A nurse in a prenatal clinic is caring for a client. Using Leopold's maneuvers, the nurse palpates a round, firm, movable part in the fundus of the uterus and a long smooth surface on the client's right side. In which abdominal quadrant should the nurse expect to auscultate fetal heart tones?

Choice A reason:
Reducing exercise to 3 days a week may not be sufficient for managing gestational diabetes. Regular physical activity is an important part of diabetes management because it helps lower blood sugar levels and can improve insulin sensitivity. The American Diabetes Association recommends that pregnant women with gestational diabetes engage in at least 150 minutes of moderate-intensity aerobic activity per week. This can be distributed over at least three days per week, with no more than two consecutive days without exercise.

Choice B reason:
The statement that the client knows she is at increased risk of developing type 2 diabetes is accurate. Women with gestational diabetes have a higher risk of developing type 2 diabetes later in life. Therefore, they should be monitored for diabetes postpartum and in the years following the birth.

Choice C reason:
Taking glyburide, an oral hypoglycemic agent, is a common treatment for gestational diabetes when diet and exercise are not enough to control blood sugar levels. It is usually taken before breakfast to help control blood sugar levels throughout the day.

Choice D reason:
The statement about limiting carbohydrates to 50% of caloric intake indicates a need for further teaching. While it is important to monitor carbohydrate intake, there is no one-size-fits-all recommendation for the percentage of calories that should come from carbohydrates. Dietary needs can vary based on individual factors, and it is generally recommended to follow a balanced diet with carbohydrates coming from whole grains, fruits, vegetables, and legumes. The client should work with a dietitian to determine the appropriate amount of carbohydrates for her specific needs.

Choice a reason:
Observing for meconium in respiratory secretions is crucial for SGA newborns because they are at increased risk for meconium aspiration syndrome (MAS). MAS occurs when a newborn breathes in meconium-stained amniotic fluid into their lungs, which can cause respiratory distress. It is more common in full-term or post-term babies, and early detection and treatment are vital for improving outcomes.

Choice b reason:
Monitoring for hyperglycemia is important as SGA newborns are at risk for blood sugar imbalances. Hyperglycemia in newborns can be due to various factors, including stress, and requires careful management to prevent complications. However, it is not the primary concern immediately post-delivery for SGA newborns compared to the risk of MAS.

Choice c reason:
Monitoring for hyperthermia is less commonly a primary concern for SGA newborns immediately after birth. Hyperthermia can lead to dehydration and increase metabolic demands, which can be harmful to newborns. However, the immediate risk of hyperthermia is not as high as the risk of MAS for SGA newborns.

Choice d reason:
Identifying manifestations of anemia is important in newborn care. Anemia in newborns can present as pale skin, irritability, and a fast heart rate. While it is a condition that requires attention, the immediate post-delivery concern for SGA newborns is typically the risk of MAS rather than anemia.