A nurse in a prenatal clinic is teaching a client who is in her second trimester and has a new diagnosis of gestational diabetes. Which of the following statements by the client indicates a need for further teaching?

Choice A reason: Hypocalcemia is not the priority focus of care, as it is a low level of calcium in the blood that can cause muscle twitching, seizures, or cardiac arrhythmias. Hypocalcemia can affect newborns who have mothers with diabetes mellitus, but it is less common and less severe than hypoglycemia.

Choice B reason: Hyperbilirubinemia is not the priority focus of care, as it is a high level of bilirubin in the blood that can cause jaundice, a yellowish discoloration of the skin and eyes. Hyperbilirubinemia can affect newborns who have macrosomia, but it is usually a benign and self-limiting condition that resolves within a few days.

Choice C reason: Hypomagnesemia is not the priority focus of care, as it is a low level of magnesium in the blood that can cause tremors, tetany, or seizures. Hypomagnesemia can affect newborns who have mothers with diabetes mellitus, but it is rare and usually asymptomatic.

Choice D reason: Hypoglycemia is the priority focus of care, as it is a low level of glucose in the blood that can cause diaphoresis, jitteriness, lethargy, or apnea. Hypoglycemia can affect newborns who have macrosomia and mothers with diabetes mellitus, as they have increased insulin production and decreased glucose supply after birth. Hypoglycemia can lead to brain damage or death if not treated promptly.

Choice A reason: This order does not require clarification, as it is an appropriate and standard order for a client who has severe preeclampsia, which is a hypertensive disorder of pregnancy that can cause fetal distress, growth restriction, or demise. Continuous fetal monitoring can help detect and evaluate the fetal heart rate, variability, accelerations, decelerations, and contractions, and guide the management and intervention.

Choice B reason: This order requires clarification, as it is an inappropriate and contraindicated order for a client who has severe preeclampsia, which is a hypertensive disorder of pregnancy that can cause seizures, stroke, or organ failure. Ambulation can increase the blood pressure, stimulate the labor, and worsen the condition. The client should be on bed rest, with the head of the bed elevated, and receive medications to lower the blood pressure and prevent seizures.

Choice C reason: This order does not require clarification, as it is an appropriate and standard order for a client who has severe preeclampsia, which is a hypertensive disorder of pregnancy that can cause edema, proteinuria, or oliguria. Obtaining a daily weight can help monitor the fluid status, the severity of the edema, and the response to the treatment.

Choice D reason: This order does not require clarification, as it is an appropriate and standard order for a client who has severe preeclampsia, which is a hypertensive disorder of pregnancy that can cause hyperreflexia, clonus, or seizures. Assessing deep tendon reflexes every hour can help evaluate the neuromuscular irritability, the risk of eclampsia, and the effect of magnesium sulfate.