A nurse is reinforcing teaching with 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?

The nurse's first action should be to massage the client's fundus, as this can help stimulate uterine contraction and prevent hemorrhage. The fundus is the upper part of the uterus that contracts and involutes after delivery to compress the blood vessels and stop bleeding. The nurse should palpate the fundus for firmness, height, and position, and massage it gently if it is boggy or displaced.

The other actions are not the first priority and may be done after massaging the fundus.

The nurse should observe for the pooling of blood under the buttocks, as this can indicate a large amount of blood loss that may not be visible on the perineal pad. However, this is not the first action to take, as it does not address the cause of the bleeding or stop it from continuing.

The nurse should assess the client's blood pressure, as this can indicate the severity of blood loss and the presence of shock. However, blood pressure may not change significantly until a large amount of blood is lost, and it is not specific to the cause of bleeding. Therefore, blood pressure is not the first action to take.

The nurse should prepare to administer a prescribed oxytocic preparation, such as oxytocin or methylergonovine, as this can enhance uterine contraction and reduce bleeding. However, this requires a provider's order and may take time to obtain and administer. Therefore, an oxytocic preparation is not the first action to take.

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.