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A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client?
Select one:

Insulin needs decrease in the first trimester, but increase in the second trimester as the woman's body becomes more insulin-resistant.

Vascular disease that always accompanies diabetes slows fetal growth.

The risk of ketoacidosis decreases during the length of the pregnancy.

The baby is likely to have a congenital abnormality because of the uncontrolled diabetes.

Answer and Explanation

The Correct Answer is A

Choice A Reason: Insulin needs decrease in the first trimester, but increase in the second trimester as the woman's body becomes more insulin-resistant. This is because this statement describes the typical patern of insulin requirements during pregnancy for women with pre-existing diabetes. Insulin needs decrease in the first trimester due to increased insulin production by the pancreas, increased insulin sensitivity by the tissues, and increased risk of hypoglycemia due to nausea and vomiting. Insulin needs increase in the second trimester due to increased levels of placental hormones such as human placental lactogen (hPL), which antagonize insulin action and cause insulin resistance.

Choice B Reason: Vascular disease that always accompanies diabetes slows fetal growth. This is an incorrect answer that makes a false and exaggerated claim about diabetes and fetal growth. Vascular disease does not always accompany diabetes, but it can be a complication of long-term or poorly controlled diabetes that aﬀects blood vessels and circulation. Vascular disease can aﬀect fetal growth by reducing placental perfusion and oxygen delivery, but it is not the only factor that inﬂuences fetal growth. Other factors include maternal nutrition, genetics, infections, or anomalies.

Choice C Reason: The risk of ketoacidosis decreases during the length of the pregnancy. This is an incorrect answer that contradicts the evidence and guidelines on diabetes and ketoacidosis during pregnancy. Ketoacidosis is a metabolic emergency where high levels of ketones accumulate in the blood due to insufficient insulin or excessive glucose utilization, which causes acidosis, dehydration, electrolyte imbalance, and coma. Ketoacidosis can occur in women with diabetes during pregnancy due to infection, stress, starvation, or inadequate insulin therapy. The risk of ketoacidosis does not decrease during the length of the pregnancy, but rather increases in the second and third trimesters due to increased insulin resistance and glucose production.

Choice D Reason: The baby is likely to have a congenital abnormality because of the uncontrolled diabetes. This is an incorrect answer that implies a negative and deterministic outcome for the baby. Congenital abnormalities are structural or functional defects that are present at birth, which can aﬀect various organs or systems in the baby.

Congenital abnormalities can be caused by genetic or environmental factors, or a combination of both. Diabetes can increase the risk of congenital abnormalities, especially if the blood glucose levels are high during the first trimester, when organogenesis occurs. However, the risk of congenital abnormalities is not inevitable or predictable, and it can be reduced by maintaining good glycemic control before and during pregnancy.

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Correct Answer is B

Explanation

Choice A Reason: Milia. This is an incorrect answer that describes a diﬀerent skin condition. Milia are tiny white or yellow cysts that appear on the nose, chin, or cheeks of newborns. They are caused by the retention of keratin in the sebaceous glands or hair follicles. They usually disappear within a few weeks without treatment.

Choice B Reason: Dermal melanosis. This is a correct answer that explains the finding of bluish markings across the newborn's lower back. Dermal melanosis. This is because dermal melanosis, also known as Mongolian spots, is a common benign skin condition that aﬀects newborns of Asian, African, or Hispanic descent. It is characterized by bluish-gray or brown patches of pigmentation on the lower back, butocks, or extremities. It is caused by the migration of melanocytes from the neural crest to the dermis during embryonic development. It usually fades by 2 to 4 years of age.

Choice C Reason: Stork bites. This is an incorrect answer that refers to another skin condition. Stork bites, also known as salmon patches or nevus simplex, are ﬂat pink or red marks that appear on the forehead, eyelids, nose, upper lip, or nape of the neck of newborns. They are caused by dilated capillaries in the superficial dermis. They usually fade by 18 months of age.

Choice D Reason: Birth trauma. This is an incorrect answer that implies an injury or damage to the newborn's skin or tissues during labor and delivery. Birth trauma can cause bruises, abrasions, lacerations, fractures, or nerve injuries. It is not related to bluish markings on the lower back.

A. Preterm infant. B. Female infant. C. GBS status of mother. D. Cesarean section.

Correct Answer is D

Explanation

Choice A Reason: Preterm infant. This is an incorrect answer that confuses TTN with another respiratory condition called respiratory distress syndrome (RDS). RDS is a serious condition where the newborn's lungs are immature and lack sufficient surfactant, which is a substance that reduces surface tension and prevents alveolar collapse. RDS can cause respiratory distress, hypoxia, acidosis, and organ failure. It is more common in preterm infants, especially those born before 37 weeks' gestation.

Choice B Reason: Female infant. This is an incorrect answer that has no evidence or rationale to support it. TTN does not have a gender preference or diﬀerence in incidence or severity.

Choice C Reason: GBS status of mother. This is an incorrect answer that relates to another respiratory complication called early-onset neonatal sepsis (EONS). EONS is a bacterial infection that occurs within 72 hours after birth, which can aﬀect multiple organs and systems in the newborn. EONS can be caused by group B streptococcus (GBS), which is a common bacterium that colonizes in some women's vagina or rectum. GBS can be transmited to the newborn during delivery and cause pneumonia, meningitis, or septic shock.

Choice D Reason: Cesarean section. This is because cesarean section is a risk factor for TTN, which is a mild respiratory problem that results from delayed clearance of fetal lung ﬂuid after birth. TTN causes rapid breathing, nasal ﬂaring, grunting, and mild cyanosis. It usually resolves within 24 to 48 hours after birth. Cesarean section can increase the risk of TTN because it bypasses the normal process of labor, which helps squeeze out some of the ﬂuid from the fetal lungs.

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A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client? Select one:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

During a physical assessment of a newborn, the nurse observes bluish markings across the newborn's lower back. The nurse interprets this finding as: Select one:

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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A client with insulin-dependent type 2 diabetes and an HbA1c of 6.0% is planning to become pregnant soon. What anticipatory teaching should the nurse provide this client?
Select one: