A nurse is caring for a 24-year-old pregnant woman in the prenatal clinic. She is gravida 2, para 1 (G2P1), and her mother has a history of type 2 diabetes mellitus.
Exhibits:
Which is likely causing this client's increased blood glucose at 28 weeks? Select all that apply.
Fetal health problems
Decreased cortisol
Increased insulin needs
Placental infection
Normal weight gain of pregnancy
Fetus with macrosomia
Correct Answer : C,E,F
Choice A rationale: Fetal health problems are not directly linked to maternal blood glucose levels. The fetus relies on maternal glucose, but fetal health issues do not cause maternal hyperglycemia.
Choice B rationale: Decreased cortisol is unlikely to cause increased blood glucose levels. Cortisol typically raises blood glucose by promoting gluconeogenesis and decreasing glucose uptake by cells.
Choice C rationale: Increased insulin needs during pregnancy are due to insulin resistance caused by placental hormones. This physiological change ensures adequate glucose supply to the fetus, leading to higher maternal blood glucose levels.
Choice D rationale: Placental infection can cause inflammation and other complications but is not a common cause of increased blood glucose levels. Infections typically present with fever and other systemic symptoms.
Choice E rationale: Normal weight gain during pregnancy can contribute to insulin resistance. Increased adipose tissue leads to higher levels of circulating free fatty acids, which impair insulin signaling and glucose uptake.
Choice F rationale: A fetus with macrosomia is often associated with maternal hyperglycemia. Excess glucose crosses the placenta, stimulating fetal insulin production and growth, leading to larger fetal size.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Starting oxytocin infusion immediately may cause uterine hyperstimulation in clients who have already responded to misoprostol. Close monitoring and spacing out uterotonic agents help prevent adverse effects like uterine tachysystole and fetal distress.
Choice B rationale
Beginning oxytocin 4 hours after misoprostol ensures sufficient time for cervical ripening and reduces the risk of uterine hyperstimulation. This allows for safer labor induction and better outcomes for both mother and fetus.
Choice C rationale
Ambulating the client after misoprostol administration is generally safe but doesn't address the need for controlled uterotonic administration. Monitoring and timing of further uterotonics are crucial to avoid adverse effects and ensure safe induction.
Choice D rationale
Administering misoprostol every 2 hours is not recommended due to the risk of uterine hyperstimulation. It’s important to follow safe dosing intervals to reduce the risk of complications such as uterine tachysystole and fetal compromise.
Correct Answer is D
Explanation
Choice A rationale
Asking another nurse to validate the costal angle finding is unnecessary, as the increased costal angle is a common physiological change during pregnancy due to the expanding uterus.
Choice B rationale
Examining for tissue anoxia, such as pallor, is not relevant in this scenario, as the nasal stuffiness and nosebleeds are likely due to increased blood volume and hormonal changes in pregnancy.
Choice C rationale
Requesting the healthcare provider to evaluate the client's respiratory status is unwarranted, as the described symptoms are typical physiological adaptations during pregnancy and not indicative of respiratory pathology.
Choice D rationale
Documenting the respiratory finding as normal is appropriate, as the increased chest circumference, thoracic breathing, elevated diaphragm, and increased costal angle are expected physiological changes during pregnancy.
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