N137 Endocrine and Metabolic Disorders
Which client may need a cesarean delivery because of complications related to gestational diabetes? 1 A client with a big fetus 2 A client with uterine growth 3 A client with reduced fetal movement 4 A client with less than normal pelvic brim
1 Fetal macrosomia is a common complication associated with gestational diabetes. Hypersecretion of fetal insulin hormone as a response to maternal hyperglycemia results in an increased size of the fetus. Maternal hyperglycemia does not cause the development of uterine growths. Fetal movements may be cause for a cesarean, but they are not associated with the client's gestational diabetes. The size of the pelvic brim is not altered by maternal hyperglycemia.
The nurse finds that the blood pH of a pregnant client who is diabetic is 6.5. What should the nurse administer to normalize the client's blood pH? 1 Dextrose solution 2 Normal saline solution 3 Sodium citrate solution 4 Sodium bicarbonate solution
4 A blood pH of 6.5 indicates that the client has acidosis. In order to revert this state, the nurse should administer an alkaline solution, such as sodium bicarbonate solution. Dextrose and normal saline solution are neither acidic nor alkaline. These solutions would not help to normalize the blood pH. Sodium citrate solution would increase acidity and would worsen the client's condition.
Which manifestation does the nurse relate to hypoglycemia in a diabetic client? 1 Clammy skin 2 Rapid breathing 3 Nausea or vomiting 4 Increased urination
1 A client with hypoglycemia experiences sweating, pallor, and clammy skin. The hypoglycemic client has shallow respirations, whereas the hyperglycemic client takes rapid breaths. Hyperglycemia causes nausea and vomiting. The client with hypoglycemia experiences hunger. In cases of hyperglycemia, the kidneys excrete large volumes of urine in an attempt to regulate excess vascular volume.
The blood glucose level of a pregnant client is 325 mg/dl. Which test should be performed on the patient to assess the risk of maternal or intrauterine fetal death? 1 Ketones in urine 2 Glucose in urine 3 Arterial blood gases 4 Abdominal ultrasound
1 Diabetic ketoacidosis is a potentially fatal complication of diabetes that can lead to fetal death. This complication may occur if the client's blood glucose levels rise above 200mg/dl. Diabetic ketoacidosis can be confirmed by assessing the presence of ketones in the urine. The client's blood glucose level is 325 mg/dl and, hence, the patient has poorly controlled diabetes. Therefore, the nurse need not assess the urine glucose levels. Arterial blood gases and abdominal ultrasound are not useful for diagnosis of intrauterine fetal death.
Diabetes in pregnancy puts the fetus at risk in several ways. Of what should the nurse be aware regarding this? 1 With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern 2 The most important cause of perinatal loss in diabetic pregnancy is congenital malformations 3 Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring 4 At birth, the neonate of a diabetic mother is no longer in any greater risk
2
The nurse is assessing a pregnant client at 16 weeks of gestation. Which diagnostic test should the nurse say is used to identify neural tube defects in the fetus? 1 Serum alpha-fetoprotein 2 Fetal echocardiography 3 Glycosylated hemoglobin 4 Nonstress test (NST)
1 Measurement of maternal serum alpha-fetoprotein is performed between 16 and 18 weeks of gestation to determine the risk of neural tube defects. The fetus is at increased risk for neural tube defects such as spina bifida, anencephaly, and microcephaly. Fetal echocardiography is performed between 20 and 22 weeks of gestation to detect cardiac anomalies. Glycosylated hemoglobin is measured to assess glycemic control over the previous 4 to 6 weeks. The nonstress test (NST) is performed between 28 and 32 weeks of gestation in clients with vascular disease or poor glucose control. The NST is used to evaluate fetal well-being. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.
Which factor is known to increase the risk of gestational diabetes mellitus? 1 Previous birth of large infant 2 Maternal age younger than 25 3 Underweight before pregnancy 4 Previous diagnosis of type 2 diabetes mellitus
1 Previous birth of a large infant suggests gestational diabetes mellitus. A woman younger than 25 is not at risk for gestational diabetes mellitus. Obesity (greater than 90 kg or 198 lb) creates a higher risk for gestational diabetes. The person with type 2 diabetes mellitus already has diabetes and will continue to have it after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.
The nurse is caring for a client in the first trimester of pregnancy who is prescribed propylthiouracil (PTU) for hyperthyroidism. What are the side effects of this medication? 1 Facial anomalies 2 Hepatic toxicity 3 Esophageal atresia 4 Developmental delay
2 Although PTU controls the symptoms of hyperthyroidism effectively, it can cause hepatic toxicity serious enough to require liver transplantation. PTU is generally used only in the first trimester of pregnancy, after which the client is prescribed methimazole (MM). If MM is taken in the first trimester of pregnancy, it can cause facial anomalies, esophageal atresia, and developmental delay in the fetus.
The nurse is teaching a client diagnosed with phenylketonuria (PKU) about foods to be avoided in the daily diet. Which foods can have an adverse effect on the mother and fetus? Select all that apply. 1 Milk 2 Eggs 3 Nuts 4 Fruits 5 Vegetables
1,2,3 A client diagnosed with PKU must avoid milk, eggs, and nuts in her diet before conception and throughout the pregnancy. The client must have a modified diet that excludes all high-protein foods. The client lacks the enzyme phenylalanine hydrolase; this lack impairs her body's ability to metabolize the amino acid phenylalanine, found in all protein foods. Most fruits and vegetables contain very little or no proteins; the client may include these in her diet.
The nurse is advising a pregnant client who has been prescribed lispro (Humalog). What information does the nurse provide about the insulin? Select all that apply. 1 It is rapid-acting insulin preferred for use during pregnancy. 2 It is injected just before meals and causes less hyperglycemia. 3 It has shorter duration of action as compared to regular insulin. 4 It is released slowly in small amounts with no pronounced peak. 5 Its action lasts for 12 hours maintaining optimal blood glucose levels.
1,2,3 Lispro (Humalog) is rapid-acting insulin preferred for use during pregnancy. It is convenient, because it is injected just before mealtime. It causes less hyperglycemia and fewer hypoglycemic episodes. It has a shorter duration of action as compared to regular insulin. Lispro (Humalog) is not released slowly in small amounts. Glargine (Lantus) is long-acting insulin that is released slowly in small amounts with no pronounced peak. The action of lispro (Humalog) lasts for 3 to 5 hours. Therefore clients often need additional longer-acting insulin to maintain optimal blood glucose levels. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.
What are the manifestations associated with hypoglycemia? Select all that apply. 1 Dizziness 2 Fruity breath 3 Blurred vision 4 Excessive hunger 5 Presence of acetone in urine
1,3,4 Hypoglycemia refers to decreased blood sugar levels. Decreased availability of glucose impairs brain function, which results in dizziness and blurred vision. Decreased glucose levels stimulate the satiety center of the brain, which results in excessive hunger. Fruity breath and the presence of acetone in urine result from increased ketone levels in the blood. This complication may occur when the blood glucose increases over 300 mg/dl in the non-pregnant client and 200 mg/dl in the pregnant client.
Diabetes in pregnancy puts the fetus at risk in several ways. What should nurses be aware of? 1 With good control of maternal glucose levels, sudden and unexplained stillbirth is no longer a major concern. 2 The most important cause of perinatal loss in diabetic pregnancy is congenital malformations. 3 Infants of mothers with diabetes have the same risks for respiratory distress syndrome because of the careful monitoring. 4 At birth, the neonate of a diabetic mother is no longer at any greater risk.
2 Congenital malformations account for 30% to 50% of perinatal deaths. Even with good control, sudden and unexplained stillbirth remains a major concern. Infants of diabetic mothers are at increased risk for respiratory distress syndrome. The transition to extrauterine life often is marked by hypoglycemia and other metabolic abnormalities. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously.
A pregnant woman has contacted the nurse about severe nausea and vomiting. What is the priority assessment in evaluating a pregnant woman with severe nausea and vomiting? 1 Fasting blood glucose level 2 Ketonuria 3 Bilirubin 4 White Blood cell count
2 Determination of ketonuria would be a critical assessment that would lead toward determination of hyperemesis. A pregnant client with severe nausea and vomiting may have hyperemesis gravidarum and, as such, requires critical monitoring to determine the nature of the problem. A FBS, although informative would not be the priority assessment at this time. Although a bilirubin level would be needed, it would not be the priority assessment. A WBC count would indicate the possibility of an infectious source but it would not be a priority assessment in terms of the client's presentation.
The nurse is caring for a client in early pregnancy with hyperemesis. What changes in diet will benefit this client? 1 Avoiding dairy products and cold foods 2 Eating a high-protein snack at bedtime 3 Eating foods that are served warm 4 Avoiding dry, bland, and low-fat foods
2 Eating a high-protein snack at bedtime may help the client overcome protein deficiency and reduce hyperemesis. The client can have dairy products, which are easily accepted by the body. Dairy products also contain proteins. Clients with hyperemesis are able to tolerate cold foods better than foods that are served warm. The client can have dry, bland, and low-fat foods, because they do not induce hyperemesis.
Which of the following findings is not likely to be seen in a pregnant client who has hypothyroidism? 1 Miscarriage 2 Macrosomia 3 Gestational hypertension 4 Placental abruption
2 Infants born to mothers with hypothyroidism are more likely to be of low birth weight or preterm. These outcomes can be improved with early diagnosis and treatment. Hypothyroidism is often associated with both infertility and an increased risk of miscarriage. Pregnant women with hypothyroidism are more likely to experience both preeclampsia and gestational hypertension. Placental abruption and stillbirth are risks associated with hypothyroidism. Test-Taking Tip: Do not spend too much time on one question, because it can compromise your overall performance. There is no deduction for incorrect answers, so you are not penalized for guessing. You cannot leave an answer blank; therefore, guess. Go for it! Remember: You do not have to get all the questions correct to pass.
Which patients with diabetes may develop complications if they perform exercises? Select all that apply. 1 A client who is on insulin 2 A client with diabetic ketoacidosis 3 A client with uncontrolled hypertension 4 A client with severe peripheral neuropathy 5 A client who has lost 5 kg weight after diagnosis
2,3,4 Exercise is usually prescribed for the prevention of complications in diabetic clients. However, a client with ketoacidosis should not do exercises, because exercises burn more fats and proteins, thereby increasing the blood ketone levels. Blood pressure increases with exercise; therefore, a client with uncontrolled blood pressure should not perform exercises. A client with severe peripheral neuropathy is susceptible to injury because of loss of sensations. Therefore, exercise is contraindicated in this client. A client with insulin dependent diabetes mellitus can perform exercises under supervision. Weight loss is a common complication associated with diabetes. A client who has lost weight can perform exercises to prevent complications of diabetes.
What does the nurse instruct a pregnant client who is diabetic to do? Select all that apply. 1 "Perform exercises just before meals." 2 "Perform exercises with a partner." 3 "Stop exercising if contractions occur." 4 "Lie supine if contractions occur." 5 "Exercise at the same time every day."
2,3,5 The nurse should instruct the client to exercise with a partner as a safety measure. The client should be instructed to stop exercising immediately if contractions occur. The client should perform exercises, eat meals, and take insulin at the same time every day. It is best to perform exercises after meals, when the blood glucose levels are rising. If contractions occur, the client should drink two to three glasses of water and lie down on her side for an hour. If contractions do not cease, the client should contact the primary health care provider. Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of resources over an extended period of time ensures your understanding and increases your confidence about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding to your strength and inner conviction to achieve success.
In which pregnant client does the nurse identify the need to screen for undiagnosed homozygous maternal phenylketonuria (PKU)? 1 A client who had a macrosomic fetus in a previous pregnancy 2 A client who had obstructed labor in a previous pregnancy 3 A client who has given birth to a microcephalic infant 4 A patient who had placental insufficiency in a previous pregnancy
3 A client who has previously had a microcephalic infant must be screened for undiagnosed homozygous maternal PKU in the first prenatal visit. Toxic accumulation of phenylalanine in the blood due to a lack of the enzyme phenylalanine hydrolase interferes with brain development. The client who had a previous macrosomic fetus must be screened for hyperglycemia. A client with a macrosomic fetus may have obstructed labor. Placental insufficiency may lead to stillbirth. The client who had placental insufficiency in a previous pregnancy need not be screened for PKU.
The nurse is assessing a client at 30 weeks of pregnancy with poorly controlled pregestational diabetes. The client has come for the antenatal visit on a Monday. When should the nurse ask the client to come next? 1 Next week on a Monday 2 Next week on a Thursday 3 Same week on a Thursday 4 Week after next week on a Monday
3 An antepartum client with pregestational diabetes requires more frequent antenatal visits. A client with poorly controlled diabetes who is in the third trimester of pregnancy should visit the clinic twice a week. If the client visited the clinic on a Monday, the nurse should instruct the client to come for the next visit on the same week on a Thursday. A client who is in the first and second trimester of pregnancy can come once in a week or two weeks. Because this client is in the third trimester and has poorly controlled diabetes, the nurse should not ask the client to come on next week on Monday, Thursday, or the week after next on Monday.
A pregnant woman has maternal phenylketonuria (PKU) and is interested in whether or not she will be able to breastfeed her baby. Which statement made by the nurse indicates accurate information? 1 The client can breastfeed the baby as long as she continues to maintain a PKU-restricted diet. 2 The client should alternate breastfeedings with bottle feedings in order to reduce PKU levels provided to the baby. 3 The client should be advised to not breastfeed the infant, because her breast milk will contain large amounts of phenylalanine 4 The client can breasteed for the first three months without any untoward effects on the infant.
3 Breastfeeding is not advised for a client who has maternal PKU, because phenylalanine levels will be high in the client's breast milk. Dietary restriction will not limit the amount of this substance in breast milk. Alternating feeding sources is not advised. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
What is the pathologic change associated with diabetic ketoacidosis? 1 Loss of electrolytes 2 Metabolic alkalosis 3 Cellular dehydration 4 Increase in the blood volume
3 Diabetic ketoacidosis is characterized by an increase in blood sugar and ketone levels. This causes osmotic diuresis, which ultimately results in cellular dehydration. There is loss of electrolytes in ketoacidosis. Ketone bodies in the blood would result in decreased blood pH, which is referred to as metabolic acidosis. In this condition, the kidneys excrete large amounts of fluid, which results in a decrease in blood volume.
A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. What is the primary goal of her treatment at this time? 1 Rest the gastrointestinal (GI) tract by restricting all oral intake for 48 hours 2 Reduce emotional distress by encouraging the woman to discuss her feelings 3 Reverse fluid, electrolyte, and acid-base imbalances 4 Restore the woman's ability to take and retain oral fluid and foods
3 Fluid, electrolyte, and acid-base imbalances present the greatest immediate danger to the well-being of the mother and fetus and should be corrected as soon as possible. Resting the GI tract is a component of treatment; however, it is not an immediate goal for this client. Discussing her feelings is also a component of treatment but not an immediate goal at this time. The ability to retain oral fluid and foods is a longer-term goal of treatment for this condition. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. Usually your first answer is correct and should not be changed without reason.
A client who is pregnant already has type 2 diabetes and a hemoglobin A1c of 7. What does the nurse would categorize this client as having? 1 Gestational diabetes 2 Insulin-dependent diabetes complicated by pregnancy. 3 Pregestational diabetes mellitus 4 Non-insulin-dependent diabeteswith complications
3 Pregestational diabetes mellitus is a term used to describe type 1 or type 2 diabetic clients in whom the diabetes existed prior to pregnancy. Gestational diabetes occurs when during the pregnancy, a woman becomes diabetic. A type 2 diabetic is non-insulin dependent. This option indicates type 1, or insulin-dependent, diabetes. There is no information presented that indicates complications at this point, because the hemoglobin A1c is within normal range, indicating adequate glycemic control.
The nurse is caring for a diabetic client who is breastfeeding her infant. Within what time frame following childbirth do the client's insulin requirements return to prepregnancy levels? 1 Immediately after childbirth 2 Seven to 10 days after childbirth 3 On completion of weaning 4 During the lactation period
3 The breastfeeding mother's insulin requirements return to prepregnancy levels after the infant has been completely weaned. At birth, there is a sudden drop in the levels of insulinase following expulsion of the placenta, but they do not return to prepregnancy levels. When the mother is not breastfeeding, the insulin carbohydrate balance returns in 7 to 10 days. Maternal glucose is used up during lactation; therefore the breastfeeding mother's insulin requirement remains low. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer.
The nurse is assessing a client with hyperemesis gravidarum during the early stages of pregnancy. Which nonpharmacologic measure is appropriate to alleviate the discomforts associated with nausea and vomiting? 1 Having the client cook her favorite foods 2 Allowing frequent visits from friends 3 Providing environment that is free from odors 4 Having the client eat warm, low-fat, soupy foods
3 The client must be allowed to rest in an environment that is free from odors. This helps to alleviate the discomforts associated with hyperemesis gravidarum. Most clients find exposure to cooking odors nauseating; it is better to have other family members cook for the client. It is important for the client to have limited periods of visitation and receive adequate rest, because sleep disturbances accompany hyperemesis. The client is able to tolerate dry, cold foods better than warm, soupy foods.
The nurse is assessing a client for gestational diabetes mellitus (GDM) using the oral glucose tolerance test (OGTT). What intervention by the nurse is appropriate while caring for this client? 1 Teach the client to eat an unrestricted diet the day before the test. 2 Instruct the client to avoid caffeine for 6 hours before the test. 3 Draw blood for a fasting blood glucose level just before the test. 4 Obtain the plasma glucose level an hour after a 50 g oral glucose load.
3 The nurse must draw blood for a fasting blood glucose level just before the test begins. This is the first sample, after which blood is drawn 1, 2, and 3 hours after providing the glucose load. The nurse must teach the client to eat an unrestricted diet that includes at least 150 g of carbohydrates for at least 3 days before the test. The client must be instructed to avoid caffeine for 12 hours before the test because it increases glucose levels. The client is given a 100 g oral glucose load, and then the client's blood glucose levels are determined every hour for up to 3 hours. The plasma glucose level is obtained after a 50 g oral glucose load in the first step of screening for GDM.
A cesarean birth is planned for a diabetic client with fetal macrosomia. Which intervention by the nurse is appropriate when preparing the client for surgery? 1 Instruct the client to avoid insulin the night before the surgery. 2 Administer a full dose of insulin on the morning of the surgery. 3 Ensure the client has nothing by mouth on the morning of the surgery. 4 Infuse intravenous 5% dextrose if the client's glucose level is below 100 mg/dl.
3 The nurse must ensure the client is not given anything by mouth on the morning of the surgery. The client must take a full dose of insulin at bedtime the night before surgery. The client is fasting; therefore insulin is not administered on the morning of the surgery. The client is given intravenous 5% dextrose if her glucose levels fall below 70 mg/dl during active labor. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.
What are maternal and neonatal risks associated with gestational diabetes mellitus? 1 Maternal premature rupture of membranes and neonatal sepsis. 2 Maternal hyperemesis and neonatal low birth weight. 3 Maternal preeclampsia and fetal macrosomia. 4 Maternal placenta previa and fetal prematurity.
3 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. Hyperemesis is not seen with gestational diabetes, nor is there an association with low birth weight of the infant. Placental previa and subsequent prematurity of the neonate are not risks associated with gestational diabetes.
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes what as the most important factor affecting pregnancy outcome? 1 Mother's age 2 Number of years since diabetes was diagnosed 3 Amount of insulin required prenatally 4 Degree of glycemic control during pregnancy
4 Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Test-Taking Tip: Become familiar with reading questions on a computer screen. Familiarity reduces anxiety and decreases errors.
What is gestational diabetes? 1 Diabetes that accompanies hypertension 2 Diabetes that begins abruptly at a young age 3 Diabetes caused by absolute insulin deficiency 4 Diabetes that is diagnosed during pregnancy
4 Gestational diabetes is a type of diabetes that did not exist before it was diagnosed during pregnancy. Hypertension is a risk factor for type 2 diabetes. Type 1 diabetes usually begins abruptly at a young age. People with type 1 diabetes have absolute insulin deficiency resulting from the destruction of beta cells in the pancreas. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation.
The insulin dose of a client in the second trimester of pregnancy has been increased. When does the nurse expect the client's prepregnant dose of insulin to be recommended again? 1 When the client starts lactating 2 When the client delivers the baby 3 When the client is in the third trimester 4 When the client weans the baby from breastfeeding
4 Pregnancy hormones cause increased glucose tolerance and decreased sensitivity to insulin. This results in an increased need of insulin to obtain glycemic control. In this case, the client's glucose metabolism would reach its prepregnant state only when the client stops breastfeeding the baby. During lactation, the maternal glucose is utilized and, therefore, the client would require a low dose of insulin. When the client delivers the baby, the insulin-glucose levels do not return to their nonpregnant state immediately. Therefore, the client still has to continue with the recommended high insulin dose for some time. During the third trimester, the diabetogenic effect of hormones is excessive, and maternal insulin requirements may double.
Which assessment finding does the nurse recognize as an indicator for early screening for gestational diabetes mellitus (GDM)? 1 The client is 24 years old. 2 The client's body mass index (BMI) is 22. 3 The client does not have diabetes. 4 The client had a previous stillbirth.
4 Screening for GDM usually takes place between 24 and 28 weeks of gestation. However, the client is screened for GDM earlier if there is a history of stillbirth or birth of a malformed or macrosomic infant. A 24-year-old client would not be considered for earlier screening for GDM; maternal age older than 25 years is a risk factor for GDM. A client with a BMI of 22 is not obese and is not considered for earlier screening for GDM. If the client does not have diabetes before gestation, the client need not be screened early for GDM. Test-Taking Tip: The night before the examination you may wish to review some key concepts that you believe need additional time, but then relax and get a good night's sleep. Remember to set your alarm, allowing yourself plenty of time to dress comfortably (preferably in layers, depending on the weather), have a good breakfast, and arrive at the testing site at least 15 to 30 minutes early.
A pregnant woman at 28 weeks of gestation has been diagnosed with gestational diabetes. The nurse caring for this woman understands what? 1 Oral hypoglycemic agents can be used if the woman is reluctant to give herself insulin. 2 Dietary modifications and insulin are both required for adequate treatment. 3 Glucose levels are monitored by testing urine 4 times a day and at bedtime. 4 Dietary management involves distributing nutrient requirements over three meals and two or three snacks.
4 Small frequent meals over a 24-hour period help decrease the risk for hypoglycemia and ketoacidosis. Oral hypoglycemic agents can be harmful to the fetus and less effective than insulin in achieving tight glucose control. In some women gestational diabetes can be controlled with dietary modifications alone. Blood, not urine, glucose levels are monitored several times a day. Urine is tested for ketone content; results should be negative.
The nurse is caring for a client with gestational diabetes. What does the nurse teach the client about using insulin? 1 Store unused vials of insulin in the freezer. 2 Shake the prepared syringes well before use. 3 Administer long-acting insulin before meals. 4 Inject insulin in the abdomen.
4 The nurse must teach the client that the abdomen is the preferred site for injecting insulin, because insulin is best absorbed in the abdominal area. Other suitable sites include the upper outer arm, the thighs, and the buttocks. Insulin must not be frozen, so unused vials of insulin are stored in the refrigerator, but not in the freezer. Syringes containing mixed insulin may be stored for up to 2 weeks in the refrigerator. The syringe must not be shaken; it must be gently rotated 20 times before injection. Long-acting insulin is usually administered at bedtime, because it provides glucose control for a longer duration. Test-Taking Tip: What happens if you find yourself in a slump over the examination? Take a time-out to refocus and reenergize! Talk to friends and family who support your efforts in achieving one of your major accomplishments in life. This effort will help you regain confidence in yourself and get you back on track toward the realization of your long-anticipated goal.
The nurse is caring for a pregnant client prescribed levothyroxine for hypothyroidism. The client is also prescribed an iron supplement. What information does the nurse provide the client about taking these medications? 1 Take both medications together in the morning. 2 Take levothyroxine 1 hour after taking the iron supplement. 3 Take the iron supplement 2 hours after taking levothyroxine. 4 Take the two medications at different times of the day.
4 The nurse should teach the client to take the medications at different times of the day. Ferrous sulfate in the iron supplement decreases the absorption of T4, so their administration should be spaced at least 4 hours apart. If the medications are taken together, the levothyroxine will not be effective. The client should maintain a gap of at least 4 hours between both medications so that both medications are effective.
In planning for the care of a 30-year-old woman with pregestational diabetes, the nurse recognizes that which is the most important factor affecting pregnancy outcome? 1 Mother's age 2 Number of years since diabetes was diagnosed 3 Amount of insulin required prenatally 4 Degree of glycemic control during pregnancy
4 Women with excellent glucose control and no blood vessel disease should have good pregnancy outcomes. Although advanced maternal age may pose some health risks, for the woman with pregestational diabetes the most important factor remains the degree of glycemic control during pregnancy. The number of years since diagnosis is not as relevant to outcomes as the degree of glycemic control. The key to reducing risk in the pregestational diabetic woman is not the amount of insulin required but rather the level of glycemic control. Test-Taking Tip: Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush! Students who achieve higher scores on examinations are typically those who use their time judiciously.
