Difficulty: Medium
Average Score: 89%
Simulated
Passage / Scenario
Gravida 4 Para 3, 32 weeks of gestation, BMI 32, History of two newborns weighing over 4.5 kg (10lb.), Family history of Type 1 diabetes mellitus (maternal), Fetal heart rate 140/min via Doppler, Fasting blood glucose 138 mg/dl (60-105 mg/dl), Fasting blood glucose 142 mg/dl (60-105 mg/dl), HbA1C 12% (<6.5%)A nurse is caring for a client who is pregnant. Select the 3 actions that the nurse should plan to take
Correct answer
A,C,D
Rationale
A: For clients with gestational diabetes, dietary modifications are a critical intervention. Limiting carbohydrate intake to 40% of daily calories can help regulate blood glucose levels. C: Given the elevated fasting blood glucose levels and high HbA1C (12%), this client may require pharmacological management to control blood sugar levels. Metformin is a common oral hypoglycemic agent used during pregnancy when diet and lifestyle changes are insufficient. D: Clients with uncontrolled gestational diabetes or poorly controlled blood sugar levels are at increased risk of fetal complications such as macrosomia, stillbirth, and preterm labor. A non-stress test (NST) twice a week helps monitor fetal well-being and detect early signs of distress.