A nurse in a prenatal clinic is completing a skin assessment of a client who is in the second trimester. Which of the following findings should the nurse expect? (Select all that apply.)

Explanation:

A. Preparation for cesarean birth:

This is the correct choice. Placenta previa is a condition where the placenta partially or completely covers the cervix, leading to vaginal bleeding. In cases of suspected placenta previa with significant bleeding, cesarean birth is the safest delivery option to minimize the risk of complications such as hemorrhage. Therefore, immediate preparation for cesarean birth is indicated to ensure the safety of both the mother and the baby.

B. Initiation of pushing:

Pushing or active pushing efforts are contraindicated in cases of suspected placenta previa with significant vaginal bleeding. Pushing can increase the risk of further placental detachment and exacerbate bleeding. It is crucial to avoid any actions that could worsen the bleeding or harm the mother and baby. Therefore, initiation of pushing is not appropriate in this situation.

C. Examination to determine cervical status:

While cervical examinations are important during labor to assess progress and determine readiness for delivery, they are not appropriate in cases of suspected placenta previa with active vaginal bleeding. Cervical examinations can potentially increase bleeding and should be avoided until the placental location and stability are assessed through ultrasound or other diagnostic methods. Therefore, examination to determine cervical status is not appropriate in this situation.

D. A magnesium sulfate infusion:

Magnesium sulfate infusion is not indicated for suspected placenta previa with significant vaginal bleeding. Magnesium sulfate is commonly used to prevent or manage preterm labor and certain hypertensive disorders during pregnancy but is not a treatment for placenta previa or its associated bleeding. Immediate preparation for cesarean birth is the priority in this situation to ensure the safety of the mother and baby. Therefore, a magnesium sulfate infusion is not appropriate in this situation.

Explanation:

A. Acarbose:

Acarbose is an oral antidiabetic medication that works by slowing down the digestion and absorption of carbohydrates in the intestines. It is typically used in the management of type 2 diabetes but is not commonly prescribed for gestational diabetes mellitus (GDM). Acarbose is not usually recommended during pregnancy, especially since there are other safer options available for managing GDM.

B. Repaglinide:

Repaglinide is another oral antidiabetic medication that stimulates insulin release from the pancreas. While it is effective in lowering blood sugar levels, it is not commonly used as a first-line treatment for gestational diabetes. Repaglinide may have a more rapid onset of action compared to other oral antidiabetic drugs, but its use during pregnancy is not as common as other medications like glyburide or insulin.

C. Glipizide:

Glipizide is an oral sulfonylurea medication used primarily in the management of type 2 diabetes. It stimulates insulin secretion from the pancreas. However, like other sulfonylureas, glipizide is not typically recommended for use during pregnancy due to safety concerns for the developing fetus. It may also have a higher risk of hypoglycemia compared to other options.

D. Glyburide:

Glyburide is an oral sulfonylurea medication that helps lower blood sugar levels by stimulating insulin release from the pancreas. It is one of the commonly used medications for managing gestational diabetes when diet and exercise alone are not sufficient. Glyburide is generally considered safe for use during pregnancy, especially after the first trimester, and it has been found to effectively control blood glucose levels in many pregnant individuals with GDM.