Chapter 15: Pregnancy at Risk: Pre-Existing Conditions
MULTIPLE CHOICE
1. In assessing the knowledge of a pregestational woman with type 1 diabetes about changing
insulin needs during pregnancy, which information is accurate?
a. Insulin dosage during the first 3
months of pregnancy needsto be
increased.
b. Insulin dosage will likely need to be
decreased during the second and third
trimesters.
c. Episodes of hypoglycemia are more
likely to occur during the last 3
months.
d. Insulin needs should return to normal
within 7 to 10 days after birth if bottle-
feeding.
ANS: D
“Insulin needs should return to normal within 7 to 10 days after birth if bottle-feeding” is an
accurate statement and signifies that the woman understands control of her diabetes during
pregnancy. Insulin needs are reduced in the first trimester because of increased insulin
production by the pancreas and increased peripheral sensitivity to insulin. Insulin dosage will
likely need to be increased, not decreased, during the second and third trimesters. Episodes of
hypoglycemia are more likely to occur during the first 3 months, not the last 3 months.
DIF: Cognitive Level: Application REF: p. 360 | Figure 15-1 OBJ:
Nursing Process: Evaluation
2. Which is attributable to poor glycemic control before and during early pregnancy?
a. Frequent episodes of maternal
hypoglycemia
b. Congenital anomalies in the fetus
c. Polyhydramnios
d. Hyperemesis gravidarum
ANS: B
Preconception counselling is particularly important because strict metabolic control before
conception and in the early weeks of gestation is instrumental in decreasing the risks of
congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first
trimester (not before conception) as a result of hormone changes and the effects on insulin
, production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies
than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy.
Hyperemesis gravidarum may exacerbate hypoglycemic events, as the decreased food intake
by the mother and glucose transfer to the fetus contribute to hypoglycemia.
DIF: Cognitive Level: Comprehension REF: p. 361 OBJ: Nursing Process: Planning
3. In planning for the care of a 30-year-old woman with pregestational diabetes, what does the
nurse recognize as the most important factor affecting pregnancy outcome?
a. Mother’s age
b. Number of years since diabetes was
diagnosed
c. Amount of insulin required prenatally
d. Degree of glycemic control during
pregnancy
ANS: D
Women with excellent glucose control and no blood vessel disease should have good
pregnancy outcomes. The mother`s age is not related to gestational diabetes. Number of years
since diabetes was diagnosed is not the most important factor affecting pregnancy outcome.
The amount of insulin required prenatally is not the most important factor affecting pregnancy
outcome.
DIF: Cognitive Level: Comprehension REF: p. 361 OBJ: Nursing Process: Planning
4. What normal fasting glucose level should the nurse recommend for a woman with
pregestational diabetes?
a. 2.5–3.5 mmol/L
b. 3.8–5.2 mmol/L
c. 5.5–7.7 mmol/L
d. 5.0–6.6 mmol/L
ANS: B
Target glucose levels during a fasting period are 3.8–5.2 mmol/L. A glucose level of 2.5– 3.5
mmol/L is low. A glucose level of 5.5–7.7 mmol/L is consistent with expected levels with 1-hour
postprandial plasma glucose (PG). A glucose level of 5.0–6.6 mmol/L is considered normal for a
2-hour postprandial PG.
DIF: Cognitive Level: Knowledge REF: p. 365 | Table 15-2 OBJ:
Nursing Process: Assessment
, 5. What is the greatest risk for a fetus of a pregnant woman who has gestational diabetes mellitus
(GDM)?
a. Macrosomia
b. Congenital anomalies of the central
nervous system
c. Postterm birth
d. Low birth weight
ANS: A
Fetal macrosomia is a risk to the fetus of a mother with GDM. Poor glycemic control during the
preconception time frame and into the early weeks of the pregnancy is associated with
congenital anomalies. Preterm labour or birth is more likely to occur with severe diabetes, not
postterm birth. Increased weight, or macrosomia, is the greatest risk factor for this woman.
DIF: Cognitive Level: Comprehension REF: p. 361
OBJ: Nursing Process: Planning | Nursing Process: Implementation
6. Which should the nurse know regarding drug testing during pregnancy in Canada?
a. It is required at the first prenatal visit.
b. Only those drugs disclosed by the
woman are tested for.
c. There is no legal requirement to test
the mother or the newborn child.
d. Testing is required before labour and
delivery.
ANS: C
There is no legal requirement in Canada for a health care provider to test either the mother or
the newborn child for the presence of drugs. Testing is not required on the initial prenatal visit.
If testing were to occur, all substances would be tested for, not just those disclosed by the
mother. Testing is not required before labour and delivery.
DIF: Cognitive Level: Comprehension REF: p. 394
OBJ: Nursing Process: Assessment
7. Which should the nurse know in terms of the incidence and classification of diabetes?
MULTIPLE CHOICE
1. In assessing the knowledge of a pregestational woman with type 1 diabetes about changing
insulin needs during pregnancy, which information is accurate?
a. Insulin dosage during the first 3
months of pregnancy needsto be
increased.
b. Insulin dosage will likely need to be
decreased during the second and third
trimesters.
c. Episodes of hypoglycemia are more
likely to occur during the last 3
months.
d. Insulin needs should return to normal
within 7 to 10 days after birth if bottle-
feeding.
ANS: D
“Insulin needs should return to normal within 7 to 10 days after birth if bottle-feeding” is an
accurate statement and signifies that the woman understands control of her diabetes during
pregnancy. Insulin needs are reduced in the first trimester because of increased insulin
production by the pancreas and increased peripheral sensitivity to insulin. Insulin dosage will
likely need to be increased, not decreased, during the second and third trimesters. Episodes of
hypoglycemia are more likely to occur during the first 3 months, not the last 3 months.
DIF: Cognitive Level: Application REF: p. 360 | Figure 15-1 OBJ:
Nursing Process: Evaluation
2. Which is attributable to poor glycemic control before and during early pregnancy?
a. Frequent episodes of maternal
hypoglycemia
b. Congenital anomalies in the fetus
c. Polyhydramnios
d. Hyperemesis gravidarum
ANS: B
Preconception counselling is particularly important because strict metabolic control before
conception and in the early weeks of gestation is instrumental in decreasing the risks of
congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first
trimester (not before conception) as a result of hormone changes and the effects on insulin
, production and usage. Hydramnios occurs about 10 times more often in diabetic pregnancies
than in nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy.
Hyperemesis gravidarum may exacerbate hypoglycemic events, as the decreased food intake
by the mother and glucose transfer to the fetus contribute to hypoglycemia.
DIF: Cognitive Level: Comprehension REF: p. 361 OBJ: Nursing Process: Planning
3. In planning for the care of a 30-year-old woman with pregestational diabetes, what does the
nurse recognize as the most important factor affecting pregnancy outcome?
a. Mother’s age
b. Number of years since diabetes was
diagnosed
c. Amount of insulin required prenatally
d. Degree of glycemic control during
pregnancy
ANS: D
Women with excellent glucose control and no blood vessel disease should have good
pregnancy outcomes. The mother`s age is not related to gestational diabetes. Number of years
since diabetes was diagnosed is not the most important factor affecting pregnancy outcome.
The amount of insulin required prenatally is not the most important factor affecting pregnancy
outcome.
DIF: Cognitive Level: Comprehension REF: p. 361 OBJ: Nursing Process: Planning
4. What normal fasting glucose level should the nurse recommend for a woman with
pregestational diabetes?
a. 2.5–3.5 mmol/L
b. 3.8–5.2 mmol/L
c. 5.5–7.7 mmol/L
d. 5.0–6.6 mmol/L
ANS: B
Target glucose levels during a fasting period are 3.8–5.2 mmol/L. A glucose level of 2.5– 3.5
mmol/L is low. A glucose level of 5.5–7.7 mmol/L is consistent with expected levels with 1-hour
postprandial plasma glucose (PG). A glucose level of 5.0–6.6 mmol/L is considered normal for a
2-hour postprandial PG.
DIF: Cognitive Level: Knowledge REF: p. 365 | Table 15-2 OBJ:
Nursing Process: Assessment
, 5. What is the greatest risk for a fetus of a pregnant woman who has gestational diabetes mellitus
(GDM)?
a. Macrosomia
b. Congenital anomalies of the central
nervous system
c. Postterm birth
d. Low birth weight
ANS: A
Fetal macrosomia is a risk to the fetus of a mother with GDM. Poor glycemic control during the
preconception time frame and into the early weeks of the pregnancy is associated with
congenital anomalies. Preterm labour or birth is more likely to occur with severe diabetes, not
postterm birth. Increased weight, or macrosomia, is the greatest risk factor for this woman.
DIF: Cognitive Level: Comprehension REF: p. 361
OBJ: Nursing Process: Planning | Nursing Process: Implementation
6. Which should the nurse know regarding drug testing during pregnancy in Canada?
a. It is required at the first prenatal visit.
b. Only those drugs disclosed by the
woman are tested for.
c. There is no legal requirement to test
the mother or the newborn child.
d. Testing is required before labour and
delivery.
ANS: C
There is no legal requirement in Canada for a health care provider to test either the mother or
the newborn child for the presence of drugs. Testing is not required on the initial prenatal visit.
If testing were to occur, all substances would be tested for, not just those disclosed by the
mother. Testing is not required before labour and delivery.
DIF: Cognitive Level: Comprehension REF: p. 394
OBJ: Nursing Process: Assessment
7. Which should the nurse know in terms of the incidence and classification of diabetes?
