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?

"I should limit my carbohydrates to 50% of my daily caloric intake."

"I know I am at increased risk to develop type 2 diabetes."

"I will reduce my exercise schedule to 3 days a week."

"I will take my glyburide daily with breakfast."

Answer and Explanation

The Correct Answer is C

c. "I will reduce my exercise schedule to 3 days a week."

The client should not reduce her exercise schedule, as physical activity can help lower blood glucose levels and improve insulin sensitivity in gestational diabetes. The client should aim for at least 30 minutes of moderate-intensity exercise on most days of the week unless contraindicated by her provider. Exercise can also help prevent excessive weight gain, preeclampsia, and macrosomia in pregnancy.

The other statements are correct and do not indicate a need for further teaching.

The client should limit her carbohydrates to 50% of her daily caloric intake, as carbohydrates have the most impact on blood glucose levels. The client should also choose complex carbohydrates that are high in fiber and low in glycemic index, such as whole grains, fruits, and vegetables. The client should know that she is at increased risk of developing type 2 diabetes, as gestational diabetes is a risk factor for future diabetes mellitus. The client should undergo screening for diabetes 6 to 12 weeks after delivery and every 1 to 3 years thereafter. The client should also adopt lifestyle modifications such as a healthy diet, regular exercise, and weight management to prevent or delay the onset of type 2 diabetes. The client should take her glyburide daily with breakfast, as glyburide is an oral antidiabetic agent that can be used to treat gestational diabetes when diet and exercise are not enough to control blood glucose levels. Glyburide stimulates the pancreas to produce more insulin and lowers blood glucose levels. Glyburide should be taken with the first meal of the day to avoid hypoglycemia.

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Correct Answer is B

Explanation

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.

A. Decreased energy B. Mood swings C. Urinary frequency D. Facial edema

Correct Answer is D

No explanation

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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?

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