A nurse is caring for a client who is experiencing an early second-trimester spontaneous abortion and is hemodynamically stable.
Which of the following prescriptions should the nurse expect the provider to prescribe?

Choice A rationale

Restricting carbohydrate intake to 30 percent is generally considered too restrictive for a pregnant client. Standard nutritional guidelines for gestational diabetes usually recommend that carbohydrates comprise approximately 40 to 50 percent of total daily caloric intake to ensure adequate energy for fetal development. Extreme restriction can lead to ketonemia, which is potentially harmful to the developing fetal neurological system. Complex carbohydrates are preferred over simple sugars to prevent rapid glycemic spikes and maintain steady energy levels.

Choice B rationale

High fiber foods are essential in the management of gestational diabetes because they slow the absorption of glucose in the intestinal tract. Soluble fiber creates a viscous gel that delays gastric emptying and reduces the postprandial glycemic response. This helps in maintaining blood glucose levels within the target range of 60 to 95 mg/dL preprandial and less than 140 mg/dL one hour postprandial. Fiber also assists in maintaining bowel regularity and promotes a feeling of fullness.

Choice C rationale

Monitoring blood glucose levels only once per day is insufficient for a client with gestational diabetes. Effective management typically requires testing at least four times daily, including a fasting glucose level upon waking and postprandial levels after each major meal. Frequent monitoring allows the healthcare team to adjust dietary or pharmacological interventions accurately. Consistent tracking is vital to prevent complications such as fetal macrosomia, neonatal hypoglycemia, and maternal preeclampsia associated with poorly controlled hyperglycemia.

Choice D rationale

Moderate exercise for 30 minutes a day, five days a week, is a recommended strategy to improve insulin sensitivity. Physical activity increases the uptake of glucose by skeletal muscles through insulin-independent mechanisms, such as the translocation of GLUT4 transporters. This helps lower blood glucose levels naturally. Safe exercises for pregnant women include walking or swimming, which improve cardiovascular health without causing excessive physical stress or fetal distress, provided there are no contraindications like ruptured membranes.

Choice E rationale

If lifestyle modifications such as medical nutrition therapy and regular physical activity fail to achieve glycemic targets, pharmacological intervention becomes necessary. Insulin is often the gold standard because it does not cross the placenta, though oral hypoglycemic agents like glyburide or metformin may be considered in specific cases. The goal is to prevent maternal hyperglycemia, which triggers fetal hyperinsulinemia. Consistent blood glucose control is critical to reduce the risks of birth trauma and respiratory distress syndrome.

Choice A rationale

Maternal age of 29 years is not considered a specific risk factor for placental abruption. While very young maternal age (under 20) or advanced maternal age (over 35) can be associated with various pregnancy complications, the late twenties are generally considered a lower-risk period for this specific condition. Risk factors usually involve vascular disruptions or mechanical stressors rather than the physiological state associated specifically with being 29 years old in an otherwise healthy pregnancy.

Choice B rationale

Being a primigravida, or having a first pregnancy, is actually a risk factor for preeclampsia, but it is not a primary risk factor for placental abruption. In fact, multiparity (having had multiple pregnancies) is sometimes more closely linked to abruption risks due to potential changes in the uterine environment or placental attachment sites over time. A first pregnancy does not inherently increase the likelihood of the placenta detaching from the uterine wall before delivery occurs.

Choice C rationale

Sickle cell anemia is a hemoglobinopathy that can cause various complications during pregnancy, such as increased risk for infections, anemia, and painful crises. However, it is not listed as one of the primary, classic risk factors for placental abruption. While any systemic vascular disease could theoretically impact the placenta, conditions like chronic hypertension, cocaine use, or blunt abdominal trauma are much stronger and more direct predictors of an abruption event occurring during gestation.

Choice D rationale

Polyhydramnios is a recognized risk factor for placental abruption. The presence of excessive amniotic fluid causes the uterus to become overdistended. If there is a sudden loss of this fluid, such as when the membranes rupture, the rapid decompression of the uterine cavity can cause a sudden decrease in the surface area of the uterine wall. This mechanical shift can shear the placenta away from its attachment site, leading to a partial or complete abruption. .