A 26-year-old pregnant woman at 26 weeks gestation is undergoing a 1-hour glucose challenge screening. She drinks the 50-gram glucose solution, and her blood glucose is measured 1 hour later at 150 mg/dL. Which of the following is the most appropriate next step?
Repeat the 1-hour test tomorrow
Schedule a 3-hour oral glucose tolerance test for diagnostic confirmation
Begin insulin therapy immediately
Reassure the patient that the result is normal; no further testing is needed
The Correct Answer is B
A. Repeating the screening test is not standard practice. A screening value above the threshold requires a diagnostic test, not a repeat screening.
B. The 1-hour 50-gram glucose challenge is a screening test for gestational diabetes mellitus (GDM). A blood glucose level of ≥140 mg/dL (some guidelines use 130 mg/dL) indicates a positive screen. The next step is a 3-hour, 100-gram OGTT, which is the diagnostic test to confirm or rule out GDM.
C. Initiating insulin therapy is premature. Diagnosis of GDM requires confirmation by the 3-hour OGTT. Treatment decisions, including diet, exercise, or insulin therapy, are based on confirmed diagnosis and blood glucose patterns.
D. A 1-hour glucose level of 150 mg/dL exceeds the normal screening threshold, so further diagnostic testing is required. Reassuring without follow-up could miss a diagnosis of GDM, increasing maternal and fetal risks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Alveolar collapse (atelectasis) due to surfactant deficiency is typically seen in neonatal respiratory distress syndrome, not asthma. Asthma primarily affects the airways, not alveolar surfactant production.
B. In asthma, bronchial smooth muscle constriction occurs, not relaxation. Surfactant production is not a central factor in asthma pathophysiology.
C. These features lead to edema and hyperresponsiveness, contraction of smooth muscle around the bronchi and bronchioles, and mucus accumulation, all contributing to the child’s symptoms.
D. While upper respiratory infections can trigger asthma exacerbations, sinus obstruction itself is not the primary pathophysiologic process in asthma. The key changes occur in the lower airways.
Correct Answer is C
Explanation
A. Fever is a common symptom of RSV, and antipyretics can improve comfort. However, fever itself is not life-threatening and does not directly address the risk of airway compromise or hypoxia. Therefore, antipyretics are secondary to interventions that support breathing and oxygenation.
B. Hydration is important because RSV can cause poor oral intake, dehydration, and increased mucus viscosity, which may worsen airway obstruction. While promoting fluids is necessary, it is not as urgent as ensuring adequate oxygenation.
C. Continuous monitoring of oxygen saturation allows for early detection of hypoxemia. Hypoxia can develop rapidly in infants and toddlers with RSV due to their smaller airway size and limited respiratory reserve. Humidified oxygen helps maintain airway moisture, reduces airway irritation, and supports gas exchange. Ensuring adequate oxygenation prevents complications such as respiratory failure, apnea, or cardiac compromise, making it the highest priority intervention.
D. RSV is highly contagious and spreads via respiratory droplets and direct contact. Precautions are essential to protect staff and other patients, but infection control measures do not address the immediate threat to the patient’s respiratory status. Priority interventions must first ensure the child’s airway and oxygenation are stable.
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