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 B
Explanation
Choice A rationale
Turning the newborn on his side is a good practice to prevent aspiration, but it is not the first action to take. The newborn’s airway must be clear first to ensure proper breathing.
Choice B rationale
Suctioning the mouth with a bulb syringe is the priority action when a newborn has secretions bubbling out of the nose and mouth. This action helps clear the airway and allows the newborn to breathe more easily.
Choice C rationale
Suctioning the nose with a bulb syringe is also important, but the mouth should be suctioned first. This is because the newborn could aspirate oral secretions during inhalation if the mouth is not suctioned first.
Choice D rationale
Using a suction catheter with low negative pressure is not the first action to take. A bulb syringe is usually sufficient to clear the newborn’s airway of secretions.
Correct Answer is A
Explanation
Choice A rationale
Chorioamnionitis. Based on the information provided, the patient is at risk of developing chorioamnionitis, which is an infection of the membranes surrounding the fetus.
Choice B rationale
Preeclampsia. There is no information provided that would indicate the patient is at risk of developing preeclampsia.
Choice C rationale
Gestational diabetes. There is no information provided that would indicate the patient is at risk of developing gestational diabetes.
Choice D rationale
Preterm labor. There is no information provided that would indicate the patient is at risk of developing preterm labor.
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