A nurse teaching a prenatal class is asked why infants of diabetic mothers are often larger than those born to women who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response?

Consuming more calories covers the insulin secreted by the fetus.

Fetal weight gain increases as a result of the common response of maternal overeating.

Extra circulating glucose causes the fetus to acquire fatty deposits.

Taking exogenous insulin stimulates fetal growth

Answer and Explanation

The Correct Answer is C

A. Consuming more calories covers the insulin secreted by the fetus. The fetus does not secrete insulin to regulate maternal glucose levels. Instead, the maternal pancreas produces insulin in response to blood sugar levels, but in diabetes, maternal insulin resistance leads to excess glucose being transferred to the fetus.

B. Fetal weight gain increases as a result of the common response of maternal overeating. While some women with diabetes may have increased caloric intake, this is not the primary reason for fetal macrosomia (large birth weight). The major factor is maternal hyperglycemia leading to excess fetal insulin production and fat deposition.

C. Extra circulating glucose causes the fetus to acquire fatty deposits. In diabetic pregnancies, excess maternal glucose crosses the placenta, leading to fetal hyperinsulinemia. The increased insulin promotes fat storage and excessive fetal growth, leading to macrosomia, which increases the risk of birth complications such as shoulder dystocia.

D. Taking exogenous insulin stimulates fetal growth. Insulin does not cross the placenta, so maternal insulin therapy does not directly affect fetal growth. Instead, fetal macrosomia results from prolonged exposure to maternal hyperglycemia, which causes the fetus to produce excessive insulin and store extra fat.

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Correct Answer is A

Explanation

A. Perform vaginal exam and apply upward digital pressure to the presenting part. A prolapsed umbilical cord is an obstetric emergency that can lead to cord compression and fetal hypoxia. The priority intervention is for the nurse to manually lift the presenting part (usually the fetal head) off the cord to relieve pressure and restore blood flow. The nurse should maintain this position until an emergency cesarean section is performed.

B. Immediately turn the client to her side. Positioning changes, such as the knee-chest or Trendelenburg position, can help relieve pressure on the cord, but they are secondary to manually lifting the presenting part. While turning the client may assist, it is not the most immediate life-saving action.

C. Call the physician immediately. While notifying the provider is essential, relieving pressure on the umbilical cord takes priority. Delaying intervention to make a call could result in prolonged fetal hypoxia and compromise.

D. Place a moist, clean towel over the cord to prevent drying. Covering the cord with a moist towel helps prevent vasospasm and drying, but it does not relieve the compression that is cutting off oxygen to the fetus. The priority is to relieve pressure on the cord first before taking other measures.

A. The patient's blood pressure dropped from 160/120 to 130/90 B. The patient states that her headache is gone C. The patient's postoperative weight has dropped from 155 to 144 pounds D. The patient has had no seizures since delivery

Correct Answer is A

Explanation

A. The patient's blood pressure dropped from 160/120 to 130/90. Hydralazine is an antihypertensive medication used to lower blood pressure in conditions such as eclampsia. A reduction in blood pressure indicates that the medication is achieving its intended effect of controlling hypertension, reducing the risk of complications like stroke or organ damage.

B. The patient states that her headache is gone. While headaches are a symptom of severe hypertension, their resolution does not directly confirm the effectiveness of hydralazine. Other factors, such as pain relief or improved postpartum recovery, could contribute to headache relief.

C. The patient's postoperative weight has dropped from 155 to 144 pounds. Postpartum weight loss is expected due to fluid shifts and loss of pregnancy-related fluids, but it is not a direct measure of hydralazine’s effectiveness. The medication does not act as a diuretic or weight-loss agent.

D. The patient has had no seizures since delivery. While hydralazine helps lower blood pressure, preventing seizures in eclamptic patients is primarily managed with magnesium sulfate, not hydralazine. The absence of seizures is important but does not indicate the specific effectiveness of this antihypertensive medication.

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A nurse teaching a prenatal class is asked why infants of diabetic mothers are often larger than those born to women who do not have diabetes. On what information about pregnant women with diabetes should the nurse base the response?

Nursing Test Bank

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Explanation

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Explanation

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