The nurse is teaching a prenatal class about the effects of substance abuse during pregnancy.
What potential outcome(s) will the nurse include? (Select all that apply).

Choice A rationale

Macrosomia, or excessive birth weight, is a common complication of maternal diabetes, but it is typically a concern in the second and third trimesters. It occurs due to fetal hyperinsulinemia in response to high maternal glucose levels. At 7 weeks gestation, the fetus is in the embryonic stage, and the primary physiological process is organogenesis rather than rapid weight gain or fat deposition. Therefore, while macrosomia is a significant risk later in pregnancy, it is not the priority fetal concern during the first trimester.

Choice B rationale

At 7 weeks gestation, the embryo is undergoing organogenesis, the critical period when major organs are formed. A glycosylated hemoglobin (HbA1C) of 8.9 percent (normal range typically below 5.7 percent) indicates poor glycemic control in the weeks leading up to and during early pregnancy. High glucose levels are teratogenic during this window, significantly increasing the risk of major congenital anomalies, particularly cardiac defects and sacral agenesis. Establishing euglycemia early is vital to reduce the risk of structural malformations during these formative weeks.

Choice C rationale

Cephalopelvic disproportion (CPD) occurs when the fetal head is too large to pass through the maternal pelvis, often as a result of fetal macrosomia. Like macrosomia, this is a concern at the end of pregnancy and during the labor process. At 7 weeks gestation, the embryo is only a few millimeters long, and the physical dimensions relative to the birth canal are irrelevant. The focus during the first trimester must be on the viability and structural integrity of the developing embryo rather than delivery complications.

Choice D rationale

Hyperbilirubinemia is a neonatal complication that occurs after birth. It is often seen in infants of diabetic mothers due to polycythemia and the subsequent breakdown of excess red blood cells. While maternal hyperglycemia during pregnancy contributes to this risk, it is not a concern that can manifest or be addressed at 7 weeks gestation. The priority at this early stage is the prevention of developmental errors that could lead to miscarriage or permanent structural birth defects.

Choice A rationale

Anorexia nervosa causes significant physiological adaptations to starvation, leading to a hypometabolic state. Bradycardia, characterized by a pulse rate less than 60 beats per minute, and hypotension occur as the body attempts to conserve energy and maintain cardiac output with reduced myocardial mass. Normal adult pulse ranges from 60 to 100 beats per minute, and normal blood pressure is typically around 120/80 mmHg. Significant drops in these parameters are common clinical findings in malnutrition.

Choice B rationale

Regular menstrual periods are not expected in clients with significant anorexia nervosa. Amenorrhea, or the absence of at least three consecutive menstrual cycles, is a hallmark diagnostic feature due to the suppression of the hypothalamic pituitary ovarian axis. Low body fat levels lead to decreased estrogen production, which halts the normal reproductive cycle. Therefore, regular periods with spotting would be an inconsistent finding in a client suffering from the severe weight loss associated with this eating disorder.

Choice C rationale

A body mass index greater than 20 is generally considered within the healthy range for most adults, whereas anorexia nervosa is characterized by a significantly low body weight. Specifically, a body mass index of 17.5 or less is often used as a clinical indicator for the diagnosis. Finding a BMI over 20 would suggest that the client is not currently in a state of severe emaciation or that their weight has been restored to a normal level.

Choice D rationale

Lanugo is the growth of fine, downy hair on the face, back, and arms, which is a physical manifestation of severe malnutrition. The body develops this hair as a compensatory mechanism to provide insulation and retain heat in the absence of adequate subcutaneous fat layers. Because individuals with anorexia nervosa often have very low body temperatures and little body fat, the presence of lanugo is a classic clinical sign of the body's attempt to regulate thermoregulation.

Choice E rationale

Protein calorie malnutrition in anorexia nervosa leads to deficiencies in essential vitamins and minerals necessary for the maintenance of integumentary structures. Hair becomes thin, dry, and brittle, often falling out in patches, a condition known as alopecia. Similarly, the nails become fragile and break easily due to the lack of keratin and other nutrients. These findings reflect the systemic impact of chronic starvation on the body's ability to renew and repair its tissues.