GESTATIONAL DIABETES - HESI CASE STUDY - NRSG376 PRACTICE TEST QUESTIONS AND ANSWERS|GUARANTEED SUCCESS

The clinic nurse reviews Danielle's prenatal record prior to performing a nursing assessment. Danielle has given birth three times; once at 35 weeks (twins), once at 38 weeks (singleton), and once at 41 weeks (singleton). All of these children are alive and well. She had one spontaneous abortion at 10 weeks' gestation. How should the nurse record Danielle's obstetrical history using the GTPAL designation? a) 3-2-0-1-3 b) 4-1-1-1-2 c) 5-2-1-1-4 d) 4-2-1-0-2 5-2-1-1-4 -Gravidity (G) is defined as the number of times pregnant, including the current pregnancy. Term (T) is defined as any birth after the end of the 37th week, and preterm (P) refers to any births between 20 and 37 weeks. Both term and preterm describe liveborn and stillborn infants. Abortion (A) is any fetal loss, whether spontaneous or elective, up to 20 weeks gestation. Living (L) refers to all children who are living at the time of the interview. Multiple fetuses such as twins, triplets, and beyond are treated as one pregnancy and one birth when recording the GTPAL. Danielle's GTPAL is 5 (pregnancies counting current one) - 2 (infants born at 38 and 41 weeks) - 1 (twins born at 35 weeks) - 1 (spontaneous abortion at 10 weeks) - 4 (each twin and the 2 singletons, all living). The nurse notes that Danielle's fasting 1-hour glucose screening level, which was done 1 week prior, is 164 mg/dL. Which information does the nurse recognize in the client's history to support a diagnosis of gestational diabetes? a) Maternal great-aunt has non-insulin dependent (Type 2) diabetes b) Child weighed 9 lbs (4.08 kg) at 41 weeks' gestation c) Trace of protein noted in urine specimen at last prenatal visit d) Client is 64 in (1.63 m) tall and weighed 134 lbs (60.78 kgs) prior to pregnancy Child weighed 9 lbs (4.08 kg) at 41 weeks' gestation 6 Ways to Show Appreciation for Your Child's Teacher 0:30 / 0:54 Danielle is scheduled for a 3-hour oral glucose tolerance test in 5 days and is told to arrive at the lab at 8:30am. Danielle asks if there are any special instructions for the test in addition to fasting for 8 hours immediately prior to the test. Which instruction should the nurse give the client? a) Only coffee or tea is allowed once the fasting level has been drawn b) Follow an unrestricted diet and exercise pattern for at least 3 days before the test c) Write down questions and call the laboratory for instructions the day before the test d) Smoking in moderation is allowed up until the time the test begins Follow an unrestricted diet and exercise pattern for at least 3 days before the test. Danielle asks the nurse why she wasn't tested for gestational diabetes until she was at almost 28 weeks' gestation. The nurse's response should be based on the understanding of which normal physiologic change of pregnancy? a) Maternal insulin crosses the placenta to regulate fetal glucose levels throughout pregnancy b) In the first trimester, estrogen and progesterone cause an increase in maternal fasting glucose levels c) Hormonal changes in the second and third trimesters result in increased maternal insulin resistance d) Fetal insulin production increases each trimester, forcing the mother's body to produce more glucose Hormonal changes in the second and third trimesters result in increased maternal insulin resistance. Danielle's 3-hour oral glucose tolerance test indicates that she does have gestational diabetes. The nurse phones Danielle and arranges for her to meet with the obstetrician, as well as an RN diabetes educator and a registered dietician (RD) the next day. The obstetrician and the nurse discuss gestational diabetes with Danielle. After seeking Danielle's input, they outline their suggested plan of care, which includes dietary control and glucose self-monitoring. After the obstetrician leaves, Danielle appears confused and asks the nurse, "How will I know if I have high blood sugar?" Which response should the nurse give to the client? (Select all that apply). a) "Hyperglycemia often presents as increased thirst and urination." b) "Hyperglycemia causes a headache and flushed, dry skin." c) "Hyperglycemia causes cool and clammy skin." d) "Hyperglycemia causes an increased sensation of being hungry." -"Hyperglycemia often presents as increased thirst and urination." -"Hyperglycemia causes a headache and flushed, dry skin." After all of her questions are answered, Danielle is scheduled for a return visit with the obstetrician in 1 week, and she is escorted to the office of the RD. The RD discusses the need to control carbohydrates while maintaining an appropriate carbohydrate-protein-fat ration to promote consistent weight gain (based on the woman's body mass index), prevent ketoacidosis, and encourage normoglycemia (euglycemia). Danielle is then introduced to the RN diabetes educator. She asks the nurse to clarify what the RD told her about the content and timing of her meals. Which responses should the nurse give to the client? (Select all that apply). a) Eliminate the bedtime snack if heartburn develops after eating b) Choose complex carbohydrates that are high in fiber content c) Increase the percentage of protein in the diet if anemia develops d) Avoid foods high in refined sugars e) Drink between 8 to 10 cups of fluid daily -Choose complex carbohydrates that are high in fiber content -Avoid foods high in refined sugars -Drink between 8 to 10 cups of fluids daily The RN diabetes educator makes a plan of care to teach Danielle to monitor her glucose levels. The RN diabetes educator discusses the use of self-glucose monitoring and gives Danielle verbal and written guidance about optimal glucose levels at each glucose testing point throughout the day. The nurse also provides instructions about calibration of the glucose monitor, fingerstick technique, and use of the monitor for testing. After a review of the instructions and a successful return demonstration by Danielle, the diabetes educator and Danielle agree to meet after Danielle's prenatal appointment to follow-up on the teaching/learning. Which instructions should the diabetes educator include regarding fingerstick blood glucose (FSBG) monitoring? a) Check fasting blood sugar at lunch time b) Prior to breakfast (fasting) and before each meal c) Two hours after all meals, at bedtime, and in the middle of the night d) Once Prior to breakfast (fasting) and before each meal