Nokea
Nursing intervention for pregnant patients with diabetes is based on the knowledge that the need for insulin is
- A. varied depending on the stage of gestation.
- B. increased throughout pregnancy and the postpartum period.
- C. decreased throughout pregnancy and the postpartum period.
- D. should not change because the fetus produces its own insulin.
Correct Answer: A
Rationale: The correct answer is A because insulin needs vary during pregnancy due to hormonal changes affecting insulin sensitivity. In early pregnancy, insulin needs may decrease due to increased insulin sensitivity, but in late pregnancy, insulin needs may increase due to insulin resistance. Choice B is incorrect as insulin needs do not consistently increase throughout pregnancy and postpartum. Choice C is incorrect as insulin needs typically increase rather than decrease during pregnancy. Choice D is incorrect as the fetus does not produce its own insulin to regulate the mother's blood sugar levels.
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Which factor is most important in diminishing maternal, fetal, and neonatal complications in a pregnant patient with diabetes?
- A. Evaluation of retinopathy by an ophthalmologist
- B. The patient's stable emotional and psychological status
- C. Degree of glycemic control before and during the pregnancy
- D. Total protein excretion and creatinine clearance within normal limits
Correct Answer: C
Rationale: The correct answer is C, the degree of glycemic control before and during the pregnancy. Proper management of blood sugar levels is crucial in reducing complications in pregnant patients with diabetes. Uncontrolled blood sugar levels can lead to adverse outcomes for both the mother and the baby. Monitoring and maintaining optimal glycemic control before and during pregnancy can help prevent complications such as birth defects, preterm birth, macrosomia, and neonatal hypoglycemia.
Choice A, evaluation of retinopathy by an ophthalmologist, is important for diabetic patients but is not the most critical factor in reducing maternal, fetal, and neonatal complications.
Choice B, the patient's stable emotional and psychological status, is important for overall well-being but does not directly impact maternal, fetal, and neonatal complications in the same way as glycemic control.
Choice D, total protein excretion and creatinine clearance within normal limits, is important for assessing kidney function in diabetic patients but is not as directly related to
Which finding would indicate concealed hemorrhage in abruptio placentae?
- A. Bradycardia
- B. Hard boardlike abdomen
- C. Decrease in fundal height
- D. Decrease in abdominal pain
Correct Answer: B
Rationale: The correct answer is B: Hard boardlike abdomen. This finding indicates concealed hemorrhage in abruptio placentae because it suggests intra-abdominal bleeding causing rigidity and firmness. This is due to blood pooling in the abdomen, leading to a tense, boardlike feeling upon palpation. The other choices are incorrect because: A) Bradycardia is not a specific indicator of concealed hemorrhage in this context; C) Decrease in fundal height is more characteristic of a missed miscarriage or intrauterine fetal demise; D) Decrease in abdominal pain is not typically associated with concealed hemorrhage, which often presents with severe abdominal pain.
A patient at 25 weeks' gestation has just been diagnosed with gestational diabetes. What is the most important education for the nurse to provide the patient at this time?
- A. induction of labor
- B. nutrition
- C. potential fetal complications
- D. potential maternal complications
Correct Answer: B
Rationale: The correct answer is B: nutrition. At 25 weeks' gestation with gestational diabetes, nutrition education is crucial to manage blood sugar levels and prevent complications. Proper diet control can help regulate blood glucose levels, ensuring optimal fetal growth and reducing the risk of macrosomia. Educating the patient on a balanced diet, monitoring carbohydrate intake, and understanding the glycemic index are essential. Induction of labor (choice A) is not indicated at this stage and may lead to potential complications. While discussing potential fetal (choice C) and maternal (choice D) complications is important, addressing nutrition takes precedence as it directly impacts the health of both the mother and the fetus.
A patient who was pregnant had a spontaneous abortion at approximately 4 weeks' gestation. At the time of the miscarriage, it was thought that all products of conception were expelled. Two weeks later, the patient presents at the clinic office complaining of “crampy†abdominal pain and a scant amount of serosanguineous vaginal drainage with a slight odor. The pregnancy test is negative. Vital signs reveal a temperature of 100°F, with blood pressure of 100/60 mm Hg, irregular pulse 88 beats/minute (bpm), and respirations, 20 breaths per minute. Based on this assessment data, what does the nurse anticipate as a clinical diagnosis?
- A. Ectopic pregnancy
- B. Uterine infection
- C. Gestational trophoblastic disease
- D. Endometriosis
Correct Answer: B
Rationale: The correct answer is B: Uterine infection. The patient's presentation with crampy abdominal pain, scant serosanguineous vaginal drainage, negative pregnancy test, and vital signs indicating fever, hypotension, and tachycardia are indicative of a uterine infection, most likely post-miscarriage. The timing of symptoms 2 weeks after miscarriage aligns with the typical onset of infection. The absence of products of conception being expelled completely could have led to retained tissue causing infection. Ectopic pregnancy (A) would typically present with severe abdominal pain, vaginal bleeding, and positive pregnancy test. Gestational trophoblastic disease (C) would present with irregular vaginal bleeding and elevated hCG levels. Endometriosis (D) is a chronic condition characterized by pelvic pain and abnormal menstrual bleeding, not an acute post-miscarriage complication.
Which technique would the nurse employ for an obstetrical client with a foreign body airway obstruction?
- A. Back blows
- B. Chest thrusts
- C. Suprapubic thrusts
- D. Abdominal thrusts
Correct Answer: B
Rationale: The correct technique for an obstetrical client with a foreign body airway obstruction is chest thrusts. This is because back blows, suprapubic thrusts, and abdominal thrusts can potentially harm the fetus. Chest thrusts are safer as they target the area above the uterus, avoiding direct pressure on the abdomen. The forceful thrusts to the chest can help dislodge the foreign body without putting the fetus at risk. It is important to prioritize the safety of both the mother and the unborn child in this situation.