A nurse in a prenatal clinic is caring for a client who is at 24 weeks of gestation. Which of the following findings is a potential indication the client has gestational diabetes mellitus?

A. Administer calcium gluconate for urine output less than 50 mL/hr: Calcium gluconate is given to treat magnesium sulfate toxicity, which is indicated by absent deep tendon reflexes, respiratory depression, or high serum magnesium levels. Low urine output requires monitoring but does not automatically warrant calcium gluconate administration.

B. Check deep tendon reflexes every 8 hr: Deep tendon reflexes should be assessed frequently during magnesium sulfate therapy, usually every 1–2 hours, to detect early signs of toxicity. Checking only every 8 hours is insufficient for safe monitoring.

C. Administer one dose of betamethasone now and repeat in 24 hr: Betamethasone is given to accelerate fetal lung maturity in preterm gestation, which is critical at 31 weeks. Administering the two-dose course as prescribed helps reduce neonatal respiratory complications, making this a priority intervention alongside magnesium sulfate therapy.

D. Limit IV intake to no more than 200 mL/hr: Monitoring and limiting IV fluids helps prevent fluid overload and pulmonary edema in preeclamptic clients, but ensuring fetal lung maturity with betamethasone takes priority at this gestational age in case of an early delivery.

A. The client's shoulders are rounded slightly forward: Slightly rounded shoulders can indicate poor posture or musculoskeletal issues. While minor rounding is common, it is not a defining characteristic of a normal, standard gait and may reflect postural deviations.

B. The client's heels touch the ground before their toes: A standard gait involves initial contact with the heel, followed by a smooth rolling motion to the toes during the stance phase. This heel-to-toe pattern indicates normal foot mechanics and weight transfer, reflecting a healthy, functional gait for ADLs.

C. The client's dominant foot bears more weight: Unequal weight bearing between the dominant and non-dominant foot suggests an abnormal gait or musculoskeletal imbalance. In a normal gait, weight is distributed evenly between both lower extremities during walking.

D. The client looks at the floor when walking: Looking at the floor may indicate visual or balance issues, poor confidence, or gait instability. A standard gait typically involves a forward gaze with a stable, upright posture to maintain balance and coordination.