A nurse is caring for a client who is 2 weeks postpartum.
The client tells the nurse, "I feel really down and sad lately.
I have no energy and I feel like I'm going to cry.”. Which of the following actions should the nurse take first?

Choice A rationale:

Increasing carbohydrates to 65% of daily nutritional intake is not the appropriate action for a client with blood glucose levels ranging from 180 mg/dL to 250 mg/dL following meals. In this scenario, the client's blood glucose levels are already elevated, and increasing carbohydrates may further exacerbate hyperglycemia. It's important to focus on blood glucose control rather than increasing carbohydrate intake.

Choice B rationale:

Scheduling a 2-hour oral glucose tolerance test is not the immediate action required in this case. While this test can help diagnose gestational diabetes, the client's elevated post-meal blood glucose levels are already a concern. The primary concern is addressing and managing these high levels before proceeding with additional testing.

Choice C rationale:

Anticipating an order for insulin administration is the correct action. When a client with gestational diabetes has blood glucose levels consistently above the target range, despite dietary modifications, insulin administration may be necessary to achieve glycemic control. This is a key intervention to prevent complications for both the mother and the baby.

Choice D rationale:

Obtaining an HbA1c is not typically done during pregnancy to assess glucose control, as it reflects the average blood glucose levels over the past 2-3 months. In this case, more immediate monitoring and intervention are required to address the high post-meal blood glucose levels. Now, let's move on to the final question.

Choice A rationale:

The client is experiencing symptoms that suggest hyperventilation due to paced breathing, which can lead to respiratory alkalosis. Breathing into a paper bag or cupped hand allows the client to rebreathe carbon dioxide and helps correct the alkalosis by increasing the carbon dioxide levels in the blood. This is a common intervention for clients experiencing lightheadedness and tingling in the fingers due to hyperventilation.

Choice B rationale:

Instructing the client to maintain a breathing rate no less than twice the normal rate is not appropriate in this situation. It can worsen the client's symptoms and may lead to further hyperventilation. This choice does not address the underlying problem of respiratory alkalosis.

Choice C rationale:

Having the client tuck her chin to her chest is not the correct action for these symptoms. This maneuver is typically used to relieve supraventricular tachycardia (SVT) or vagal stimulation in situations of rapid heart rate. It is not relevant to the client's lightheadedness and tingling fingers.

Choice D rationale:

Administering oxygen via nasal cannula is not indicated in this case. The client's symptoms are not suggestive of hypoxemia, but rather, they are related to respiratory alkalosis. Providing oxygen could potentially worsen the condition by reducing carbon dioxide levels further.