The nurse would include which of the following statements when describing the pathophysiology of gestational diabetes?

There is progressive resistance to the effects of insulin

Pregnancy fosters the development of carbohydrate cravings.

Hypoinsulinemia develops early in the first trimester

Glucose levels decrease to accommodate fetal growth.

Answer and Explanation

The Correct Answer is A

A. There is progressive resistance to the effects of insulin. During pregnancy, placental hormones (such as human placental lactogen, estrogen, and progesterone) cause increasing insulin resistance. This ensures that glucose remains available for fetal growth. However, in gestational diabetes, the pancreas cannot compensate with increased insulin production, leading to hyperglycemia.

B. Pregnancy fosters the development of carbohydrate cravings. While some pregnant individuals experience cravings, this is not a defining cause of gestational diabetes. The condition results from hormonal changes leading to insulin resistance, not dietary habits alone.

C. Hypoinsulinemia develops early in the first trimester. Gestational diabetes is not caused by a deficiency of insulin (hypoinsulinemia) but by insulin resistance. In fact, insulin production often increases, but it is insufficient to overcome the resistance caused by placental hormones.

D. Glucose levels decrease to accommodate fetal growth. In a normal pregnancy, glucose levels remain stable, and the fetus actively takes glucose from maternal circulation. However, in gestational diabetes, maternal glucose levels rise due to insulin resistance, increasing the risk of fetal overgrowth (macrosomia).

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Correct Answer is B

Explanation

A. Oral hypoglycemic medications. While some oral hypoglycemic agents, such as metformin or glyburide, are used in gestational diabetes, the first-line treatment is always dietary modification and exercise. Medications are only introduced if blood glucose levels remain uncontrolled with lifestyle changes.

B. Diet control and exercise. The initial treatment for gestational diabetes focuses on controlling blood glucose through dietary adjustments, portion control, and regular physical activity. If lifestyle modifications fail to maintain glucose levels within the target range, insulin or oral medications may be introduced.

C. Inhaled insulin. Inhaled insulin is not commonly used in pregnancy because its safety and efficacy for gestational diabetes have not been well established. Insulin therapy, if needed, is typically administered via subcutaneous injection rather than inhalation.

D. Regular insulin injections. Insulin therapy is considered if diet and exercise alone fail to control blood glucose levels. However, it is not the first-line treatment, as many women can successfully manage gestational diabetes without requiring insulin therapy.

A. Tell the client to take a warm shower, rest, and call back tomorrow. B. Schedule an appointment for the client at the clinic tomorrow. C. Instruct the client to drink cranberry juice and call if she experiences a fever. D. Instruct the client to go to labor triage at the hospital for evaluation.

Correct Answer is D

Explanation

A. Tell the client to take a warm shower, rest, and call back tomorrow. While rest and hydration can sometimes help with mild discomfort, this client’s symptoms—pelvic pressure, low back pain, abdominal pain, and increased vaginal discharge—are concerning for preterm labor and require immediate evaluation. Delaying care could increase the risk of preterm birth.

B. Schedule an appointment for the client at the clinic tomorrow. Waiting until the next day is not appropriate, as preterm labor is an urgent condition that needs immediate assessment to prevent premature birth. Prompt intervention may allow for tocolytic therapy or steroid administration to improve fetal lung maturity if preterm birth is imminent.

C. Instruct the client to drink cranberry juice and call if she experiences a fever. Cranberry juice is sometimes used to prevent urinary tract infections (UTIs), but this client’s symptoms are more indicative of preterm labor rather than an infection. Fever is not a defining symptom of preterm labor, and delaying care could result in complications.

D. Instruct the client to go to labor triage at the hospital for evaluation. This is the best response because the symptoms suggest possible preterm labor. Evaluation in the hospital can include cervical checks, fetal monitoring, and tests such as fetal fibronectin (fFN) to assess the risk of preterm birth. Immediate intervention can help delay labor and improve neonatal outcomes.

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The nurse would include which of the following statements when describing the pathophysiology of gestational diabetes?

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