A nurse is caring for a client who is pregnant.
Which of the following provider prescriptions should the nurse plan to implement? Select the 3 actions the nurse should plan to take.
Encourage the client to limit carbohydrate intake to 40% of their daily calories.
Instruct the client to check a random blood glucose level once daily.
Anticipate a prescription for metformin.
Conduct a non-stress test twice per week.
Tell the client to refrain from exercise until after delivery.
Correct Answer : A,C,D
A. Encourage the client to limit carbohydrate intake to 40% of their daily calories. This can help manage blood glucose levels more effectively, especially considering the client's history of delivering large newborns and family history of diabetes.
C. Anticipate a prescription for metformin. Metformin is commonly prescribed to manage blood glucose levels in gestational diabetes and may be considered by the healthcare provider due to the client's elevated blood glucose and HbA1c levels.
D. Conduct a non-stress test twice per week. This test monitors the fetal heart rate and provides information about the baby's health, which is crucial given the mother's high BMI and poorly controlled blood glucose levels.
B. The client should check their blood glucose three to four times a day instead of once daily.
E. Regular exercise is beneficial for managing blood glucose levels in pregnancy, especially for clients with diabetes. Exercise helps improve insulin sensitivity and can aid in controlling weight gain and reducing the risk of complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. The rooting reflex is essential for breastfeeding. When the newborn's cheek or lip is stroked, the baby will turn their head toward the stimulus and open their mouth in preparation for breastfeeding. This reflex helps the newborn find the nipple and initiate feeding by latching onto it.
A. The Moro reflex, also known as the startle reflex, is triggered by a sudden noise, movement, or change in position that causes the newborn to extend their arms, arch their back, and then bring their arms back toward their body. This reflex is not directly involved in promoting newborn latching during breastfeeding. It typically occurs in response to stimuli unrelated to feeding.
B. The Babinski reflex is elicited by stroking the sole of the newborn's foot, causing the toes to fan out and the big toe to dorsiflex while the other toes spread out. This reflex is also not involved in breastfeeding and does not contribute to latching.
D. The stepping reflex occurs when the newborn is held upright with their feet touching a flat surface. The baby will make stepping movements as if walking. This reflex is unrelated to breastfeeding and does not assist in latching.
Correct Answer is D
Explanation
D. Newborns of mothers with poorly controlled diabetes mellitus, particularly type 2 diabetes, are at risk for hyperinsulinemia. High levels of insulin can suppress lung maturation in utero, leading to surfactant deficiency and subsequent respiratory distress syndrome (RDS) after birth. Surfactant is crucial for maintaining the expansion of alveoli and preventing collapse, especially in premature infants or those with immature lungs.
A. Increased blood viscosity due to polycythemia (high red blood cell count) can occur in newborns of diabetic mothers, but it is not typically associated with respiratory distress syndrome (RDS). Polycythemia may lead to other complications such as hyperviscosity syndrome, but it is not directly related to RDS.
B. Brachial plexus injury refers to damage to the network of nerves that control the muscles of the arm and hand. It is typically related to birth trauma and affects the arm rather than causing respiratory distress syndrome (RDS). This option is not related to the respiratory issues seen in the newborn.
C. Newborns of diabetic mothers are at increased risk of macrosomia (excessive birth weight) due to fetal hyperinsulinemia (increased insulin levels in response to maternal hyperglycemia). This can lead to increased fat deposits, particularly in the chest and shoulder area. However, while macrosomia is a risk factor for RDS, the direct cause of RDS in this scenario is not primarily due to fat deposits.
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