A nurse is reinforcing teaching to a client at 28 weeks of gestation who has gestational diabetes mellitus (GDM) about treatments and therapies.
Which of the following statements by the client indicates that the reinforced teaching was effective? (Select all that apply.)

I should restrict my carbohydrate intake to 30 percent of total daily calories.

I should include high fiber foods in my diet to stabilize my blood glucose.

I must monitor my blood glucose level once per day.

I will exercise moderately for 30 minutes a day, five days each week.

If diet and exercise do not stabilize my blood glucose, I may need medication.

Answer and Explanation

Correct Answer : B,D,E

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.

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Correct Answer is B

Explanation

Choice A rationale

A client at 8 weeks gestation with moderate bleeding and minimal pain is likely experiencing a threatened or inevitable abortion. While this requires medical attention, her vital signs are currently stable with a blood pressure of 118/72 mm Hg and a pulse of 96/min. Normal pregnancy pulse ranges from 60 to 100/min. She is not showing signs of immediate hemodynamic collapse. Therefore, she is a lower priority compared to a client exhibiting active signs of hypovolemic shock.

Choice B rationale

This client is the highest priority because her clinical presentation suggests a ruptured ectopic pregnancy. Severe abdominal pain combined with a blood pressure of 86/58 mm Hg and a heart rate of 132/min indicates stage II or III hypovolemic shock. Tachycardia is a compensatory mechanism to maintain cardiac output, while hypotension signifies that compensation is failing. Internal hemorrhage from a tubal rupture is a life-threatening emergency requiring immediate surgical intervention and fluid resuscitation to prevent death.

Choice C rationale

While an ectopic pregnancy is a serious diagnosis, this client is currently hemodynamically stable. A blood pressure of 128/84 mm Hg and a pulse of 88/min indicate that she is not experiencing an acute rupture or significant internal bleeding at this moment. Crying is an expected emotional response to a distressing diagnosis but does not take precedence over a client in physiological shock. She requires monitoring and psychological support, but she is stable compared to Choice B.

Choice D rationale

Methotrexate is used to treat unruptured ectopic pregnancies by inhibiting cell division. While pain and dizziness are concerning side effects or signs of potential rupture, this client’s vital signs are stable with a blood pressure of 116/80 mm Hg and a pulse of 86/min. These parameters suggest she is not currently in shock. She requires a thorough assessment to rule out tubal rupture, but the client in Choice B already shows definitive signs of cardiovascular instability and hemorrhage.

A. Labor will be induced at 36 weeks of gestation. B. There is an increased risk of fetal loss. C. You will begin weekly visits for non-stress tests at 36 weeks of gestation. D. Weekly fetal monitoring is required starting at 32 weeks of gestation.

Correct Answer is B

Explanation

Choice A rationale

Induction of labor at 36 weeks is not a standard requirement for clients with thrombophilia unless other obstetric complications like severe preeclampsia or fetal growth restriction are present. Late preterm delivery carries risks of respiratory distress and jaundice for the neonate. Management usually focuses on anticoagulation therapy until the onset of labor or a scheduled induction closer to full term, typically between 39 and 40 weeks, to ensure fetal lung maturity and better neonatal outcomes.

Choice B rationale

Thrombophilia in pregnancy significantly increases the risk of fetal loss, including recurrent miscarriage and stillbirth. The hypercoagulable state can lead to the formation of microthrombi within the placental vasculature, which impairs uteroplacental perfusion. Reduced blood flow restricts the delivery of oxygen and essential nutrients to the developing fetus. This ischemic environment can result in placental abruption, intrauterine growth restriction, or fetal death, necessitating close monitoring and often pharmacological intervention with heparin-based medications.

Choice C rationale

While fetal surveillance is necessary for high-risk pregnancies, starting weekly non-stress tests specifically at 36 weeks is not the universal protocol for thrombophilia alone. The timing and frequency of antenatal testing are individualized based on the specific type of thrombophilia and the presence of other risk factors. Non-stress tests assess the fetal heart rate pattern in response to movement, providing data on fetal oxygenation. If placental insufficiency is suspected earlier, testing might begin sooner than 36 weeks.

Choice D rationale

Weekly fetal monitoring typically begins between 32 and 34 weeks of gestation for clients with thrombophilia to detect early signs of placental insufficiency. Monitoring often includes non-stress tests and biophysical profiles to evaluate fetal well-being. By 32 weeks, the risk of placental vascular complications increases as the metabolic demands of the fetus grow. Early detection of fetal distress allows for timely interventions, such as adjusting medication or planning for delivery if the intrauterine environment becomes unsafe.

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A nurse is reinforcing teaching to a client at 28 weeks of gestation who has gestational diabetes mellitus (GDM) about treatments and therapies. Which of the following statements by the client indicates that the reinforced teaching was effective? (Select all that apply.)

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A nurse is reinforcing teaching to a client at 28 weeks of gestation who has gestational diabetes mellitus (GDM) about treatments and therapies.
Which of the following statements by the client indicates that the reinforced teaching was effective? (Select all that apply.)