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.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Placenta previa typically presents with painless bleeding, not pain. Abdominal pain with bleeding is more suggestive of placental abruption, not previa.
B. Placenta previa is characterized by bright red, painless vaginal bleeding during the second or third trimester, often without uterine tenderness or contractions. The bleeding occurs because the placenta implants over or near the cervical os, which disrupts vascular integrity as the cervix begins to efface or dilate.
C. This presentation is more consistent with abruptio placentae, where the placenta separates prematurely, leading to painful bleeding and a firm, tender uterus.
D. This describes bloody show, which is a sign of labor onset, not placenta previa. It is associated with cervical effacement and dilation rather than abnormal placental implantation.
Correct Answer is C
Explanation
A. A routine abdominal ultrasound is not used to assess bone age or growth delays. While abdominal ultrasounds can detect organ abnormalities, they provide no information about skeletal maturation.
B. A complete blood count (CBC) evaluates blood cell levels and can detect anemia or infection, but it does not provide information about bone growth or skeletal development.
C. A hand-wrist X-ray is the standard diagnostic test to assess bone age and skeletal maturation. By comparing the X-ray of the child’s hand and wrist bones to standardized age-related charts (such as the Greulich and Pyle atlas), providers can determine if the child’s skeletal growth is appropriate for chronological age. This helps identify growth delays, endocrine disorders, or other conditions affecting stature.
D. Anthropometric hand-wrist measurement refers to physical measurements of the hand and wrist, which do not provide sufficient information to determine bone age or detect growth delays. X-ray imaging is required for accurate assessment of skeletal maturity.
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