A client is being educated on how to perform kick counts. Which of the following indicates a cause for concern
10 movements in 1 hour
Increased movement
No movement after interventions
Movement at night
The Correct Answer is C
Fetal kick counts are a low-technology method for assessing fetal oxygenation and central nervous system integrity. A healthy fetus exhibits a regular pattern of movement that correlates with a reactive nonstress test. A sudden decrease in activity often precedes fetal compromise or intrauterine growth restriction.
A. 10 movements in 1 hour: This is considered a reassuring finding and indicates a well-oxygenated fetus. Most protocols define a normal count as 10 movements within 2 hours. This frequency suggests the placental unit is providing sufficient nutrients and oxygen for activity.
B. Increased movement: While extremely violent or frantic movement can occasionally be noted before a hypoxic event, general "increased movement" is usually not a primary concern. It often reflects fetal wakefulness or a maternal glucose spike. It does not typically indicate acute distress.
C. No movement after interventions: If the client does not feel 10 movements after drinking cold water or lying on their side, it is a red flag. Absent movement suggests the fetus may be in a state of hypoxic depression to conserve energy. This requires immediate clinical evaluation with a biophysical profile.
D. Movement at night: Fetal activity often increases at night when the mother is resting and maternal glucose levels may be higher. This is a normal circadian variation and is not a cause for medical concern. It indicates a functioning fetal nervous system.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A 1-hour glucose challenge test (GCT) with a value of 160 mg/dL exceeds the standard screening threshold (usually 130-140 mg/dL). This "positive" screen indicates impaired glucose handling but is not diagnostic of gestational diabetes on its own. A confirmatory multi-step tolerance test is required to evaluate insulin response over time.
A. Repeat 1-hour test: Repeating the screening test is not clinically useful as it has already identified the need for further diagnostic workup. The 1-hour test is a non-fasting screen designed for high sensitivity. Progression to a more specific diagnostic test is the standard of care.
B. Start insulin: Insulin therapy is only initiated after a definitive diagnosis of GDM is made and lifestyle modifications have failed to maintain euglycemia. Starting insulin based on a single screening value would be premature and potentially cause iatrogenic hypoglycemia. Diagnosis must be confirmed first.
C. Order 3-hour glucose tolerance test: The 3-hour GTT is the definitive diagnostic procedure, requiring the client to fast and undergo four separate blood glucose draws. If two or more values are elevated, the diagnosis of gestational diabetes is confirmed. It provides a detailed metabolic profile.
D. Diagnose gestational diabetes mellitus (GDM): A single 1-hour value of 160 mg/dL is insufficient for a formal diagnosis. Only extremely high values (e.g., > 200 mg/dL) may allow for a direct diagnosis in some protocols. Most cases require the 3-hour fasting test to ensure diagnostic accuracy.
Correct Answer is A
Explanation
Gestational diabetes results from placental hormones like human placental lactogen inducing maternal insulin resistance. Management aims to maintain euglycemia to prevent fetal macrosomia and neonatal hypoglycemia. The initial approach focuses on stabilizing postprandial glucose levels through lifestyle and behavioral modifications.
A. Diet modification: Controlling the intake of complex carbohydrates and spreading caloric consumption throughout the day often successfully manages blood sugar levels. Most women can achieve glycemic targets without pharmacological assistance. It is the established standard of care for initial GDM management.
B. Insulin: Pharmacological intervention with insulin is only initiated if nutritional therapy and exercise fail to meet glycemic goals. While highly effective, it requires intensive training and carries a risk of hypoglycemia. It is a second-line treatment rather than the primary starting point.
C. Steroids: Corticosteroids are used to promote fetal lung maturity in cases of threatened preterm labor but actually worsen hyperglycemia by increasing insulin resistance. They are contraindicated as a treatment for GDM. Administering steroids would cause a dangerous rise in maternal glucose levels.
D. Surgery: There is no surgical procedure used to treat or manage the metabolic dysfunction of gestational diabetes. Management is strictly medical and nutritional during the pregnancy. Postpartum, the condition usually resolves spontaneously after the delivery of the placenta.
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