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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason: Enhance uterine contractions. This is an incorrect answer that contradicts the effect of narcotic analgesia on uterine activity. Narcotic analgesia can reduce uterine contractions by decreasing maternal catecholamine levels, which can prolong labor or increase bleeding.
Choice B Reason: Be used in place of preoperative sedation. This is an irrelevant answer that does not apply to this scenario. Preoperative sedation is a medication given before surgery to reduce anxiety, pain, or nausea. Narcotic analgesia can be used as a preoperative sedative, but it is not related to labor or delivery.
Choice C Reason: Result in neonatal respiratory depression. This is because narcotic analgesia can cross the placenta and affect the fetal central nervous system, which can cause decreased respiratory drive, apnea, bradycardia, or hypotonia in the newborn. The risk of neonatal respiratory depression is higher when narcotic analgesia is administered close to delivery, as there is less time for placental clearance or maternal metabolism.
Choice D Reason: Prevent the need for anesthesia with an episiotomy. This is an inaccurate answer that overestimates the effect of narcotic analgesia on perineal pain. Narcotic analgesia can provide some relief of labor pain, but it does not block pain sensation completely or locally. An episiotomy is a surgical incision made in the perineum to enlarge the vaginal opening during delivery, which requires local anesthesia or regional anesthesia (such as epidural or spinal). Narcotic analgesia does not prevent or replace anesthesia with an episiotomy.
Correct Answer is B
Explanation
Choice A Reason: Shoulder dystocia. This is an incorrect answer that describes a different obstetric complication. Shoulder dystocia is a condition where the baby's shoulder gets stuck behind the mother's pubic bone during delivery, which can cause nerve injury, fracture, or asphyxia to the baby. Shoulder dystocia does not cause fetal bradycardia, abdominal pain, or vaginal bleeding.
Choice B Reason: Placental abruption. This is a correct answer that explains the symptoms of fetal bradycardia, abdominal pain, and vaginal bleeding in a woman with a history of crack cocaine use. Placental abruption. This is because placental abruption is a condition where the placenta separates from the uterine wall before delivery, which can cause fetal distress, maternal hemorrhage, and shock. Placental abruption can be triggered by maternal hypertension, trauma, or substance abuse, such as crack cocaine.
Choice C Reason: Anaphylactoid syndrome of pregnancy. This is an incorrect answer that refers to a rare and fatal condition also known as amniotic fluid embolism. Anaphylactoid syndrome of pregnancy is a condition where amniotic fluid enters into the maternal bloodstream and causes an allergic reaction, which can lead to respiratory failure, cardiac arrest, coagulopathy, and coma. Anaphylactoid syndrome of pregnancy does not cause fetal bradycardia or vaginal bleeding.
Choice D Reason: Placenta previa. This is an incorrect answer that indicates another placental disorder. Placenta previa is a condition where the placenta covers or is near the cervix, which can cause painless bright red bleeding during pregnancy or labor. Placenta previa does not cause fetal bradycardia or abdominal pain.
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