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 D

Explanation

A. Preterm labor. Methotrexate is not used for preterm labor. Medications such as tocolytics (e.g., nifedipine, magnesium sulfate, or terbutaline) are typically used to delay labor and improve neonatal outcomes, but methotrexate does not serve this purpose.

B. Abruptio placentae. Methotrexate is not indicated for abruptio placentae, which is the premature separation of the placenta from the uterine wall. Management of abruptio placentae focuses on stabilizing the mother, monitoring fetal well-being, and delivering the baby if necessary.

C. Pre-eclampsia. Methotrexate does not treat pre-eclampsia. The management of pre-eclampsia includes antihypertensive medications, magnesium sulfate for seizure prevention, and delivery of the baby when indicated.

D. Unruptured ectopic pregnancy. Methotrexate is the first-line treatment for an unruptured ectopic pregnancy. It works by inhibiting rapidly dividing trophoblastic cells, stopping the growth of the ectopic pregnancy while preserving the fallopian tube. It is only used in stable patients with small, unruptured ectopic pregnancies and no signs of internal bleeding.

A. 2+ Deep Tendon Reflexes. B. Platelets of 20,000 C. Urine output of 75 ml per hour. D. 1+ proteinuria.

Correct Answer is B

Explanation

A. 2+ Deep Tendon Reflexes. A 2+ deep tendon reflex is considered normal and does not indicate worsening preeclampsia. Severe preeclampsia is often associated with hyperreflexia, typically 3+ or 4+, which can signal worsening central nervous system involvement and an increased risk for seizures.

B. Platelets of 20,000. A platelet count of 20,000 is dangerously low and suggests the development of HELLP syndrome, a severe complication of preeclampsia that includes hemolysis, elevated liver enzymes, and low platelets. This condition increases the risk of spontaneous bleeding and requires immediate medical intervention.

C. Urine output of 75 ml per hour. A urine output of 75 mL per hour is adequate and does not indicate worsening kidney function. In severe preeclampsia, oliguria (urine output less than 30 mL per hour) is a more concerning sign, as it suggests impaired renal perfusion and possible acute kidney injury.

D. 1+ Proteinuria. While proteinuria is a key feature of preeclampsia, a 1+ reading is mild and not necessarily indicative of worsening disease. Severe preeclampsia is typically associated with proteinuria of 3+ or higher, along with other symptoms such as hypertension, headache, and visual disturbances.

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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

Naxlex Comprehensive Predictor Exams

The nurse is preparing to administer methotrexate to the patient. This drug is most often used for which obstetric complication?

Correct Answer is D

Explanation

The nurse is assessing a patient who has severe preeclampsia. The assessment finding that should be reported to the physician is:

Correct Answer is B

Explanation

A patient is 3 days post c-section delivery for eclampsia. The client is receiving hydralazine (Apresoline). Which of the following would indicate that the medication is effective?

The least common cause of long. difficult, or abnormal labor (dystocia) is:

A woman, G4P0210, and 12 weeks' gestation has been admitted to labor and delivery for a cerclage procedure. Which of the following long-term goals for this patient would we anticipate by doing this procedure?

During augmentation of labor with intravenous oxytocin (Pitocin), a multiparous client becomes pale and diaphoretic and complains of severe lower abdominal pain with a tearing sensation. An abnormal FHR tracing is noted on the monitor. The nurse should suspect:

A patient has just spontaneously ruptured her membranes. Which of the following factors makes her especially high risk for having a prolapsed cord? Select all that apply.

A primigravida who is 28 weeks pregnant visits the clinic fearing she is experiencing preeclampsia. Which of the following assessments would the nurse make to confirm or negate these thoughts? Select all that apply.

A woman is in the second stage of labor and has a spinal block in place for pain management. The nurse obtains the woman's blood pressure and notes that it is 20% lower than the baseline level. Which action should the nurse take?

A woman with preeclampsia has a seizure. The nurse's primary duty during the seizure is to: