The mother of a preschool child asks the practical nurse (PN) to clarify the healthcare provider's (HCP) diagnosis of acute otitis media.
Which is the most accurate explanation?

Choice A rationale

Deep tendon reflexes are neurological assessments primarily used to evaluate neuromuscular excitability, particularly in conditions like preeclampsia where magnesium sulfate is administered. They are not indicated for managing fetal heart rate decelerations or chorioamnionitis, as these conditions do not directly impact spinal reflex arcs or necessitate this specific neurological monitoring. Normal reflexes range from 1+ to 2+.

Choice B rationale

Late decelerations, occurring after the peak of a contraction, indicate uteroplacental insufficiency, meaning reduced blood flow and oxygen to the fetus. A left side-lying position alleviates compression of the vena cava and aorta by the gravid uterus, thereby increasing venous return to the heart and improving uterine perfusion and oxygenation to the fetus, which is a crucial intervention.

Choice C rationale

Insertion of an indwelling urinary catheter to monitor hourly output is primarily indicated for assessing renal perfusion and fluid balance, particularly in critically ill clients or those at risk for fluid volume alterations, such as severe preeclampsia. It does not directly address or correct the underlying physiological cause of late fetal heart rate decelerations. Normal urine output is typically greater than 30 mL/hour.

Choice D rationale

Collecting a urine specimen for electrolytes and protein is a diagnostic measure for evaluating renal function, hydration status, and potential complications like preeclampsia, which presents with proteinuria. While important for overall assessment, it does not provide an immediate physiological intervention to improve uteroplacental perfusion and resolve acute fetal distress manifested by late decelerations.

Choice A rationale

Preterm birth can be a complication of gestational diabetes due to polyhydramnios or preeclampsia, but macrosomia carries a higher risk of birth trauma and neonatal complications. Prematurity can lead to respiratory distress syndrome and other developmental challenges.

Choice B rationale

Macrosomic newborn is the greatest risk to the fetus if euglycemia is not maintained. High maternal glucose levels lead to excessive fetal insulin production, resulting in increased fat deposition and growth. This can cause birth injuries, hypoglycemia, and respiratory distress in the neonate.

Choice C rationale

Low birth weight is typically associated with maternal malnutrition or placental insufficiency, not poorly controlled gestational diabetes. Uncontrolled gestational diabetes usually leads to fetal overgrowth (macrosomia) due to constant glucose supply.

Choice D rationale

Cleft palate is a congenital anomaly primarily linked to genetic and environmental factors during early fetal development, not directly or primarily to poorly controlled gestational diabetes. Metabolic imbalances of diabetes are not a primary cause of such structural malformations.