A nurse at a provider’s office is caring for a 24-year-old female client.
Complete the following sentence by using the lists of options.
The nurse should prepare to reinforce teaching with the client about a
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"D"}
? Rationale for Correct Answers
Diabetic diet is appropriate because the client meets diagnostic criteria for gestational diabetes mellitus (GDM). The 3-hour oral glucose tolerance test (OGTT) shows two or more elevated values:
- 1-hour: 220 mg/dL (normal <180 mg/dL)
- 2-hour: 165 mg/dL (normal <140 mg/dL)
- 3-hour: 142 mg/dL (normal 70–115 mg/dL)
According to the American Diabetes Association and ACOG, GDM is diagnosed when at least two values exceed thresholds. GDM increases risks for macrosomia, preeclampsia, and neonatal hypoglycemia, and requires dietary management as first-line therapy.
30 cal/kg/day is the recommended caloric intake for overweight or obese pregnant individuals with GDM. Caloric needs are based on pre-pregnancy weight:
- Normal BMI: 30–35 kcal/kg/day
- Overweight (BMI 25–29.9): 25 kcal/kg/day
- Obese (BMI ≥30): 30 kcal/kg/day is often used to balance fetal growth and glycemic control.
❌ Rationale for Incorrect Response 1 Options
Low-sodium diet is used for hypertension or preeclampsia, but this client has no signs of preeclampsia (e.g., proteinuria, headache, visual changes, epigastric pain).
High-protein diet is not a standard intervention for GDM and may worsen insulin resistance if not balanced.
Gluten-free diet is indicated for celiac disease, which is not present here.
❌ Rationale for Incorrect Response 2 Options
15–25 cal/kg/day are too low for pregnancy and may risk fetal growth restriction, especially in obese clients.
20 cal/kg/day is used in severe obesity or when caloric restriction is medically necessary, but not standard for GDM.
25 cal/kg/day is more appropriate for overweight (not obese) clients.
? Take-Home Points
- GDM is diagnosed with ≥2 abnormal values on a 3-hour OGTT.
- Dietary therapy is first-line management for GDM, focusing on controlled carbohydrate intake.
- Obese pregnant clients with GDM should receive ~30 kcal/kg/day based on pre-pregnancy weight.
- GDM increases risks for maternal and fetal complications and requires close monitoring.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"},"F":{"answers":"B"}}
Explanation
✅ Anticipated Orders – Rationales
- Initiate morphine per protocol Morphine is commonly used to manage moderate to severe symptoms of NAS. It helps reduce central nervous system irritability and autonomic overactivity by binding to opioid receptors, thereby easing withdrawal symptoms.
- Encourage breastfeeding Breastfeeding is encouraged unless contraindicated (e.g., maternal HIV or ongoing illicit drug use). Breast milk may contain small amounts of opioids if the mother is on medication-assisted treatment (e.g., methadone or buprenorphine), which can help ease withdrawal symptoms in the newborn.
- Offer small, frequent feedings Infants with NAS often have poor feeding due to uncoordinated suck and gastrointestinal symptoms. Small, frequent feedings help maintain adequate nutrition and prevent hypoglycemia.
- Consult social services Given the maternal history of opioid use disorder and lack of stable housing, social services involvement is essential for discharge planning, ensuring a safe environment, and connecting the family with community resources.
- Monitor using the eat, sleep, console scoring tool This tool is a functional assessment method used to evaluate NAS severity and guide treatment. It focuses on the infant’s ability to eat, sleep, and be consoled rather than just symptom counting.
❌ Not Anticipated Order – Rationale
- Administer naloxone Naloxone is contraindicated in neonates with NAS because it can precipitate acute, severe withdrawal. It is only used in cases of life-threatening opioid overdose, not for withdrawal management.
Correct Answer is D
Explanation
Choice A rationale
Combined estrogen-progestin contraceptive pills typically regulate the menstrual cycle and can often lead to shorter, lighter periods, or even amenorrhea in some individuals, due to the suppression of endometrial proliferation. The synthetic hormones, estrogen and progestin, stabilize the endometrium, preventing excessive build-up and subsequent heavy bleeding.
Choice B rationale
Medroxyprogesterone acetate (Depo-Provera) is an injectable contraceptive that provides long-acting contraception. It is administered intramuscularly or subcutaneously, but the typical administration frequency is once every 3 months (13 weeks), not once per month. This extended duration of action is due to the sustained release of the progestin.
Choice C rationale
Diaphragms are reusable barrier contraceptive devices. While a single diaphragm can be used for several years, it typically needs to be replaced every 1 to 2 years, or sooner if there is a significant weight change (gain or loss of 10-15 pounds), or after pregnancy, to ensure proper fit and contraceptive efficacy.
Choice D rationale
Oral contraceptives, particularly those containing estrogen and progestin, have been shown to significantly reduce the risk of endometrial cancer. This protective effect is primarily attributed to the progestin component, which counteracts the proliferative effects of estrogen on the endometrium, thereby preventing hyperplasia and subsequent malignant transformation.
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