Gestational diabetes
When are most pregnant patients tested for gestational diabetes? A. 6-12 weeks gestation B. 12-20 weeks gestation C. 24-28 weeks gestation D. 34-36 week gestation
c
Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic? A. Blood glucose 55 mg/dL B. Blood glucose 82 mg/dL C. Blood glucose 148 mg/dL D. Blood glucose 325 mg/dL
b (Euglycemic means "normal" blood glucose level. Typically a normal blood glucose level is about 70-140 mg/dL. The only option that reflects a normal blood glucose level is option B: 82 mg/dL...Option A is HYPOglycemic, Option C is slightly HYPERglycemic, Option D is HYPERglycemic.)
Fill-in the blank: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is _____________. This is majorly influenced by hormones such as estrogen, progesterone, _______________ and _______________. A. high; prolactin and human chorionic gonadotropin (hCG) B. low; estriol and human placental lactogen (hPL) C. high; human chorionic gonadotropin (hCG) and cortisol D. low; human placental lactogen (hPL) and cortisol
D (The statement should read: When a woman develops gestational diabetes it is during a time in the pregnancy when insulin sensitivity is LOW. This is majorly influenced by hormones such as estrogen, progesterone, HUMAN PLACENTAL LACTOGEN (hPL) and CORTISOL.)
A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician's order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician? A. "It burns when I urinate." B. "My back is hurting." C. "I feel tired." D. "I feel the baby kick about 10 times an hour."
a (Gestational diabetes places a patient at risk for urinary tract infections because the glucose can leak into the urine leading to infection (remember bacteria thrive on glucose). This scenario tells us the patient has uncontrolled hyperglycemia, which definitely puts her at risk for glycosuria (glucose in the urine). The physician should be notified if the patient reports burning on urination so a urine analysis can be performed. All the other options are normal findings in a pregnancy at this stage.)
A primip diagnosed with type 1 dm reviews the insuliln regimen with the nurse. The nurse explains which changes in insulin requirements will occur in pregnancy? a. insulin requirements will increase during pregnancy and decrease after delivery b. insulin requirements will decrease during pregnancy and increase after delivery c. insulin requirements will increase during pregnancy and remain increased after delivery d. insulin requirements decrease during pregnancy and remain decreased after delivery
a (hormones will interfere with glucose metabolism and insulin will need to be increased during pregnancy)
Where will the nurse expect to palpate the uterine fundus two hours post birth? a midline at the umbilicus b. midline 2 cm above the umbilicus c. shifted left at the umbilicus d. shifted right 4 cm below umbilicus
a (the fundus will be midline after birth for 24 hours. A fundus above the umbilicus or shifted right or left may indicate blood in the uterus or a full bladder)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures. She has a shoulder dystocia in which the nurse performed the McRobert's and the OB performed an episiotomy. The baby is born 9 lb 9 oz, the 1 minute apgar is 1 and the 5 minute apgar is 9. Stimulation and flow by oxygen was used for 1 minute. Which newborn behavior would indicate to the nurse that the infant has suffered a complication from the shoulder dystocia? a. unilateral absence of the moro reflex b. one eye remains open when crying c. positive babinksi reflex bilaterally d. presence of caput succedaneum
a (this indicates fractured clavicle, a common complication of shoulder dystocias. The fracture heals rapidly and immobilization is accomplished with slings, splints, or simple swaddling. option b is indicative of facial paralysis (palsy) which is not common with shoulder dystocia. A positive babinski is normal. option d is a common finding and has no pathological significance.)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for GDM are positive. The patient asks how she will know if she has high blood sugar. Which response should the nurse give? (select all) a. hyperglycemia often presents as increased thirst and urination b. hyperglycemia causes a headache and flushed, dry skin c. hyperglycemia causes cool and clammy skin d. hyperglycemia causes an increased sensation of being hungry
a, b, and d (hypoglycemia causes cool and clammy skin)
A 32 year old multigravida at 36 weeks with GDM delivers and is transferred to postpartum 2 hours after delivery. In postpartum there is a new graduate RN, an RN with 3 years of experience, and an RN with 10 years of experience as well as a LPN with 20 years of experience. Which client should the charge nurse assign to the LPN? a. the 32 year old multigravida with GDM and breasfeeding problems b. a multigravida who had an uncomplicated delivery and is breastfeeding c. a primigravida who had a c/s 4 hours ago and is bottle feeding d. a primigravida who is 12 hours posteclamptic seizure and is bottle feeding
b (LPN is qualified to care for non complicated patients)
A 32 year old multigravida at 36 weeks comes into the clinic. Her screenings for GDM are positive. She manages GDM with diet. She has decreased fetal movement is is admitted to antepartum for a nonstress test and biophysical profile. She has a nonreactive nonstress test. her total BPP score is 6: 2 for fetal movement, 0 for gross body movement, 2 for fetal tone, 0 for nonreactive nonstress test, and 2 for qualitative amniotic fluid volume. For this reason, the doctor orders an amniocentesis. Which action should the nurse take first? a. administer Rh immune globulin (RhoGAM) if the client is Rh negative b. assist the client to the bathroom and ask her to empty her bladder c. apply the external fetal monitor to evaluate uterine contractility d. clean the abdomen with betadine solution and sterile 4x4
b (this is to avoid accidental bladder puncture during procedure)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures. She is 6 cm dilated and requests pain medication, but not an epidural. The nurse gets an order for 1 mg IV tartrate (stadol). The patient would like one half of the prescribed dose of butorphanol tartrate (stadol). What action should the nurse take? a. administer one half the dose as requested b. b. Tell the client that she must take the whole dose c. request a change in prescription d. substitute medication with fewer side effects
c
A patient completes a one hour glucose tolerance test. The patient's result is 190 mg/dL. As the nurse you know that the next step in the patient's care is to? A. Continue monitoring pregnancy, the test is normal B. Reassess blood glucose in 2 weeks C. Notify the physician who will order the patient to take a 3 hour glucose tolerance test D. Provide education to the patient about how to manage gestational diabetes during pregnancy
c (A test result >140 mg/dL for 1 hour glucose tolerance test requires that the patient take a 3 hour glucose tolerance test. This test will be used to diagnose if the patient has gestational diabetes)
A 32 year old multigravida at 36 weeks comes into the clinic. Her screenings for GDM are positive. She manages GDM with diet. She has decreased fetal movement is is admitted to antepartum for a nonstress test and biophysical profile. Which fetal heart rate changes indicate a reactive nonstress test? a. persistent late decelerations associated with three uterine contractions, lasting 40 to 60 seconds each in a 10 minute period b. increase in fetal heart rate baseline to 170 bpm, lasting for 20 minutes c. marked variability in fetal heart rate in response to contractions caused by nipple stimulation d. two episodes of acceleration (greater than 15 beats/minute, lasting more than 15 seconds) related to fetal movement in a 20 minute period
d
When do most patients tend to develop gestational diabetes during pregnancy? A. usually during the 1-3 month of pregnancy B. usually during the 2-3 month of pregnancy C. usually during the 1-2 trimester of pregnancy D. usually during the 2-3 trimester of pregnancy
d (Gestational diabetes is a form of diabetes that develops during pregnancy, usually during 2nd or 3rd trimester)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures. She is 6 cm dilated and requests pain medication, but not an epidural. The nurse gets an order for 1 mg IV tartrate (stadol). Which assessment information is most important for the nurse to validate with the laboring client before giving the medication? a. past or present history of opioid dependence b. length of all previous labor experiences c. herbal preparation use during pregnancy d. previous use of analgesia or anesthesia in labor
a (Stadol is an opioid agonist-antagonist. It can precipitate withdrawal symptoms in both mother and neonate)
A 32 year old multigravida at 36 weeks with GDM delivers. She asks why insulin was discontinued after the baby was born. How should the nurse respond? a. most women with GDM return to normal glucose levels after birth b. sliding scale insulin will be needed for 6 weeks postpartum c. breastfeeding increases the need for insulin and so you will need a pump d. oral hypoglycemics will be started as soon as the client is eating a regular diet
a (becasue the placenta is the major source of insulin resistance and it is gone after birth, women with GDM will return to normal. Breastfeeding decreases insulin needs because of the carbohydrates used in human milk production.)
A 34-year-old female is currently 16 weeks pregnant. You're collecting the patient's health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient's risk for developing gestational diabetes? A. 34-years-old B. 16 weeks pregnant C. Gravida 5, para 4 D. BMI 28 E. Hypertension F. Depression G. Family history of Type 2 diabetes
a, c, d, and g (Remember from the lecture we talked about the risk factors for gestational diabetes. To help you remember the risk factors think of the word "MOMMA". Maternal age > 25, Obese or overweight (BMI >25), Macrosomia (fetal) previous babies greater than 9 lbs, Multiple pregnancies, A history (previous diagnoses of gestational diabetes or family history of diabetes).)
You're discharging a patient who just gave birth to a baby at 39 weeks gestation. The patient had gestational diabetes throughout her pregnancy. Her blood glucose levels have now returned to normal. When should the patient first follow-up with her physician for blood glucose testing? A. 1-3 years B. 6-12 weeks postpartum C. 1 year postpartum D. Not applicable since this condition has resolved and only occurs during pregnancy
b (Patients who've had gestational diabetes are at high risk for developing Type 2 diabetes. She should first follow-up with her physician at 6-12 weeks postpartum for initial blood glucose testing. After this, she should follow-up 1-3 years for blood glucose testing since there is a high risk of her developing Type 2 diabetes.)
A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You're educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes? A. "Once I deliver the baby, it will go away, and I will not need any further testing." B. "It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals." C. "There are no risks or complications related to gestational diabetes other than hyperglycemia." D. "I'm at risk for delivering a baby that is too small for its gestational age due to this condition."
b (This is the only correct statement in the scenario. It is important the mother monitors her blood glucose level regularly and tries to maintain an euglycemic level (normal blood glucose level): 70-95 mg/dL fasting and <140 mg/dL 1 hour after meals. In most cases, once the baby is delivered, the gestational diabetes will disappear, BUT at 6-12 weeks postpartum the mother will need to be reassessed for diabetes. Remember in the lecture, according to the CDC.gov 50% of women who are diagnosed with gestational diabetes will develop Type 2 diabetes later on. There are risks and complications associated with gestational diabetes such as pre-term labor, preeclampsia, hyper/hypoglycemia, macrosomia (large baby), hypoglycemia in baby at birth etc.)
A 32 year old multigravida at 28 weeks comes into the clinic. The nurse notes her fasting 1 hour glucose screening level is 164 mg/dL. She is scheduled for a 3 hour oral glucose tolerance test. Which special instructions in addition to fasting 8 hour before the appointment should the nurse give? a. only coffee or tea is allowed once the fasting level has been drawn b. follow an unrestricted diet and exercise pattern for 3 days before the test c. write down questions and call the lab the day before the test d. smoking in moderation is allowed up to the time the test begins
b (caffeine in any form should be avoided because it increases glucose levels. smoking should be avoided at least 12 hours before the test. Smoking shouldnt be done during pregnancy at all)
A 32 year old multigravida at 28 weeks comes into the clinic. The nurse notes her fasting 1 hour glucose screening level is 164 mg/dL. Which information does the nurse recognize in the client's history to support a diagnosis of gestational diabetes? a. maternal great-aunt has non-insulent Type-2 diabetes b. Child weighed 9 lbs (4.08 kg) at 41 weeks gestation c. Trace of protein noted in the urine d. client is 64 in tall and weighs 134 prior to pregnancy
b (family history is not a risk factor unless it is first-degree. Birth weight over 9 lbs, maternal age over 25, history of unexplained stillborn, family history of type 1, strong family history of type 2, and history of gdm in previous pregnancy are all risk factors. D is within the normal BMI range.)
A charge nurse hears another nurse give misinformation about RhoGam. Which information should the nurse give about the RhoGam injection? a. RhoGam is given to the infant 48 hours after delivery b. RhoGam is given to the mother within 72 hours of delivery if the infant is Rh positive c. RhoGam is a vaccine given to a mother with Rh-positive blood within 24 hours of delivery d. RhoGam is given at 18 weeks gestation to mothers with Rh-negative blood
b (it is never given to an infant. it is given to a Rh negative mother with a Rh positive infant with 72 hours of birth, it is an immune globulin. It is given at 28 weeks, not 18)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for GDM are positive. Which instructions should the diabetes educator include regarding fingerstick blood glucose monitoring? a. check fasting blood sugar at lunch b. prior to breakfast and before each meal c. two hours after all meals, at bedtime, and in the middle of the night d. once a day at dinner
b (you want fasting levels to see if the prescribed diet is promoting euglycemia)
A patient has a 3 hour glucose tolerance test performed. The results are the following: Fasting 94 mg/dL, 1 hour 210 mg/dL, 2 hour 180 mg/dL, 3 hour 130 mg/dL. Identify which results are abnormal: Select all that apply: A. Fasting result B. 1 hour result C. 2 hour result D. 3 hour result
b and c (Abnormal results for a 3 hour glucose tolerance test are: Fasting >95 mg/dL, 1 hour >180 mg/dL, 2 hour >155 mg/dL, 3 hour >140 mg/dL)
You're providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin: A. "Insulin is a type of cell that provides glucose to the body from the blood." B. "Insulin is a hormone secreted by the beta cells of the pancreas." C. "Insulin influences cells by causing them to uptake glucose from the blood." D. "Insulin is a protein that helps carry glucose into the cell for energy."
b and c (Insulin is a HORMONE secreted by the beta cells found in the pancreas. It influences or causes cells to take in glucose from the blood. Option A and D are incorrect statements about insulin.)
A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply: A. Blood glucose 129 mg/dL B. Blood pressure 190/102 C. Proteinuria D. Linea nigra E. Negative glycosuria
b and c (Preeclampsia is a potential complication of gestational diabetes. It can cause hypertension (option B) and protein in the urine (option C). Option A is a normal blood glucose reading, option D is a normal finding during pregnancy, and option E is a normal finding (an abnormal finding would be positive glycosuria...meaning there is glucose leaking in the urine).)
A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply: A. Hyperglycemia B. Hypoglycemia C. Respiratory distress D. Jaundice E. Hyperthermia
b and c (The newborn is at risk for hypoglycemia and respiratory distress. When a baby of a mom, who has gestational diabetes, is still in utero there is a constant high supply of glucose. This causes the baby to increase its fat stores (producing a large baby) and create a lot of insulin to deal with the high glucose it is receiving from mom. BUT once the baby leaves utero, the glucose supply decreases but the baby still has a lot of insulin on board. This can lead to a drop in blood glucose (hypoglycemia) at birth. In addition, uncontrolled gestational diabetes can affect lung maturity in babies and this increases the newborn's risk of respiratory distress at birth.)
A 32 year old multigravida at 36 weeks with GDM delivers. Which information is the most important for the nurse to discuss concerning the use of contraception while breast feeding? (select all) a. irregular vaginal bleeding (breakthrough bleeding) is not unusual when using this medication and usually lessens over time b. if a dose is taken more than 3 hours late, a backup method birth control must be used for 48 hours c. it is important to notify lab personnel that this medication is being used because it alters the results of certain tests d. it is important to use another method of contraception prior to starting the mini pill e. the medication may be taken with food if the side effect of nausea occurs when ingested on an empty stomach
b and d (a is true, but not relevant to discuss. contraception should be taken at the same time every day. c is true, but not important to discuss for this question. Breast feeding can suppress fertility, but you need another method as soon as there is a decline because protection decreases. d is true, but not important to discuss for this question.)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for GDM are positive. She asks about content and timing of her meals How should the nurse advice? (select all) a. eliminate the bedtime snack if heartburn develops b. choose complex carbs that are high in fiber c. increase the protein if anemia develops d .avoid foods high in refined sugars e. drink between 8 to 10 cups of fluid daily
b, d, and e (a bedtime snack can prevent hypoglycemia through the night. proteins and fats should not be altered to control anemia, iron would be prescribed.)
A 32 year old multigravida at 28 weeks comes in to the clinic. She has given birth three times, once at 35 weeks (twins), once at 38 weeks (singleton), and once at 41 weeks (singleton). All children are alive and well. She had one spontaneous abortion at 10 weeks. How should the nurse record her obstetrical history using GTPAL designation? a. 3-2-0-1-3 b. 4-1-1-1-2 c. 5-2-1-1-4 d. 4-2-1-0-2
c (G is for gravidity, the number of times she was pregnant, including the current pregnancy. T is for term, meaning babies born at 37 weeks or older. P refers to any births between 20 and 37 weeks, both term and preterm describe live births. A is abortion for any fetal loss whether spontaneous or elective, up to 20 weeks gestation. L is for living, referring to all living children.)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures. The patients husband asks why blood sugar is maintained between 70 and 90. What nurse response is best? a. more insulin will be available for fetal use via placental transfer b. a glucose level more than 90-100 puts the client at risk for infection c. an elevated glucose in labor increases the risk for neonatal hypoglycemia d. maintaining euglycemia in labor decreases the need for insulin postpartum
c (maternal glucose crosses the placenta and the fetus responds by making insulin. Over time, hyperplasia of the fetal pancreas occurs with subsequent hyperinsulinemia. When the maternal glucose disappears after delivery, the neonate's blood glucose level decreases rapidly.)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for GDM are positive. The patient asks why she wasnt tested until 28 weeks. The nurse's response should be based on the understanding of which normal physiologic change of pregnancy? a. maternal insulin crosses the placenta to regulate fetal glucose levels throughout the pregnancy b. in the first trimester, estrogen and progesterone cause an increase in fasting glucose levels c. hormonal changes in the second and third trimester increase the maternal insulin resistance d. fetal insulin increases each trimester, forcing the mother's body to produce more glucose
c (maternal insulin does not cross the placenta. increased estrogen and progesterone stimulate the pancreas to increase insulin production, decreasing glucose levels. Increasing hormones in the second and third trimester act as insulin antagonists. Most pregnant bodies are able to handle this, but some are not as tolerant. Fetal insulin starts around 10 weeks gestation and is adequate for the glucose the baby gets from the mother.)
A 32 year old multigravida at 36 weeks comes into antepartum with decreased fetal movement and GDM. An amniocentesis reveals fetal lung maturity and an induction is scheduled for the next morning. The next morning she complains of uterine discomfort and contractions every 10 minutes, her membranes rupture spontaneously. Which action by the nurse takes priority? a. notify the OB b. transfer patient to a labor and delivery recovery suite c. reapply the external fetal monitor to evaluate the fetal heart rate d. start an IV using an 18 or large IV catheter
c (the babys response to the rupture needs to be evaluated due to risk of cord prolapse)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures. She is 8 cm dilated, fully effaced, and at 0 station and received the pain medication stadol. The nurse is called away to care for a 29 week gestation with painless vaginal bleeding. The nurse is concerned for the care of her 28 week gestation, but the charge nurse says there is no one else. What should the nurse do? a. care for both clients b. call the clients HCP c. contact the nursing supervisor d. refuse to care for either client
c (this is appropriate use of chain of command.)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures. She has a shoulder dystocia in which the nurse performed the McRobert's and the OB performed an episiotomy. The newborn's assessment is normal. The mother is worried about the baby developing hypoglycemia. What should the nurse recommend for feeding? a. The baby needs formula to prevent hypoglycemia and jaundice b. the newborn needs breast milk and 5% dextrose in water c. breastfeeding should be initiated immediately and done on demand d. a mixture of breastmilk and formula will prevent complications
c (this is the best option and should be done before anything else is considered)
You're teaching a pregnant mother with gestational diabetes about the signs and symptoms of hyperglycemia. What are the signs and symptoms you will include in your education to the patient? Select all that apply: A. Sweating B. Confusion C. Frequent hunger D. Polydipsia E. Anxiety F. Frequent urination
c, d, and f (Remember the 3 Ps for hyperglycemia: Polyphagia (frequent hunger), polydipsia (frequent thirst), polyuria (frequent urination). Sweating, confusion, and anxiety are signs and symptoms of HYPOglycemia (low blood glucose).)
You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of ______________ 1 hour after a meal. A. <70 mg/dL B. <250 mg/dL C. >160 mg/dL D. <140 mg/dL
d
A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition? A. 1 hour glucose tolerance test B. 24 hour urine collection C. Hemoglobin A1C D. 3 hour glucose tolerance test
d (If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.)
A 32 year old multigravida at 36 weeks with GDM spontaneously ruptures, is complete and feels a strong urge to push. The fetal heart rate indicates moderate variability and a baseline of 145 bpm. After three pushes the head is crowning. The head is born over an intact perineum, but rotates externally and retracts back against the perineum. The nurse and OB recognize these as signs of a should dystocia. Which immediate action should the nurse take? a. notify the operating room to prepare for c/s b. apply external pressure to the fundus c. administer 0.25 mg terbutaline (brethine) subq d. reposition the client using McRobert's maneuver
d (option a (Zavanelli's maneuver) is a last resort. option b the pressure would further wedge the should under the symphysis pubis and may cause injury to mom and baby. Option b would relax the uterus and is not needed at this time. option d is helping the mother flex and abduct hips, placing thighs up to the abdomen. This position decreses the angle of the pelvic inclination, rotates the symphysis pubis and causes the sacrum to straighten, freeing the shoulder. This could be combined with suprapubic pressure which also helps free the shoulder from the symphysis pubis.)
