A nurse is caring for a client in the immediate postoperative period following removal of an ectopic pregnancy via salpingostomy. The nurse should prepare to administer Rho(D) immune globulin (RhoGAM or RhiG) as prescribed if the record indicates that the client

This statement by the client indicates a need for further teaching, as it shows that the client does not understand the importance of regular physical activity for managing gestational diabetes. Physical activity can help lower blood glucose levels, improve insulin sensitivity, and prevent excessive weight gain during pregnancy. The client should aim for at least 30 minutes of moderate-intensity exercise on most days of the week, unless contraindicated by medical or obstetric complications.

The other statements by the client indicate that the client understands the key aspects of gestational diabetes management.

"I should limit my carbohydrates to 50% of caloric intake.” This statement is correct, as the client should follow a balanced diet that provides adequate nutrition for herself and her fetus, while controlling blood glucose levels. Carbohydrates are the main source of glucose and should be limited to 50% of caloric intake, distributed evenly throughout the day, and preferably from complex sources such as whole grains, fruits, and vegetables.

"I will take my glyburide daily with breakfast.” This statement is correct, as the client should take her prescribed oral hypoglycemic medication as directed by her provider. Glyburide is a sulfonylurea that stimulates insulin secretion and lowers blood glucose levels. It is usually taken once or twice a day with meals, depending on the dose and blood glucose response.

d. "I know I am at increased risk to develop type 2 diabetes." This statement is correct, as the client should be aware of the long-term implications of gestational diabetes. Gestational diabetes is a condition where the body becomes resistant to insulin during pregnancy, resulting in high blood glucose levels. It usually resolves after delivery, but it increases the risk of developing type 2 diabetes later in life. The client should monitor her blood glucose levels regularly, maintain a healthy weight, and have screening tests for diabetes every 1 to 3 years.

b. Eat foods fortified with folic acid.

Folic acid is a B vitamin that is essential for the development of the neural tube, which forms the brain and spinal cord of the fetus. A deficiency of folic acid can lead to neural tube defects such as spina bifida and anencephaly, which can cause serious complications or death for the newborn. Therefore, it is recommended that women who are planning to conceive or are pregnant consume at least 400 mcg of folic acid daily from supplements or foods fortified with folic acid, such as cereals, breads, and pasta.

The incorrect options are:

a. Increase intake of iron. Iron is a mineral that is important for the production of red blood cells and the prevention of anemia in pregnant women. However, iron deficiency does not cause neural tube defects. Iron supplements may be recommended for pregnant women who have low iron levels, but they do not affect the risk of neural tube defects².

c. Avoid the use of aspirin. Aspirin is a type of nonsteroidal anti-inflammatory drug (NSAID) that can have harmful effects on the fetus if taken during pregnancy, especially in the second and third trimesters. Aspirin can cause kidney problems, bleeding problems, premature closure of a blood vessel in the fetal heart, and increased risk of pregnancy loss¹. However, aspirin does not cause neural tube defects. Low-dose aspirin may be prescribed for some pregnant women who have certain medical conditions that increase the risk of preeclampsia or blood clots, but only under the guidance of a health care provider¹.

d. Limit consumption of alcohol. Alcohol is a known teratogen that can cause a range of physical, mental, and behavioral problems in the fetus, collectively known as fetal alcohol spectrum disorders (FASD). Alcohol can interfere with the development of the brain and other organs, and cause facial abnormalities, growth problems, learning difficulties, and behavioral issues³. However, alcohol does not cause neural tube defects. There is no safe amount or type of alcohol to drink during pregnancy, and abstaining from alcohol is the best way to prevent FASD³.