A nurse is educating a client who has gestational diabetes mellitus. Which of the following disease management strategies should the nurse include?

Consume 2,800 calories daily during the third trimester.

Distribute daily calories among three meals and three snacks.

Maintain a blood glucose level between 100 to 130 mg/dL before meals.

Restrict daily carbohydrate intake to 60% of total caloric intake.

Answer and Explanation

The Correct Answer is B

A. Consume 2,800 calories daily during the third trimester.: The caloric needs during pregnancy vary, but 2,800 calories might be excessive for someone with gestational diabetes. The focus should be on maintaining a balanced diet that helps control blood glucose levels rather than meeting a specific caloric target.

B. Distribute daily calories among three meals and three snacks.: Distributing calories throughout the day with balanced meals and snacks can help manage blood glucose levels and prevent significant spikes or drops. This approach is commonly recommended for managing gestational diabetes.

C. Maintain a blood glucose level between 100 to 130 mg/dL before meals.: The target for fasting blood glucose levels in gestational diabetes is generally less than 95 mg/dL. Maintaining blood glucose levels within this range is crucial to manage the condition effectively.

D. Restrict daily carbohydrate intake to 60% of total caloric intake.: Carbohydrate intake should be managed carefully, but it is not typically restricted to a specific percentage like 60%. Instead, a balanced approach with an emphasis on complex carbohydrates and monitoring individual responses is recommended.

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Correct Answer is C

Explanation

A) "I should limit my weightlifting to three times per week.": While weightlifting can be beneficial for bone health, it is generally recommended to engage in weight-bearing and resistance exercises more frequently than three times a week for optimal bone density. The frequency and type of weightlifting should be tailored to individual needs and safety considerations.

B) "I can continue to horseback ride.": Horseback riding, especially if not done carefully, poses a risk of falls and fractures, which can be dangerous for individuals with osteoporosis. Activities with a higher risk of injury should be avoided or approached with caution.

C) "I will go walking with a friend around our neighborhood.": Walking is a low-impact, weight-bearing exercise that promotes bone health and mobility without high risk. It is a suitable and recommended activity for individuals with osteoporosis to help maintain bone density and prevent falls.

D) "I will join my brother at his community aerobics class.": Aerobics classes may involve high-impact exercises and movements that could increase the risk of fractures or falls in individuals with osteoporosis. Low-impact, bone-strengthening activities are generally recommended instead.

A. Help the client role play alternative solutions to identified problems. B. Have the client write a list of personal characteristics they feel need improvement. C. Give the client detailed instructions when providing teaching about ways to cope. D. Give the client an alternative interpretation of the client's perception of a situation.

Correct Answer is A

Explanation

A) Help the client role play alternative solutions to identified problems: Role-playing can be a highly effective intervention for clients with generalized anxiety disorder (GAD). It allows clients to practice and develop problem-solving skills in a safe and supportive environment. By simulating different scenarios, clients can explore various responses and coping mechanisms, which can help reduce anxiety by increasing their confidence and preparedness for real-life situations.

B) Have the client write a list of personal characteristics they feel need improvement: This approach may inadvertently increase a client's anxiety by focusing on perceived personal shortcomings. It is more beneficial to focus on strengths and positive attributes to build self-esteem and resilience. Encouraging self-criticism can exacerbate feelings of inadequacy and contribute to a negative self-concept.

C) Give the client detailed instructions when providing teaching about ways to cope: While providing information is important, detailed instructions can sometimes overwhelm clients with GAD, leading to increased anxiety. It is more effective to offer clear, concise, and manageable steps and to ensure that the client fully understands and feels comfortable with each coping strategy before moving on to the next one.

D) Give the client an alternative interpretation of the client's perception of a situation: Offering alternative interpretations can be helpful, but it must be done cautiously. Clients with GAD may feel invalidated if their perceptions are dismissed or challenged too directly. It is more supportive to guide clients to explore and consider different perspectives on their own, fostering a sense of autonomy and self-efficacy in managing their anxiety.

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