A nurse is providing care for a pregnant patient.
The patient’s medical history includes Gravida 4 Para 3, 32 weeks of gestation, and a BMI of 32. The patient has a history of two newborns weighing over 4.5 kg (10 lb) and a family history of type one diabetes mellitus (maternal). The fetal heart tones are 140/min via doppler.
Which of the following provider prescriptions should the nurse plan to implement? Select the three actions the nurse should plan to take.
Conduct a non-stress test twice per week.
Encourage the patient to limit carbohydrate intake to 40% of their daily calories.
Instruct the patient to check a random blood glucose level once daily.
Anticipate a prescription for metformin.
Correct Answer : A,B,D
Choice A rationale
A nonstress test (NST) is a test during pregnancy that measures the baby’s heart rate and response to movement. It is designed to ensure the baby is doing well and getting enough oxygen. Your provider might order it during the third trimester if you’re experiencing certain complications.
Choice B rationale
During pregnancy, women need nutrient-rich sources of carbohydrate, in the right amounts. Restriction of simple carbohydrates has been shown to reduce postprandial hyperglycemia, fetal glucose exposure, and fetal overgrowth. Therefore, encouraging the patient to limit carbohydrate intake to 40% of their daily calories could be beneficial.
Choice C rationale
Checking a random blood glucose level once daily is not typically recommended during pregnancy. Instead, blood glucose levels are usually checked at specific times, such as fasting (before breakfast), before other meals, and 1 hour after meals. This helps to provide more accurate information about how the body is managing blood glucose levels throughout the day.
Choice D rationale
Metformin is generally considered safe for use during pregnancy. It can also be used to treat women with gestational diabetes mellitus (diabetes that develops during pregnancy)7. Given the patient’s history and risk factors, it would be reasonable to anticipate a prescription for metformin.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale
While congenital anomalies, growth restriction, and fetal distress during labor can occur in pregnancies, they are not directly associated with polyhydramnios. Polyhydramnios is a condition characterized by an excessive accumulation of amniotic fluid in the uterus during pregnancy.
Choice B rationale
Carrying more than one fetus can lead to a condition known as twin-to-twin transfusion syndrome, which can result in polyhydramnios in one twin and oligohydramnios in the other. However, carrying more than one fetus does not directly mean the mother will experience polyhydramnios.
Choice C rationale
Polyhydramnios is indeed characterized by an excessive amount of amniotic fluid present in the uterus during pregnancy. This can be due to various reasons such as fetal abnormalities, maternal diabetes, and others.
Choice D rationale
An elevated level of alpha-fetoprotein (AFP) in the amniotic fluid can be an indication of certain fetal abnormalities, but it is not a direct indicator of polyhydramnios.
Correct Answer is C
Explanation
The correct answer is Choice C.
Choice A rationale: A respiratory rate of 16/min is within the normal range for an adult and does not indicate immediate concern.
Choice B rationale: A headache can be a symptom of preeclampsia, but it is not as immediate a concern as the other options unless it is severe or accompanied by other symptoms.
Choice C rationale: A urinary output of 40 ml in 2 hours is significantly below the normal range. Oliguria (low urine output) can be a sign of renal impairment and magnesium toxicity, which requires immediate reporting to the healthcare provider.
Choice D rationale: A fetal heart rate of 158/min is within the normal range for a fetus and does not indicate immediate concern.
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