HESI Case Studies - Gestational
Diabetes (Danielle Greene)
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 G-T-P-A-L designation? - ANS 5-2-1-
1-4
Gravida (no. pregnancies, including current)
Term (after wk 37) {live and stillborn}
Preterm (between 20-37 wk) {live and stillborn}
Abortion (fetal loss, up to 20 weeks)
Living (all alive at time of interview)
Which information does the nurse recognize in the client's history to support a diagnosis of gestational
diabetes? - ANS Child weighed 9 lbs (4.08 kg) at 41 weeks' gestation
Risk Factors:
- previous birth over 9 lbs
- maternal age > 25
- obesity
- hx. of unexplained stillborn
- fam hx of Type 1 diabetes in a first-degree relative
- strong fam hx of type 2 DM
- hx of gest diabetes.
, Which instruction should the nurse give the client? - ANS Follow an unrestricted diet and exercise
pattern for at least 3 days before the test.
this allows the test to be a true determination of the body's ability to handled the glucose load given
after the fasting BG is drawn.
The nurse's response should be based on the understanding of which normal physiologic change of
pregnancy? - ANS Hormonal changes in the second and third trimesters result in increased maternal
insulin resistance.
increased levels of H increase insulin resistance bc they act as insulin antagonists --> glucose-sparing
mechanism to ensure an adequate glucose supply to the fetus. Most pregnant women can handle this
insulin resistance, but gest diabetes cannot and demonstrate an impaired tolerance to glucose during
pregnancy --> hyperglycemia
Which response should the nurse give to the client?
Select all that apply - ANS "Hyperglycemia often presents as increased thirst and urination."
"Hyperglycemia causes a headache and flushed, dry skin."
Which responses should the nurse give to the client? - ANS Choose complex carbohydrates that are high
in fiber content.
Avoid foods high in refined sugars.
Drink between 8 to 10 cups of fluids daily.
Carbs: starch and protein in high-fiber complex carbohydrates help regulate the BG as a result of a more
sustantained glucose release over time.
Diabetes (Danielle Greene)
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 G-T-P-A-L designation? - ANS 5-2-1-
1-4
Gravida (no. pregnancies, including current)
Term (after wk 37) {live and stillborn}
Preterm (between 20-37 wk) {live and stillborn}
Abortion (fetal loss, up to 20 weeks)
Living (all alive at time of interview)
Which information does the nurse recognize in the client's history to support a diagnosis of gestational
diabetes? - ANS Child weighed 9 lbs (4.08 kg) at 41 weeks' gestation
Risk Factors:
- previous birth over 9 lbs
- maternal age > 25
- obesity
- hx. of unexplained stillborn
- fam hx of Type 1 diabetes in a first-degree relative
- strong fam hx of type 2 DM
- hx of gest diabetes.
, Which instruction should the nurse give the client? - ANS Follow an unrestricted diet and exercise
pattern for at least 3 days before the test.
this allows the test to be a true determination of the body's ability to handled the glucose load given
after the fasting BG is drawn.
The nurse's response should be based on the understanding of which normal physiologic change of
pregnancy? - ANS Hormonal changes in the second and third trimesters result in increased maternal
insulin resistance.
increased levels of H increase insulin resistance bc they act as insulin antagonists --> glucose-sparing
mechanism to ensure an adequate glucose supply to the fetus. Most pregnant women can handle this
insulin resistance, but gest diabetes cannot and demonstrate an impaired tolerance to glucose during
pregnancy --> hyperglycemia
Which response should the nurse give to the client?
Select all that apply - ANS "Hyperglycemia often presents as increased thirst and urination."
"Hyperglycemia causes a headache and flushed, dry skin."
Which responses should the nurse give to the client? - ANS Choose complex carbohydrates that are high
in fiber content.
Avoid foods high in refined sugars.
Drink between 8 to 10 cups of fluids daily.
Carbs: starch and protein in high-fiber complex carbohydrates help regulate the BG as a result of a more
sustantained glucose release over time.
