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. 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.

Explanation:

A. The biparietal diameter

The biparietal diameter is a measurement of the fetal head's diameter, which is often assessed during routine prenatal ultrasounds to estimate gestational age and monitor fetal growth. However, in the scenario described, the client is experiencing heavy vaginal bleeding without contractions at 38 weeks of gestation. The focus is on the immediate concern of the fetus's well-being rather than assessing specific fetal measurements like the biparietal diameter.

B. Viability of the fetus

This choice is correct for the scenario described. Viability refers to the ability of the fetus to survive outside the uterus. Heavy vaginal bleeding near term raises concerns about potential harm to the fetus and its viability. An ultrasound would be performed to assess the fetal heart rate, movement, and overall condition to determine if the fetus is viable or if there are any immediate concerns that need to be addressed.

C. Fetal lung maturity

Fetal lung maturity is typically assessed closer to the end of pregnancy, usually around 36 to 39 weeks of gestation, to determine if the fetus's lungs are developed enough for birth. While important for planning deliveries, assessing fetal lung maturity is not the primary concern in a situation where the client is experiencing heavy vaginal bleeding without contractions at 38 weeks of gestation.

D. Location of the placenta

The location of the placenta is important for monitoring placental health and assessing potential complications such as placenta previa. However, in the context of heavy vaginal bleeding without contractions at 38 weeks of gestation, the immediate concern is the well-being and viability of the fetus rather than the placental location.