A nurse is reinforcing teaching with a client who has thrombophilia about low molecular weight heparin.
Which of the following information should the nurse include in the teaching?
Labor will be induced at 36 weeks of gestation.
There is an increased risk of fetal loss.
You will begin weekly visits for non-stress tests at 36 weeks of gestation.
Weekly fetal monitoring is required starting at 32 weeks of gestation.
The Correct Answer is B
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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Correct Answer is B
Explanation
Choice B rationale
Magnesium sulfate is a central nervous system depressant and is the primary medication used for seizure prophylaxis in clients with preeclampsia with severe features. It acts by decreasing acetylcholine release at the neuromuscular junction and producing vasodilation. The goal is to prevent the progression of preeclampsia to eclampsia, which is characterized by the onset of grand mal seizures. Therapeutic magnesium levels for this purpose are generally maintained between 4 to 7 mEq/L.
Choice A rationale
A biophysical profile is an ultrasound assessment of fetal well-being that measures fetal breathing, movements, tone, amniotic fluid volume, and heart rate reactivity. While magnesium sulfate is used to treat the mother, its primary purpose is not to improve the BPP score. In fact, high levels of magnesium can sometimes cause a temporary decrease in fetal heart rate variability or fetal breathing movements, potentially leading to a lower BPP score even if the fetus is stable.
Choice C rationale
Placental abruption is a serious complication where the placenta detaches from the uterus before delivery. While preeclampsia increases the risk of abruption due to vascular damage and high blood pressure, magnesium sulfate is not administered specifically to prevent the abruption itself. Its pharmacological action is focused on the neurological system to prevent seizures. Management of abruption risk involves blood pressure control and close monitoring of maternal symptoms and fetal heart rate patterns.
Choice D rationale
Although magnesium sulfate has a mild vasodilatory effect, it is not classified as an antihypertensive medication and is not used for the primary purpose of decreasing blood pressure. If a client's blood pressure exceeds 160/110 mmHg, specific antihypertensive agents such as labetalol or hydralazine are administered. The role of magnesium is strictly for the prevention of eclamptic seizures in the setting of severe preeclampsia. Monitoring for magnesium toxicity involves checking deep tendon reflexes.
Correct Answer is A
Explanation
Choice A rationale
Gestational diabetes mellitus is often managed with diet and exercise initially, but when glycemic targets are not met, pharmacologic therapy is required. While insulin is the traditional gold standard, oral hypoglycemic agents like glyburide or metformin are increasingly utilized for clients with unstable control who cannot manage or refuse injections. These agents help maintain euglycemia, reducing risks of macrosomia and neonatal hypoglycemia. Normal fasting blood glucose levels in pregnancy should be below 95 mg/dL.
Choice B rationale
Clients with gestational diabetes require frequent monitoring to ensure fetal safety and maternal health. Testing only 1 to 2 times per day is insufficient to capture the glycemic variability associated with meals and hormonal shifts. Standard practice typically involves checking blood glucose 4 to 7 times daily, including fasting and postprandial levels. This rigorous monitoring allows for precise adjustments in medical nutrition therapy or medication. Postprandial 1 hour levels should remain below 140 mg/dL.
Choice C rationale
Hemoglobin A1C reflects average blood glucose levels over the preceding 2 to 3 months. In gestational diabetes, the condition is often diagnosed late in the second trimester, and blood glucose can fluctuate rapidly due to placental hormones. Monitoring A1C every 1 to 2 months is not responsive enough for acute management. Daily capillary blood glucose monitoring is the primary tool for clinical decisions. Normal non-pregnant A1C is typically below 5.7 percent, but targets vary.
Choice D rationale
During the second and third trimesters, the placenta produces increasing amounts of human placental lactogen, growth hormone, and cortisol. these hormones create significant insulin resistance to ensure adequate glucose is available for the fetus. Therefore, insulin requirements actually increase significantly during this period rather than decreasing. Decreasing the dose would lead to maternal hyperglycemia and potential fetal complications. Insulin needs often double or triple by the end of the third trimester.
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