10. Gestational Hypertension & Diabetes

gestational diabetes risk factors (4)

-obesity -hypertension -age >25 yrs -previous delivery of large infant

hyperglycemia symptoms (6)

-polydipsia -polyphagia -polyuria -nausea -abdominal pain -flushed, dry skin

insulin needs during pregnancy

-↓ 1st trimester -↑ 2nd and 3rd trimesters

HELLP abnormal lab findings (4)

-↓ Hgb (hemolysis, anemia) -↑ liver enzymes (AST, ALT, LDH) -↓ platelets/thrombocytopenia (<100,000/mm³) -↑ creatinine

During a prenatal visit, a nurse is explaining dietary management to a client with pre-existing diabetes mellitus. The nurse determines that teaching has been effective if the client makes which statement? 1. "Diet and insulin needs change during pregnancy." 2. "I will plan my diet based on the results of urine glucose testing." 3. "I will need to eat 600 more calories every day because I am pregnant." 4. "I can continue with the same diet as before pregnancy, as long as it is well balanced."

1. "Diet and insulin needs change during pregnancy." NCLEX

A maternity unit nurse is developing a plan of care for a client with severe preeclampsia who will be admitted to the nursing unit. The nurse should include which nursing intervention in the plan? 1. Restrict food and fluids. 2. Reduce external stimuli. 3. Monitor blood glucose levels. 4. Maintain the client in a supine position.

2. Reduce external stimuli. (pt at risk for seizure) NCLEX

A client with severe preeclampsia is admitted to the maternity department. Which room assignment would be most appropriate for this client? 1. A private room across from the elevator 2. A semiprivate room across from the nurses' station 3. A private room two doors away from the nurses' station 4. A semiprivate room with another client who enjoys watching television

3. A private room two doors away from the nurses' station (quiet room in which stimuli can be minimized is most important for the pt with severe preeclampsia) NCLEX

gestational hypertension (GH)

-begins after 20th week of pregnancy -BP ≥140/90 recorded 2x at least 4 hr apart -no proteinuria

hypertensive disease symptoms (4)

-headache -blurred vision, visual disturbances -facial edema -epigastric pain

gestational diabetes mellitus (GDM)

impaired tolerance to glucose with 1st onset during pregnancy

eclampsia

preeclampsia + seizures

A client has been hospitalized for several days with severe pregnancy-induced hypertension, As you care for her, she begins to have a seizure. What should you do first? A. Pad the sides of the bedframe B. Turn the client on her right side C. Have a padded tongue blade at the client's bedside for the next seizure D. Summon help immediately from the client's room

D. Summon help immediately from the client's room disc

The nurse in the prenatal clinic is planning care for a pregnant 15-year-old client. The nurse knows that this adolescent is at risk for which maternal complication? a. Postpartum hemorrhage b. Hypoglycemia c. Cesarean birth d. Preeclampsia

d. Preeclampsia (adolescents are at increased risk for preeclampsia) text

gestational hypertension risk factors (6)

-1st pregnancy -age <19 yrs or >40 yrs -obesity -diabetes -multiple gestation -hx chronic hypertension

The nurse is reviewing the medical record of a woman scheduled for her weekly prenatal appointment. The nurse notes that the woman has been diagnosed with mild preeclampsia. Which interventions should the nurse include in planning nursing care for this client? (Select all that apply) 1. Assess blood pressure. 2. Check the urine for protein. 3. Assess deep tendon reflexes. 4. Discuss the need for hospitalization. 5. Teach the importance of keeping track of a daily weight.

1. Assess blood pressure. 2. Check the urine for protein. 3. Assess deep tendon reflexes. 5. Teach the importance of keeping track of a daily weight. NCLEX

HELLP syndrome

Hemolysis Elevated Liver enzymes Low Platelets

clonus

when the foot maintained in dorsiflexion is released, but taps against the examiner's hand rather than returning to normal position

The nurse is assessing a pregnant client with type 1 diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that further teaching is needed if the client makes which statement? 1. "I will need to increase my insulin dosage during the first 3 months of pregnancy." 2. "My insulin dose will likely need to be increased during the second and third trimesters." 3. "Episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy." 4. "My insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding."

1. "I will need to increase my insulin dosage during the first 3 months of pregnancy." (Insulin needs decrease in the 1st trimester because of increased insulin production by the pancreas and increased peripheral sensitivity to insulin) NCLEX

The nurse is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy may require which treatment? 1. Increased insulin 2. Decreased insulin 3. Increased caloric intake 4. Decreased caloric intake

1. Increased insulin NCLEX

A home care nurse is visiting a pregnant client with a diagnosis of mild preeclampsia. What is the priority nursing intervention during the home visit? 1. Monitor for fetal movement. 2. Monitor the maternal blood glucose. 3. Instruct the client to maintain complete bed rest. 4. Instruct the client to restrict dietary sodium and any food items that contain sodium.

1. Monitor for fetal movement. NCLEX

The home care nurse is monitoring a pregnant client with gestational hypertension who is at risk for preeclampsia. At each home care visit, the nurse assesses the client for which classic signs of preeclampsia? (Select all that apply) 1. Proteinuria 2. Hypertension 3. Low-grade fever 4. Generalized edema 5. Increased pulse rate 6. Increased respiratory rate

1. Proteinuria 2. Hypertension NCLEX

A woman in the third trimester of pregnancy with a diagnosis of mild preeclampsia is being monitored at home. The home care nurse teaches the woman about the signs that need to be reported to the health care provider. The nurse should tell the woman to call the health care provider if which occurs? 1. Urine tests negative for protein. 2. Fetal movements are more than four per hour. 3. Weight increases by more than 1 pound in a week. 4. The blood pressure reading is ranging between 122/80 and 132/88 mm Hg.

3. Weight increases by more than 1 pound in a week. (nurse should instruct pt to report any increase in BP, protein in the urine, weight gain > 1 lb/week, or edema) NCLEX

The nurse is performing an assessment on a pregnant client with a diagnosis of severe preeclampsia. The nurse reviews the assessment findings and determines that which finding is most closely associated with a complication of this diagnosis? 1. Enlargement of the breasts 2. Complaints of feeling hot when the room is cool 3. Periods of fetal movement followed by quiet periods 4. Evidence of bleeding, such as in the gums, petechiae, and purpura

4. Evidence of bleeding, such as in the gums, petechiae, and purpura (symptoms of DIC) NCLEX

A prenatal client with diabetes asks the nurse about pregnancy-related complications for her baby from diabetes. For what is the baby at risk when the mother has diabetes? (Select all that apply.) a. Sacral agenesis b. Hyperactivity c. Macrosomia d. Respiratory distress syndrome

a. Sacral agenesis c. Macrosomia d. Respiratory distress syndrome text

The nurse is teaching a client with diabetes about insulin requirements during pregnancy. Which statement is true regarding insulin requirements? a. Insulin needs increase early in the first trimester. b. Insulin needs increase late in the first trimester. c. Insulin needs decrease early in the third trimester. d. Insulin needs decrease late in the third trimester.

b. Insulin needs increase late in the first trimester. text

A nurse in a provider's office is reviewing the medical record of a client who is in her first trimester of pregnancy. Which of the following findings should the nurse identify as a risk factor for the development of preeclampsia? a. singleton pregnancy b. BMI of 20 c. maternal age 32 years d. pregestational diabetes mellitus

d. pregestational diabetes mellitus (Other risk factors include preexisting hypertension, renal disease, systemic lupus erythematosus, and rheumatoid arthritis) ATI

preeclampsia

new-onset hypertension + proteinuria or end-organ dysfunction after 20 weeks' gestation

The nurse is caring for a laboring client with type 1 diabetes. What is the expected effect of labor on the woman's insulin requirements? a. Insulin is generally not required in labor. b. Close monitoring is unnecessary because requirements are predictable. c. They are consistently increased. d. They are likely to decrease.

d. They are likely to decrease. text

mild vs severe preeclampsia: BP

-mild = BP 140/90-160/110 mm Hg -severe = BP ≥160/110 mm Hg (2 readings 4 hrs apart)

hypoglycemia symptoms (7)

-nervousness -headache -weakness -irritability -hunger -blurred vision -tingling of mouth or extremities (ATI)

The nurse is reviewing the record of a pregnant client seen in the health care clinic for the first prenatal visit. Which data if noted on the client's record would alert the nurse that the client is at risk for developing gestational diabetes during this pregnancy? 1. The client's last baby weighed 10 pounds at birth. 2. The client's previous deliveries were by cesarean birth. 3. The client has a family history of cardiovascular disease. 4. The client is 5 feet 3 inches in height and weighs 165 pounds.

1. The client's last baby weighed 10 pounds at birth. NCLEX

A home care nurse is monitoring a 16-year-old primigravida who is at 36 weeks' gestation and has gestational hypertension. Her blood pressure during the past 3 weeks has been averaging in the 130/90 mm Hg range. She has had some swelling in the lower extremities and has had mild proteinuria. Which statement by the woman should alert the nurse to the worsening of gestational hypertension? 1. "My vision the past 2 days has been really fuzzy." 2. "The swelling in my hands and ankles has gone down." 3. "I had heartburn yesterday after I ate some spicy foods." 4. "I had a headache yesterday, but I took some acetaminophen and it went away."

1. "My vision the past 2 days has been really fuzzy." NCLEX

The nurse is developing a plan of care for a pregnant client with a diagnosis of severe preeclampsia. Which nursing actions should be included in the care plan for this client? Select all that apply. 1. Keep the room semi-dark. 2. Initiate seizure precautions. 3. Pad the side rails of the bed. 4. Avoid environmental stimulation. 5. Allow out-of-bed activity as tolerated.

1. Keep the room semi-dark. 2. Initiate seizure precautions. 3. Pad the side rails of the bed. 4. Avoid environmental stimulation. NCLEX

The nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational diabetes mellitus. Which statement made by the client indicates a need for further teaching? 1. "I should stay on the diabetic diet." 2. "I should perform glucose monitoring at home." 3. "I should avoid exercise because of the negative effects on insulin production." 4. "I should be aware of any infections and report signs of infection immediately to my health care provider."

3. "I should avoid exercise because of the negative effects on insulin production." NCLEX

The nurse in an obstetrical clinic is reviewing current prenatal laboratory results of a pregnant client who is being seen for a routine prenatal visit. The nurse discovers the client's 1-hour oral glucose tolerance test (OGTT) result to be 163 mg/dL. Which would be the nurse's best response to the client? 1. "Your OGTT results indicate that your baby is at high risk for macrosomia and special considerations may be necessary at delivery." 2. "Your OGTT results are within normal limits, but continuing your prenatal visits remains essential to monitor fetal growth and development." 3. "The OGTT is a screening tool for gestational diabetes, and you will need further testing to confirm a diagnosis owing to your results being elevated." 4. "Your OGTT results indicate that you are positive for gestational diabetes. You will be scheduled for a dietitian consultation to plan your daily dietary intake."

3. "The OGTT is a screening tool for gestational diabetes, and you will need further testing to confirm a diagnosis owing to your results being elevated." NCLEX

The nurse is counseling a pregnant woman diagnosed with gestational diabetes at 29 weeks of gestation. Which information should the nurse discuss with the client? Select all that apply. 1. Plan induction at 35 weeks. 2. Plan amniocentesis at this time. 3. Schedule biophysical profile immediately. 4. Plan for weekly non-stress test at 32 weeks. 5. Obtain nutritional counseling with a dietitian.

4. Plan for weekly non-stress test at 32 weeks. 5. Obtain nutritional counseling with a dietitian. NCLEX

The home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia. Which assessment finding indicates a worsening of the preeclampsia and the need to notify the health care provider? 1. Urinary output has increased. 2. Dependent edema has resolved. 3. Blood pressure reading is at the prenatal baseline. 4. The client complains of a headache and blurred vision.

4. The client complains of a headache and blurred vision. NCLEX