Deck 29: Endocrine and Metabolic Disorders in Pregnancy

Question 1

An 18-year-old client who has reached 16 weeks of gestation was recently diagnosed with pregestational diabetes.She attends her centering appointment accompanied by one of her girlfriends.This young woman appears more concerned about how her pregnancy will affect her social life rather than her recent diagnosis of diabetes.A number of nursing diagnoses are applicable to assist in planning adequate care.The most appropriate diagnosis at this time is:

A)Risk for injury,to the fetus related to birth trauma
B)Deficient knowledge,related to diabetic pregnancy management
C)Deficient knowledge,related to insulin administration
D)Risk for injury,to the mother related to hypoglycemia or hyperglycemia

Answer 1

Deficient knowledge,related to diabetic pregnancy management

Question 2

In terms of the incidence and classification of diabetes,maternity nurses should know that:

A)Type 1 diabetes is most common
B)Type 2 diabetes often goes undiagnosed
C)Gestational diabetes mellitus (GDM)means that the woman will receive insulin treatment until 6 weeks after birth
D)Type 1 diabetes may become type 2 during pregnancy

Answer 2

Type 2 diabetes often goes undiagnosed

Question 3

Most women with gestational diabetes mellitus (GDM)develop type 2 diabetes in the postpartum period.Is this statement true or false?

Answer 3

False

Question 4

Pregnancies complicated by nausea and vomiting generally have a more favorable outcome than those without symptoms.Is this statement true or false?

Question 5

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM).In planning her care the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM.The nurse identifies that the fetus is at greatest risk for:

A)Macrosomia
B)Congenital anomalies of the central nervous system
C)Preterm birth
D)Low birth weight

Question 6

Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand.Nurses should know that:

A)Insulin crosses the placenta to the fetus only in the first trimester,after which the fetus secretes its own
B)Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester because they are consuming more sugar
C)During the second and third trimesters,pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus
D)Maternal insulin requirements steadily decline during pregnancy

Question 7

A serious but uncommon complication of undiagnosed or partially treated hyperthyroidism is thyroid storm,which may occur in response to stress such as infection,birth,or surgery.Symptoms of this emergency disorder include (choose all that apply):

A)Fever
B)Hypothermia
C)Restlessness
D)Bradycardia
E)Hypertension

Question 8

A new mother with which of these thyroid disorders would be strongly discouraged from breastfeeding?

A)Hyperthyroidism
B)Phenylketonuria
C)Hypothyroidism
D)Thyroid storm

Question 9

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy,the nurse recognizes that further teaching is warranted when the client states:

A)"I will need to increase my insulin dosage during the first 3 months of pregnancy."
B)"Insulin dosage will likely need to be increased during the second and third trimesters."
C)"Episodes of hypoglycemia are more likely to occur during the first 3 months."
D)"Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

Question 10

A nurse caring for a woman hospitalized for hyperemesis gravidarum expects that initial treatment will involve:

A)Corticosteroids to reduce inflammation
B)IV therapy to correct fluid and electrolyte imbalances
C)An antiemetic,such as pyridoxine,to control nausea and vomiting
D)Enteral nutrition to correct nutritional deficits

Question 11

A nurse providing care for a woman with gestational diabetes understands that a laboratory test for glycosylated hemoglobin Alc:

A)Is done for all pregnant women,not just those with or likely to have diabetes
B)Is a snapshot of glucose control at the moment
C)Levels should remain at less than 7
D)Is done on the woman's urine,not her blood

Question 12

In teaching a woman with pregestational diabetes about desired glucose levels,the nurse explains that a normal fasting glucose level,such as before breakfast,is in the range of:

A)65 to 95 mg/dl
B)130 to 140 mg/dl
C)<120 mg/dl
D)150 to 180 mg/dl

Question 13

During a prenatal visit a nurse is explaining dietary management to a woman with pregestational diabetes.The nurse evaluates that teaching has been effective when the woman states:

A)"I will need to eat 600 more calories per day because I am pregnant."
B)"I can continue with the same diet as before pregnancy as long as it is well balanced."
C)"Diet and insulin needs change during pregnancy."
D)"I will plan my diet based on results of urine glucose testing."

Question 14

Maternal phenylketonuria (PKU)is an important health concern during pregnancy because:

A)It is a recognized cause of preterm labor
B)The fetus may develop neurologic problems
C)A pregnant woman is more likely to die without dietary control
D)Women with PKU are usually retarded and should not reproduce

Question 15

A 26-year-old primigravida has come to the clinic for her regular prenatal visit at 12 weeks.She appears thin and somewhat nervous.She reports that she eats a well-balanced diet,although her weight is 5 pounds less than it was at her last visit.The results of laboratory studies confirm that she has a hyperthyroid condition.Based on the available data,the nurse formulates a plan of care.What nursing diagnosis is most appropriate for the woman at this time?

A)Deficient fluid volume
B)Imbalanced nutrition: less than body requirements
C)Imbalanced nutrition: more than body requirements
D)Disturbed sleep pattern

Question 16

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus,nurses should be aware that:

A)Diabetic ketoacidosis (DKA)can lead to fetal death at any time during pregnancy
B)Hydramnios occurs approximately twice as often in diabetic pregnancies
C)Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies
D)Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being

Question 17

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with:

A)Frequent episodes of maternal hypoglycemia
B)Congenital anomalies in the fetus
C)Polyhydramnios
D)Hyperemesis gravidarum

Question 18

Achieving and maintaining constant ____________________,with blood glucose levels in the range of 65 to 140 mg/dl,is the primary goal of medical therapy for the pregnant woman with diabetes.