend developed high blood pressure on her last pregnancy. She is concerned that she will have the same problem. What is the standard of care for preeclampsia?

have her blood pressure checked at every prenatal visit Preeclampsia and eclampsia are common problems for pregnant clients and require regular blood pressure monitoring at all prenatal visits. Antihypertensives are not prescribed unless the client is already hypertensive. Monitoring for headaches and swelling is a good predictor of a problem but doesn't address prevention—nor does it predict who will have hypertension. Taking aspirin has shown to reduce the risk in women who have moderate to high risk factors, but has shown no effect on those women with low risk factors.

A client in her 20th week of gestation develops HELLP syndrome. What are features of HELLP syndrome? Select all that apply.

hemolysis elevated liver enzymes low platelet count The HELLP syndrome is a syndrome involving hemolysis (microangiopathic hemolytic anemia), elevated liver enzymes, and a low platelet count. Hyperthermia and leukocytosis are not features of HELLP syndrome.

A nurse is providing a dietary instruction to a client with diabetes who has an uncontrolled blood sugar level. The nurse tells the client to avoid which of the following foods?

high fructose corn syrup People with diabetes should avoid fructose because it causes adverse effects on serum triglycerides and LDL cholesterol.

A nurse is providing care to a client who has been diagnosed with a common benign form of gestational trophoblastic disease. The nurse identifies this as:

hydratiform mole Gestational trophoblastic disease comprises a spectrum of neoplastic disorders that originate in the placenta. The two most common types are hydatidiform mole (partial or complete) and choriocarcinoma. Hydatidiform mole is a benign neoplasm of the chorion in which the chorionic villi degenerate and become transparent vesicles containing clear, viscid fluid. Ectopic pregnancy, placenta accreta, and hydramnios fall into different categories of potential pregnancy complications.

A 24-year-old woman presents with vague abdominal pains, nausea, and vomiting. An urine hCG is positive after the client mentioned that her last menstrual period was 2 months ago. The nurse should prepare the client for which intervention if the transvaginal ultrasound indicates a gestation sac is found in the right lower quadrant?

immediate surgery The client presents with the signs and symptoms of an ectopic pregnancy, which is confirmed by the transvaginal ultrasound. Ectopic pregnancy means an embryo has implanted outside the uterus. Surgery is necessary to remove the growing structure before damage can occur to the woman's internal organs. Bed rest, a tocolytic, and internal uterine monitoring will not correct the situation. The growing structure must be removed surgically.

A client comes to the emergency department with moderate vaginal bleeding. She says, "I have had to change my pad about every 2 hours and it looks like I may have passed some tissue and clots." The woman reports that she is 9 weeks' pregnant. Further assessment reveals the following: Cervical dilation Strong abdominal cramping Low human chorionic gonadotropin (hCG) levels Ultrasound positive for products of conception The nurse suspects that the woman is experiencing which type of spontaneous abortion?

inevitable Based on the assessment findings, the woman is likely experiencing an inevitable abortion characterized by vaginal bleeding, rupture of membranes, cervical dilation, strong abdominal cramping, possible passage of products of conception, and ultrasound and hCG levels indicating pregnancy loss. A threatened abortion is characterized by slight vaginal bleeding, no cervical dilation or change in cervical consistency, mild abdominal cramping, close cervical os, and no passage of fetal tissue. An incomplete abortion is characterized by intense abdominal cramping, heavy vaginal bleeding and cervical dilation with passage of some products of conception. A complete abortion is characterized by a history of vaginal bleeding and abdominal pain along with passage of tissue and subsequent decrease in pain and decrease in bleeding.

A nurse is assigned to care for a client with diabetes who has a diet high in saturated fats. What information should the nurse provide to the client about the detrimental effect of a high-fat diet?

it increases the risk of diabetic complications Foods rich in saturated fat have been proven clinically to raise levels of bad cholesterol in the blood. The recommendation based on strong evidence is to limit saturated fat to 7% of total calories.

The nurse is caring for a client with type 1 diabetes. Because the client is at risk for hypoglycemia, the nurse teaches the client to which of the following?

keep a source of carbohydrate on the nightstand in case hypoglycemia develops during the night An appropriate source of carbohydrate should be on the nightstand in case hypoglycemia develops during the night. The client should avoid extra physical activity at night, as this can cause hypoglycemia. The nurse would not instruct a client to skip insulin intake. Monitoring of the signs and symptoms of hypoglycemia should be consistent. If left unattended, hypoglycemia could cause convulsions, loss of consciousness, or other severe health problems.

The nurse is caring for a pregnant client with severe preeclampsia. Which nursing intervention should a nurse perform to institute and maintain seizure precautions in this client?

keep the suction equipment readily available The nurse should institute and maintain seizure precautions such as padding the side rails and having oxygen, suction equipment, and call light readily available to protect the client from injury. The nurse should provide a quiet, darkened room to stabilize the client. The nurse should maintain the client on complete bed rest in the left lateral lying position and not in a supine position. Keeping the head of the bed slightly elevated will not help maintain seizure precautions.

The nurse is seeing a client who after experiencing symptoms of hyperglycemia, immediately stopped eating foods high in carbohydrates. The client recognizes that this strategy will prevent which of the following?

ketoacidosis People with diabetes, especially type 1, are susceptible to diabetic ketoacidosis. Accumulation of acidic ketone bodies due to fat catabolism will cause ketoacidosis and ketonuria, which can lead to a diabetic coma and eventually death.

Which measure would the nurse include in the plan of care for a woman with prelabor rupture of membranes if her fetus's lungs are mature?

labor induction With prelabor rupture of membranes (PROM) in a woman whose fetus has mature lungs, induction of labor is initiated. Reducing physical activity, observing for signs of infection, and giving corticosteroids may be used for the woman with PROM when the fetal lungs are immature.

A client is seeking advice for his pregnant wife who is experiencing mild elevations in blood pressure. In which position should a nurse recommend the pregnant client rest?

lateral recumbent position The nurse should encourage a client with mild elevations in blood pressure to rest as much as possible in the lateral recumbent position to improve uteroplacental blood flow, reduce blood pressure, and promote diuresis. The nurse should maintain the client with severe preeclampsia on complete bed rest in the left lateral lying position. Keeping the head of the bed slightly elevated will not help to improve the condition of the client with mild elevations in blood pressure.

The nurse is caring for a pregnant client with fallopian tube rupture. Which intervention is the priority for this client?

monitor the client's vital signs and bleeding A nurse should closely monitor the client's vital signs and bleeding (peritoneal or vaginal) to identify hypovolemic shock that may occur with tubal rupture. Beta-hCG level is monitored to diagnose an ectopic pregnancy or impending abortion. Monitoring the mass with transvaginal ultrasound and determining the size of the mass are done for diagnosing an ectopic pregnancy. Monitoring the FHR does not help to identify hypovolemic shock.

A pregnant client diagnosed with hyperemesis gravidarum is prescribed intravenous fluids for rehydration. When preparing to administer this therapy, which solution would the nurse anticipate being prescribed initially?

normal saline For the client with hyperemesis gravidarum, parenteral fluids and drugs are prescribed to rehydrate the client and reduce the symptoms. The first choice for fluid replacement is generally isotonic, such as normal saline, which aids in preventing hyponatremia, with vitamins (pyridoxine, or vitamin B6) and electrolytes added. Dextrose 5% and water and 0.45% sodium chloride are hypotonic solutions that would cause the cells to swell and possibly burst. Albumin could lead to fluid overload.

A client with diabetes is having a problem with high lipid levels in the body. Which food item would the nurse encourage the client to eat?

nuts Coconut oil, butter, and meatballs contain high saturated fats, which have long been associated with increased risk of heart disease and stroke for people with diabetes. Nuts contain monounsaturated fatty acid, which is considered to be a "good" fat.

A nurse is caring for a client who wants to consume monounsaturated fats in his diet. What should the nurse recommend the client include in the diet?

olive oil low-fat margarine, soybean oil, and corn oil are all examples of polyunsaturated fats.

A 32-year-old gravida 3 para 2 at 36 weeks' gestation comes to the obstetric department reporting abdominal pain. Her blood pressure is 164/90 mm Hg, her pulse is 100 beats per minute, and her respirations are 24 per minute. She is restless and slightly diaphoretic with a small amount of dark red vaginal bleeding. What assessment should the nurse make next?

palpate the fundus and check fetal heart rate The classic signs of placental abruption (abruptio placentae) are pain, dark red vaginal bleeding, a rigid, board-like abdomen, hypertonic labor, and fetal distress.

A pregnant woman with preeclampsia is to receive magnesium sulfate IV. Which assessment should the nurse prioritize before administering a new dose?

patellar reflex A symptom of magnesium sulfate toxicity is loss of deep tendon reflexes. Assessing for the patellar reflex or ankle clonus before administration is assurance the drug administration will be safe. Assessing the blood pressure, heart rate, or anxiety level would not reveal a potential magnesium toxicity.

The nurse understands the need to be aware of the potential of bleeding disorders in pregnant clients. Which disorder should she be aware of that occurs in the second trimester?

placenta previa Second trimester bleeding usually results from placenta previa, where the placenta lies either partially or completely over the cervical os. The pregnant client begins to experience vaginal bleeding of bright, red blood. Spontaneous abortion (miscarriage), hydatidiform mole, and ectopic pregnancy occur in the first trimester and cervical insufficiency is not a bleeding disorder.

After a regular prenatal visit, a pregnant client asks the nurse to describe the differences between placental abruption (abruptio placentae) and placenta previa. Which statement will the nurse include in the teaching?

placenta previa is an abnormally implanted placenta that is too close to the cervix Placenta previa is a condition of pregnancy in which the placenta is implanted abnormally in the lower part of the uterus and is the most common cause of painless, bright red bleeding in the third trimester. Placental abruption is the premature separation of a normally implanted placenta that pulls away from the wall of the uterus either during pregnancy or before the end of labor. Placental abruption can result in concealed or apparent dark red bleeding and is painful. Immediate intervention is required for placental abruption.

A 44-year old client has type 2 diabetes with cardiovascular complications and must follow a special diet. Which food is allowed in this diet?

plant based proteins Plant-based proteins such as soy and beans are healthy proteins sources that are recommended for diabetes. Intake of saturated-fat foods such as red meat and whole milk is linked to high cholesterol and an increased risk of coronary heart disease and stroke, and this will further aggravate the complications of diabetes. Starchy foods such as pasta are foods to avoid.

A woman at 35 weeks' gestation with severe hydramnios is admitted to the hospital. The nurse recognizes that which concern is greatest regarding this client?

preterm rupture of the membranes followed by preterm birth Even with precautions, in most instances of hydramnios, there will be preterm rupture of the membranes because of excessive pressure, followed by preterm birth. The other answers are less concerning than preterm birth in this pregnancy.

A 24-year-old client presents in labor. The nurse notes there is an order to administer Rho(D) immune globulin after the birth of her infant. When asked by the client the reason for this injection, which reason should the nurse point out?

prevent maternal D antibody forming Because Rho(D) immune globulin contains passive antibodies, the solution will prevent the woman from forming long-lasting antibodies which may harm a future fetus. The administration of Rho(D) immune globulin does not promote the formation of maternal D antibodies; it does not stimulate maternal D immune antigens or prevent fetal Rh blood formation.

A client at 27 weeks' gestation is admitted to the obstetric unit after reporting headaches and edema of her hands. Review of the prenatal notes reveals blood pressure consistently above 136/90 mm Hg. The nurse anticipates the health care provider will prescribe magnesium sulfate to accomplish which primary goal?

prevent maternal seizures The primary therapy goal for any client with preeclampsia is to prevent maternal seizures. Use of magnesium sulfate is the drug therapy of choice for severe preeclampsia and is only used to manage and attempt to prevent progression to eclampsia. Magnesium sulfate therapy does not have as a primary goal of decreasing blood pressure, decreasing protein in the urine, or reversing edema.

The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer?

previous cesarean birth The risk of placenta previa is greatly increased when a woman has had a previous cesarean delivery due to the scarring of the endometrial lining. Maternal age over 35 years, and not just more than 30 years, is considered another risk factor. Placenta previa is more common among those living in high altitudes not among those living in coastal areas. Obesity is not recognized as a potential risk for this condition. Other risk factors can include uterine insult or injury, cocaine use, prior placenta previa, infertility treatment, multiple gestations, previous induced surgical abortion, smoking, previous myomectomy to remove fibroids, short interval between pregnancies, hypertension, or diabetes.

A woman has presented to the emergency department with symptoms that suggest an ectopic pregnancy. Which finding would lead the nurse to suspect that the fallopian tube has ruptured?

referred shoulder pain Referred pain to the shoulder area indicates bleeding into the abdomen caused by phrenic nerve irritation when a tubal pregnancy ruptures. Vaginal spotting, nausea, and breast tenderness are typical findings of early pregnancy and an unruptured ectopic pregnancy.

The following hourly assessments are obtained by the nurse on a client with preeclampsia receiving magnesium sulfate: 97.3oF (36.2oC), HR 88, RR 12 breaths/min, BP 148/110 mm Hg. What other priority physical assessments by the nurse should be implemented to assess for potential toxicity?

reflexes Reflex assessment is part of the standard assessment for clients on magnesium sulfate. The first change when developing magnesium toxicity may be a decrease in reflex activity. The health care provider needs to be notified immediately. A change in lung sounds and oxygen saturation are not indicative of magnesium sulfate toxicity. Hourly blood draws to gain information on the magnesium sulfate level are not indicated.

A woman at 28 weeks' gestation has been hospitalized with moderate bleeding that is now stabilizing. The nurse performs a routine assessment and notes the client sleeping, lying on the back, and electronic fetal heart rate (FHR) monitor showing gradually increasing baseline with late decelerations. Which action will the nurse perform first?

reposition to the side The fetus is showing signs of fetal distress. The immediate treatment is putting the client in a side-lying position to ensure adequate perfusion to the fetus. After placing the client on the side, the nurse should re-assess the FHR and determine if oxygen, IV fluids, and calling the health care provider are needed.

A client at 37 weeks' gestation presents to the emergency department with a BP 150/108 mm Hg, 1+ pedal edema, 1+ proteinuria, and normal deep tendon reflexes. Which assessment should the nurse prioritize as the client is administered magnesium sulfate IV?

respiratory rate A therapeutic level of magnesium is 4 to 8 mg/dl (1.65 to 3.29 mmol/L). If magnesium toxicity occurs, one sign in the client will be a decrease in the respiratory rate and a potential respiratory arrest. Respiratory rate will be monitored when on this medication. The client's hemoglobin and ability to sleep are not factors for ongoing assessments for the client on magnesium sulfate. Urinary output is measured hourly on the preeclamptic client receiving magnesium sulfate, but urine protein is not an ongoing assessment.

The nurse is educating a 65-year-old client before his discharge on how to prevent complications of diabetes. Which of the following factors that may accelerate the deleterious effects of diabetes should the nurse tell the client to avoid? Select all that apply.

smoking obesity high blood pressure saturated fat intake Attention should be paid to factors that may accelerate the deleterious effects of diabetes. These include smoking, high dietary saturated fats, elevated cholesterol level, obesity, high blood pressure, and lack of regular exercise. Regular exercise improves the blood glucose level and reduces insulin resistance.

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable spontaneous abortion (miscarriage)?

strong abdominal cramping Strong abdominal cramping is associated with an inevitable spontaneous abortion (miscarriage). Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.

The nurse is caring for a woman at 32 weeks' gestation with severe preeclampsia. Which assessment finding should the nurse prioritize after the administration of hydralazine to this client?

tachycardia Hydralazine reduces blood pressure but is associated with adverse effects such as palpitation, tachycardia, headache, anorexia, nausea, vomiting, and diarrhea. It does not cause gastrointestinal bleeding, blurred vision (halos around lights), or sweating. Magnesium sulfate may cause sweating.

A pregnant woman at 12 weeks' gestation comes to the office reporting she has begun minimal fresh vaginal spotting. She is distressed because her primary care provider indicates after examining her that they will "wait and see." Which response would be most appropriate from the nurse in answering this client's concerns?

tell her that medications to prolong a 12 week pregnancy usually is not advised Because many early pregnancy losses occur as the result of chromosome abnormalities, an aggressive approach to prolong these is not usually recommended. It would not be appropriate for the nurse to suggest an over-the-counter tocolytic, nor to tell the client that the care provider meant something else such as maintaining strict bed rest. Advising the client to seek a second opinion would not change the end results.

The nurse is teaching a client about nutrition in diabetes management. What should be the target goal?

to keep blood glucose levels as near normal as possible The primary goal of diabetes management is to keep blood sugar level low and as near normal as possible. This will help to prevent the development of complications.

A 20-year-old client arrives at the emergency department complaining of frequent excessive urination, excessive thirst, and an increased appetite. Which disorder will the nurse most likely consider?

type 1 diabetes Frequent excessive urination, excessive thirst, and an increased appetite are classic symptoms of type 1 diabetes.

The nurse recognizes which type of diabetes is characterized by the absence of insulin secretion?

type 1 diabetes Type 1 diabetes is characterized by the absence of insulin. Type 2 diabetes is characterized by a combination of insulin resistance and relative insulin deficiency.

The nurse is facilitating a nursing class regarding the difference between type 1 and type 2 diabetes. Which type of diabetes has the risk factors of family history, increasing age, obesity, physical inactivity, ethnicity, and a history of gestational diabetes?

type 2 Risk factors for type 2 diabetes include family history, increasing age, obesity, physical inactivity, ethnicity, and a history of gestational diabetes. Family history, diet, and environmental factors are risk factors for type 1 diabetes. Studies have found an increased risk in children whose parents have type 1 diabetes, and this risk increases with maternal age.

The nurse recognizes that the type of diabetes that is controlled primarily through diet, exercise, and oral antidiabetic agents is which type?

type 2 diabetes People with type 1 diabetes require exogenous insulin for survival. Recent clinical trials have demonstrated that lifestyle modification, namely, modest weight loss, moderate physical activity, and a healthy diet, is the most effective tool in preventing or delaying type 2 diabetes.

A nurse is caring for a pregnant client admitted with mild preeclampsia. Which assessment finding should the nurse prioritize?

urine output of less than 15ml/hr Severe preeclampsia may develop suddenly and bring with it high blood pressure of more than 160/110 mm Hg, proteinuria of more than 500 mg in 24 hours, oliguria of less than 15 ml/hr, cerebral and visual symptoms, and rapid weight gain. Mild facial edema or hand edema occurs with mild preeclampsia. A urinary output of 15 ml/hr would result in an output of 360 ml/24 hours, which would be below the recommended range and should be reported. Ankle edema of 1+ could be related to regular pregnancy and not necessarily just severe preeclampsia. A finding of 3+ to 4+ pitting edema would be more alarming and require intervention.

The nurse is preparing discharge instructions for several clients after their admission for emergent care of a pregnancy complication. The nurse will stress the importance of frequent office visits to the client with:

a molar pregnancy Molar pregnancies can indicate the possibility of developing malignancy. The woman will need close observation and follow-up for a year, every 1 to 2 weeks for hCG levels to detect cancer. A follow-up visit after an ectopic pregnancy or a complete spontaneous abortion (miscarriage) are typically scheduled at 6 weeks, not monthly. A woman who is Rh negative does not need a follow-up visit because of her Rh status, but would be scheduled as per routine postpartum visits.

A woman at 8 weeks' gestation is admitted for ectopic pregnancy. She is asking why this has occurred. The nurse knows that which factor is a known risk factor for ectopic pregnancy?

use of an IUD for contraception Use of an IUD with progesterone has a known increased risk for development of ectopic pregnancies. The nurse needs to complete a full history of the client to determine if she had any other risk factors for an ectopic pregnancy. Adhesions, scarring, and narrowing of the tubal lumen may block the zygote's progress to the uterus. Any condition or surgical procedure that can injure a fallopian tube increases the risk. Examples include salpingitis, infection of the fallopian tube, endometriosis, history of prior ectopic pregnancy, any type of tubal surgery, congenital malformation of the tube, and multiple elective abortions. Conditions that inhibit peristalsis of the tube can result in tubal pregnancy. Hormonal factors may play a role because tubal pregnancy occurs more frequently in women who take fertility drugs or who use progesterone intrauterine contraceptive devices (IUDs). A high number of pregnancies, multiple gestation pregnancy, and the use of oral contraceptives are not known risk factors for ectopic pregnancy.