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A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client?
Select one:

Insulin needs decrease in the first trimester, but increase in the second trimester as the woman's body becomes more insulin-resistant.

Vascular disease that always accompanies diabetes slows fetal growth.

The risk of ketoacidosis decreases during the length of the pregnancy.

The baby is likely to have a congenital abnormality because of the uncontrolled diabetes.

Answer and Explanation

The Correct Answer is A

Choice A Reason: Insulin needs decrease in the first trimester, but increase in the second trimester as the woman's body becomes more insulin-resistant. This is because this statement describes the typical patern of insulin requirements during pregnancy for women with pre-existing diabetes. Insulin needs decrease in the first trimester due to increased insulin production by the pancreas, increased insulin sensitivity by the tissues, and increased risk of hypoglycemia due to nausea and vomiting. Insulin needs increase in the second trimester due to increased levels of placental hormones such as human placental lactogen (hPL), which antagonize insulin action and cause insulin resistance.

Choice B Reason: Vascular disease that always accompanies diabetes slows fetal growth. This is an incorrect answer that makes a false and exaggerated claim about diabetes and fetal growth. Vascular disease does not always accompany diabetes, but it can be a complication of long-term or poorly controlled diabetes that aﬀects blood vessels and circulation. Vascular disease can aﬀect fetal growth by reducing placental perfusion and oxygen delivery, but it is not the only factor that inﬂuences fetal growth. Other factors include maternal nutrition, genetics, infections, or anomalies.

Choice C Reason: The risk of ketoacidosis decreases during the length of the pregnancy. This is an incorrect answer that contradicts the evidence and guidelines on diabetes and ketoacidosis during pregnancy. Ketoacidosis is a metabolic emergency where high levels of ketones accumulate in the blood due to insufficient insulin or excessive glucose utilization, which causes acidosis, dehydration, electrolyte imbalance, and coma. Ketoacidosis can occur in women with diabetes during pregnancy due to infection, stress, starvation, or inadequate insulin therapy. The risk of ketoacidosis does not decrease during the length of the pregnancy, but rather increases in the second and third trimesters due to increased insulin resistance and glucose production.

Choice D Reason: The baby is likely to have a congenital abnormality because of the uncontrolled diabetes. This is an incorrect answer that implies a negative and deterministic outcome for the baby. Congenital abnormalities are structural or functional defects that are present at birth, which can aﬀect various organs or systems in the baby.

Congenital abnormalities can be caused by genetic or environmental factors, or a combination of both. Diabetes can increase the risk of congenital abnormalities, especially if the blood glucose levels are high during the first trimester, when organogenesis occurs. However, the risk of congenital abnormalities is not inevitable or predictable, and it can be reduced by maintaining good glycemic control before and during pregnancy.

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Correct Answer is B

Explanation

Choice A Reason: Prepare for IV dextrose administration. This is an incorrect answer that indicates an unnecessary and invasive intervention for an IDM with normal blood glucose. IV dextrose administration is indicated for an IDM with severe or persistent hypoglycemia, which is defined as a blood glucose below 40 mg/dL or below 60 mg/dL after two feedings.

Choice B Reason: Provide routine care, per hospital IDM protocol. This is because a blood glucose of 60 is within the normal range for an IDM, which is 40 to 80 mg/dL. An IDM is a newborn whose mother has pre-existing or gestational diabetes, which can aﬀect the fetal and neonatal glucose metabolism and regulation. An IDM may have hypoglycemia (low blood glucose), hyperglycemia (high blood glucose), or other complications such as macrosomia, polycythemia, or congenital anomalies. An IDM requires routine care and monitoring according to the hospital IDM protocol, which may include blood glucose testing, feeding, temperature regulation, and observation for signs of distress.

Choice C Reason: Place the infant in a warmed incubator. This is an incorrect answer that suggests an irrelevant and potentially harmful action for an IDM with normal blood glucose. Placing the infant in a warmed incubator is indicated for an IDM with hypothermia, which is a low body temperature that can impair glucose utilization and increase oxygen consumption. However, placing the infant in a warmed incubator without proper indication can cause hyperthermia, which is a high body temperature that can lead to dehydration, electrolyte imbalance, or brain damage.

Choice D Reason: Alert the clinician immediately for orders. This is an incorrect answer that implies an urgent and unwarranted situation for an IDM with normal blood glucose. Alerting the clinician immediately for orders is indicated for an IDM with signs of distress or complications, such as apnea, cyanosis, seizures, or jaundice.

A. About 1 of every 5 women will experience abuse in her lifetime. B. When women go back to the situation after the abuser has calmed down, things will be beter. C. The victimized woman can easily leave the situation. D. The violence will not stop or decrease if the woman becomes pregnant.

Correct Answer is D

Explanation

Choice A Reason: About 1 of every 5 women will experience abuse in her lifetime is a statistic that shows the prevalence of domestic violence, but it does not address the question of what the nurse should emphasize to the group of women.

Choice B Reason: When women go back to the situation after the abuser has calmed down, things will be beter is a false statement that reﬂects the cycle of abuse, where the abuser may apologize and promise to change after a violent episode, but then repeat the same behavior later. This does not help the women understand their situation or seek help.

Choice C Reason: The victimized woman can easily leave the situation is a false statement that ignores the many barriers and challenges that women face when trying to escape from domestic violence, such as fear, isolation, financial dependence, lack of support, legal issues, and threats from the abuser. This does not empower the women or provide them with realistic options.

Choice D Reason: The violence will not stop or decrease if the woman becomes pregnant is a true statement that highlights the danger of staying in an abusive relationship during pregnancy. Domestic violence can increase the risk of miscarriage, preterm birth, low birth weight, placental abruption, fetal injury, and maternal death. This may motivate the women to seek safety and protection for themselves and their unborn children.

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A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client? Select one:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client?
Select one: