A woman who has type 2 diabetes mellitus is now pregnant.
She wants to know whether to take her oral antidiabetic medication.
What instructions will she receive?
She should continue the antidiabetic medication at the same dosage.
The antidiabetic medication dosage will be increased gradually throughout her pregnancy.
She will be switched to insulin therapy while she is pregnant.
She will not receive any antidiabetic medication while pregnant and will need to monitor her dietary intake closely.
The Correct Answer is C
Choice A rationale
Continuing the oral antidiabetic medication at the same dosage is incorrect. Most oral antidiabetic medications are classified as teratogenic or potentially teratogenic, meaning they can cause harm to the developing fetus. Their use is not recommended during pregnancy due to the risk of congenital anomalies and other complications. Therefore, the medication should be discontinued immediately.
Choice B rationale
Increasing the dosage of oral antidiabetic medication is incorrect. As discussed, oral antidiabetic agents are generally contraindicated in pregnancy due to their potential teratogenic effects on the fetus. Increasing the dose would exacerbate this risk. The standard of care for managing diabetes during pregnancy involves discontinuing these medications and initiating a safer alternative.
Choice C rationale
The correct instruction is that she will be switched to insulin therapy while pregnant. Insulin is the preferred treatment for managing diabetes during pregnancy because it does not cross the placental barrier and thus does not pose a risk to the fetus. It is a safe and effective way to achieve tight glycemic control, which is essential for a healthy pregnancy outcome and to prevent complications for both mother and baby.
Choice D rationale
Not receiving any medication while pregnant is incorrect. Poorly controlled diabetes during pregnancy significantly increases the risk of complications such as preeclampsia, macrosomia, and birth defects. Therefore, relying on diet and exercise alone is generally not sufficient to maintain stable blood glucose levels. Medical intervention, specifically insulin therapy, is necessary to ensure optimal maternal and fetal health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Lithium is a mood stabilizer primarily used in the treatment of bipolar disorder. Its therapeutic and toxic effects are not directly related to blood sugar regulation. While some antipsychotics can impact glucose metabolism, lithium's mechanism of action does not involve insulin or glucagon pathways. Therefore, blood sugar assessment is not the most critical lab value prior to administration.
Choice B rationale
Lithium is a monovalent cation that competes with sodium for renal reabsorption. When sodium levels are low, the kidneys reabsorb more lithium to compensate, increasing the risk of lithium toxicity. Conversely, high sodium can increase lithium excretion. Therefore, assessing a patient's serum sodium level (normal range: 135-145 mEq/L) is crucial to prevent lithium accumulation and subsequent toxicity.
Choice C rationale
While urine osmolality can be affected by lithium's long-term effects on the kidneys, such as nephrogenic diabetes insipidus, it is not the most crucial parameter to assess before starting therapy. The primary and immediate risk is related to the competition between lithium and sodium for reabsorption, which directly influences serum lithium levels and the risk of toxicity, making sodium assessment paramount.
Choice D rationale
Hematocrit measures the proportion of red blood cells in the blood and is not directly influenced by lithium. While long-term lithium use can affect other blood cell lines, such as leukocytes, hematocrit is not a primary safety concern or a pre-administration requirement. The most critical lab value for lithium safety is its close relationship with sodium and renal function.
Correct Answer is B
Explanation
Choice A rationale
Increasing myocardial oxygen demand would be detrimental in coronary artery disease (CAD), as the underlying issue is an imbalance between oxygen supply and demand. Medications aim to decrease demand and increase supply to prevent myocardial ischemia and infarction, so this is not a goal of pharmacotherapy.
Choice B rationale
The primary goal of pharmacotherapy in coronary artery disease is to reduce myocardial oxygen demand and supply balance. This is achieved by using medications that decrease heart rate, contractility, and blood pressure (reducing demand), while simultaneously increasing blood flow to the myocardium (improving supply). This helps prevent ischemia.
Choice C rationale
Promoting vasoconstriction would be harmful in CAD, as it would further narrow already stenotic coronary arteries, thereby decreasing blood flow and oxygen supply to the myocardium. The goal of many CAD medications, such as nitroglycerin, is vasodilation to improve blood flow.
Choice D rationale
Increasing blood viscosity would be counterproductive, as it would make blood thicker and more difficult to pump through narrowed coronary arteries. This would increase the workload on the heart and further compromise oxygen supply, increasing the risk of thrombotic events and myocardial infarction.
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