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. "I know I am at increased risk to develop type 2 diabetes."

This statement indicates an understanding of the increased risk for developing type 2 diabetes after experiencing gestational diabetes. It shows awareness of the long-term implications and the importance of ongoing monitoring and lifestyle management.

B. "I will reduce my exercise schedule to 3 days a week."

This statement is concerning because regular exercise is an essential component of managing gestational diabetes. Exercise helps control blood sugar levels, improves insulin sensitivity, and promotes overall health during pregnancy. The client should not reduce their exercise schedule unless advised by their healthcare provider for specific reasons.

C. "I will take my glyburide daily with breakfast."

Glyburide is an oral medication used to help control blood sugar levels in some cases of gestational diabetes. Taking it with breakfast can help optimize its effectiveness. This statement indicates an understanding of medication management.

D. "I should limit my carbohydrates to 50% of caloric intake."

Limiting carbohydrates is often a key part of managing gestational diabetes, as it can help control blood sugar levels. However, the specific percentage of carbohydrate intake may vary based on individual factors and should be determined in consultation with a healthcare provider or registered dietitian.

Explanation:

A. An excessive amount of amniotic fluid is present.

Polyhydramnios is defined as an excessive accumulation of amniotic fluid within the amniotic sac surrounding the fetus. This condition can occur due to various factors, including fetal abnormalities, maternal health conditions such as diabetes or gestational diabetes, multiple gestations (twins, triplets, etc.), or idiopathic causes where no specific underlying condition is identified. The increased volume of amniotic fluid can be detected through ultrasound examinations, where amniotic fluid index (AFI) measurements are taken to assess the quantity of fluid present. Polyhydramnios is typically diagnosed when the AFI exceeds a certain threshold.

B. The client is carrying more than one fetus.

While it's true that multiple gestations, such as twins or triplets, can sometimes lead to polyhydramnios, the presence of polyhydramnios does not automatically indicate a multiple pregnancy. Polyhydramnios can occur in singleton pregnancies as well, particularly due to other factors like fetal anomalies, maternal health issues, or idiopathic reasons.

C. The fetus is likely to have a congenital anomaly, be growth-restricted, or demonstrate fetal distress during labor.

Polyhydramnios can be associated with various fetal and maternal conditions, but it does not directly indicate specific fetal issues like congenital anomalies, growth restriction, or fetal distress during labor. However, polyhydramnios can sometimes coexist with these conditions or be a result of them. For example, certain fetal abnormalities, such as gastrointestinal obstructions, can lead to polyhydramnios due to impaired swallowing and absorption of amniotic fluid.

D. There is an elevated level of alpha-fetoprotein (AFP) in the amniotic fluid.

Elevated levels of alpha-fetoprotein (AFP) in the amniotic fluid are typically associated with neural tube defects (such as spina bifida) or abdominal wall defects (like gastroschisis or omphalocele) in the fetus. However, AFP levels are not directly related to the presence of polyhydramnios. AFP testing is usually done separately as part of prenatal screening tests to assess the risk of certain fetal abnormalities.