MED SURG III 2026 CERTIFICATION
EVALUATION QUESTIONS AND ANSWERS
◉ Compare insulin requirements during pregnancy, the postpartum
period, and lactation. Answer: A) first trimester - Insulin need is
reduced because of increased insulin production by the pancreas
and increased peripheral sensitivity; nausea, vomiting, and
decreased food intake by mother and glucose transfer to
embryo/fetus contributes to hypoglycemia.
B) Second trimester: Insulin need increases as placental hormones,
cortisol, and insulinase act as insulin antagonists, decreasing the
effectiveness of insulin.
C)Third trimester: insulin requirements gradually increase increase
until about 36 wks of gestation.
D) Day of delivery: maternal insulin requirement drop drastically to
approach prepregnancy levels.
E) Breastfeeding mother maintains lower insulin requirements, as
much as 25% less than prepregnancy; insulin need of
nonbreastfeeding mother returns to prepregnancy levels in 7 to 10
days.
,F) at weaning of breastfeeding infant, mother's insulin need returns
to prepregnancy levels.
◉ Identify maternal and fetal risks or complications associated with
diabetes in pregnancy. Answer: A) Maternal risks/complications:
GDM with an A1c > 6 there is a 28% increase in early pregnancy loss.
Cesarean birth - failure to progress or failure of descent. Preterm
birth & labor. Ketoacidosis in 2nd & 3rd trimesters. Hypoglycemia
occurs during sleep early in pregnancy when hepatic production of
glucose is dimished and peripheral use of glucose is enhanced.
Hyadramnios - 10x more likely. Hypertensive disorders -
preeclampsia, eclampsia. UTI. severe diabetes.
B) Fetal risks/complications - Stillbirth. Congenital anomalies 6% -
10% increase. CNS defects - anencephaly, open spina bifida. Cardiac
defects - Ventricular septal defects (VSD) & transposition of the
great vessels. Caudal regression - 200 to 400x due to diabetic
mothers. Macrosomia. Hypoglycemia. Respiratory distress
syndrome. Polycythemia. Hyperbilirubinemia.
◉ Develop a plan of care for the pregnant woman with
pregestational or gestational diabetes. Answer: ...
◉ Compare the management of a pregnant woman with
hyperthyroidism with one has hypothyroidism. Answer:
, Hyperthyroidism - Tx propylthiouracil (PTU), B-Adrenergic blockers,
Radioactive iodine must not be used to diagnose because it
compromises the fetal thyroid. Thyroideectomy
Hypothyroidism - TX Levothyroxine (L-thyroxine [synthroid])
BOTH: need assistance with coping with the discomforts and
frustrations associated with symptoms of the disorder. both must
adapt and wear appropriate clothing, avoiding enviromental
temperatures that cause them harm, and stress reduction activities.
EX. hyper- heat intolerance, nervousness, hyperactivity, weakness,
fatigue.
Ex. hypo - cold intolerance.
Both- need nutrional counseling the woman with hyper have an
increased appetite and poor weight gain and the hypo woman who
are lethargy to ensure adequate intake of nutrition to meet both
maternal and fetal needs.
◉ Differentiate the management of various cardiovascular disorders
in pregnant woman. Answer: 1) Peripartum Cardiomyopathy - TX
diuretics, sodium restriction, afterload-reducing agents,
anticoagulants, digoxin. ACE- inhibitor only postpartum because it is
teratogenic agent.
EVALUATION QUESTIONS AND ANSWERS
◉ Compare insulin requirements during pregnancy, the postpartum
period, and lactation. Answer: A) first trimester - Insulin need is
reduced because of increased insulin production by the pancreas
and increased peripheral sensitivity; nausea, vomiting, and
decreased food intake by mother and glucose transfer to
embryo/fetus contributes to hypoglycemia.
B) Second trimester: Insulin need increases as placental hormones,
cortisol, and insulinase act as insulin antagonists, decreasing the
effectiveness of insulin.
C)Third trimester: insulin requirements gradually increase increase
until about 36 wks of gestation.
D) Day of delivery: maternal insulin requirement drop drastically to
approach prepregnancy levels.
E) Breastfeeding mother maintains lower insulin requirements, as
much as 25% less than prepregnancy; insulin need of
nonbreastfeeding mother returns to prepregnancy levels in 7 to 10
days.
,F) at weaning of breastfeeding infant, mother's insulin need returns
to prepregnancy levels.
◉ Identify maternal and fetal risks or complications associated with
diabetes in pregnancy. Answer: A) Maternal risks/complications:
GDM with an A1c > 6 there is a 28% increase in early pregnancy loss.
Cesarean birth - failure to progress or failure of descent. Preterm
birth & labor. Ketoacidosis in 2nd & 3rd trimesters. Hypoglycemia
occurs during sleep early in pregnancy when hepatic production of
glucose is dimished and peripheral use of glucose is enhanced.
Hyadramnios - 10x more likely. Hypertensive disorders -
preeclampsia, eclampsia. UTI. severe diabetes.
B) Fetal risks/complications - Stillbirth. Congenital anomalies 6% -
10% increase. CNS defects - anencephaly, open spina bifida. Cardiac
defects - Ventricular septal defects (VSD) & transposition of the
great vessels. Caudal regression - 200 to 400x due to diabetic
mothers. Macrosomia. Hypoglycemia. Respiratory distress
syndrome. Polycythemia. Hyperbilirubinemia.
◉ Develop a plan of care for the pregnant woman with
pregestational or gestational diabetes. Answer: ...
◉ Compare the management of a pregnant woman with
hyperthyroidism with one has hypothyroidism. Answer:
, Hyperthyroidism - Tx propylthiouracil (PTU), B-Adrenergic blockers,
Radioactive iodine must not be used to diagnose because it
compromises the fetal thyroid. Thyroideectomy
Hypothyroidism - TX Levothyroxine (L-thyroxine [synthroid])
BOTH: need assistance with coping with the discomforts and
frustrations associated with symptoms of the disorder. both must
adapt and wear appropriate clothing, avoiding enviromental
temperatures that cause them harm, and stress reduction activities.
EX. hyper- heat intolerance, nervousness, hyperactivity, weakness,
fatigue.
Ex. hypo - cold intolerance.
Both- need nutrional counseling the woman with hyper have an
increased appetite and poor weight gain and the hypo woman who
are lethargy to ensure adequate intake of nutrition to meet both
maternal and fetal needs.
◉ Differentiate the management of various cardiovascular disorders
in pregnant woman. Answer: 1) Peripartum Cardiomyopathy - TX
diuretics, sodium restriction, afterload-reducing agents,
anticoagulants, digoxin. ACE- inhibitor only postpartum because it is
teratogenic agent.
