The clinic RN reviews Amanda's prenatal record prior to performing a nursing assessment. Amanda has given birth twice, once at 35-weeks (twins) and once at 39-weeks (singleton). All of these children are alive and well. She has had one spontaneous abortion at 9-weeks gestation. 1.
How should the nurse record Amanda's obstetrical history using the G-T-P-A-L designation? A) 3-2-0-1-3.
Correct answer(s): C
The nurse notes that Amanda's fasting 1 hour glucose screening level, which was done two days previously, is 158 mg/dl. 2.
The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes? A) Maternal great-aunt has insulin dependent (Type 1) diabetes. B) Youngest child weighed 4300 grams at 39-weeks gestation.
C) Trace of protein noted in urine specimen at last prenatal visit. D) Client is 64 inches tall and weighed 134 prior to pregnancy. Correct answer(s): B
Further Glucose Screening
Amanda is scheduled for a 3 hour oral glucose tolerance test in 5 days, and is told to arrive at the lab at 8:30 am. Amanda asks if there are any special instructions for the test in addition to fasting for 8 hours immediately prior to the test. 3.
Which instruction should the nurse give the client?
A) Only coffee or tea is allowed once the fasting level has been drawn. B) Follow an unrestricted diet and exercise pattern for at least 3 days before the test. C) Write down questions and call the laboratory for instructions the day before the test. D) Smoking in moderation is allowed up until the time the test begins. Correct answer(s): B
Amanda asks the nurse why she wasn't tested for gestational diabetes until she was almost 28-weeks gestation. 4.
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 pregnancy. B) In the first trimester, estrogen and progesterone cause an increase in maternal fasting glucose levels. C) Hormonal changes in the second and third trimesters result in increased maternal insulin resistance. D) Fetal insulin production increases each trimester, forcing the mother's body to produce more glucose. Correct answer(s): C
Interdisciplinary Client Care
Amanda's 3 hour Oral Glucose Tolerance Test indicates that she does have gestational diabetes. The RN phones Amanda and arranges for her to meet with the CNM and perinatologist, as well as an RN diabetes educator and a registered dietician (RD) the next day.
The perinatologist and CNM discuss gestational diabetes with Amanda and after seeking input from Amanda, outline their suggested plan of care, which includes dietary control and glucose self-monitoring. After the perinatologist and CNM leave, Amanda appears confused and asks the RN, "Does this mean I will always have diabetes?" 5.
Which response should the nurse give to the client?
A) "You will need to be periodically evaluated for Type 2 diabetes for the rest of your life." B) "There should be no problem as long as you do not have to use insulin during this pregnancy." C) "There is no need to talk about this now. We'll discuss it at your first postpartum visit." D) "Tell me what worries you about the possibility of developing Type 2 diabetes after your pregnancy ends." Correct answer(s): A
After all her questions are answered, Amanda is scheduled for a return visit with the CNM in one week, and is escorted to the office of the registered dietician (RD). The RD discusses the need to control carbohydrates while maintaining an appropriate carbohydrate-protein-fat ratio to promote consistent weight gain (based on the woman's body mass index), prevent ketoacidosis, and encourage normoglycemia (euglycemia). Amanda is then introduced to the RN diabetes educator. She asks the nurse to clarify what the RD told her about the content and timing of her...