A client with diabetes in the second trimester of pregnancy, notes that the usual dose of insulin to maintain blood glucose levels has been increasing over the last few weeks.
What would the nurse explain to the client about insulin during pregnancy?
Insulin resistance develops because of human placental lactogen hormone and other hormones.
The fetus is using insulin to maintain adequate blood glucose levels in utero.
An increase in circulating blood volume during pregnancy makes insulin less available.
The change in diet causes an increased need for insulin to maintain normal blood glucose levels.
The Correct Answer is A
Choice A rationale
Insulin resistance is a physiological change occurring in the second and third trimesters, primarily induced by placental hormones like human placental lactogen (hPL), progesterone, and cortisol. These hormones antagonize insulin action at the cellular level, necessitating higher insulin doses to maintain euglycemia. The normal fasting blood glucose is <95 mg/dL and 1-hour postprandial is ≤ 140 mg/dL.
Choice B rationale
The fetus produces its own insulin by approximately 10 weeks gestation and is not dependent on maternal insulin to regulate its blood glucose. Maternal insulin does not cross the placenta due to its large size. Glucose, however, does cross, and maternal hyperglycemia causes fetal hyperinsulinemia and subsequent fetal macrosomia.
Choice C rationale
While circulating blood volume significantly increases (by 30-50%) during pregnancy, leading to some hemodilution, this is not the primary mechanism for increased insulin requirements. The main mechanism is the anti-insulin effect of the aforementioned placental hormones that induce peripheral insulin resistance.
Choice D rationale
While dietary intake and carbohydrate metabolism shift during pregnancy, the major underlying cause for the escalating insulin need is the hormonally mediated increased insulin resistance. Nutritional adjustments are made, but they do not independently cause the progressive need for doubling or tripling of the usual pre-pregnancy insulin dose.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["12"]
Explanation
Step 1 is to convert the oxytocin concentration from units to milliunits (mU):. 20 units× 1000 mU/unit = 20000 mU.
Step 2 is to determine the concentration in mU/mL:. 20000 mU÷ 1000 mL = 20 mU/mL.
Step 3 is to calculate the infusion rate in mL/min:. 4 mU/min÷ (20 mU/mL) = 0.2 mL/min.
Step 4 is to convert the infusion rate from mL/min to mL/hr:. 0.2 mL/min× 60 min/hr = 12 mL/hr. The final calculated answer is 12 mL/hr.
Correct Answer is C
Explanation
Choice A rationale
Peritonitis is a severe inflammation of the peritoneum, the membrane lining the abdominal cavity, usually due to bacterial contamination from a perforated viscus or the uterus. While a serious complication of advanced puerperal infection, peritonitis presents with generalized severe abdominal rigidity, rebound tenderness, and high fever, not just an increase in localized perineal pain, which is the key symptom described.
Choice B rationale
Thrombophlebitis (or superficial vein thrombosis) involves inflammation and clotting in a vein, most commonly in the legs post-delivery. It presents with localized warmth, redness, swelling, and pain along the course of the affected vein in the calf or thigh, not primarily with increased localized pain in the perineal region, which is the anatomical area described in the report.
Choice C rationale
Infection of the perineum (often related to an episiotomy, laceration repair, or hematoma) is highly likely given the combination of a prolonged rupture of membranes (a risk factor) and the specific complaint of increasing perineal pain two days postpartum. Infection leads to localized inflammation, edema, purulent drainage, and increased pain at the perineal wound site, matching the client's symptoms and risk profile.
Choice D rationale
Endometritis is an infection of the uterine lining (endometrium), a common postpartum complication, especially after prolonged rupture of membranes. Classic signs include fever, uterine subinvolution, and foul-smelling lochia, often accompanied by lower abdominal or uterine tenderness, but increasing perineal pain points more specifically to a localized wound infection or abscess in that area.
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