Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:

Choice A reason: Vascular volume increases during pregnancy to meet the increased oxygen and nutrient demands of the fetus, not to compensate for decreased renal plasma flow. In fact, renal plasma flow increases by 50% to 80% during pregnancy to facilitate the excretion of metabolic wastes.

Choice B reason: Vascular volume increases during pregnancy to ensure adequate blood supply to the uterus and other organs, not to prevent maternal and fetal dehydration. Dehydration can occur due to vomiting, diarrhea, or inadequate fluid intake, and it can be prevented by drinking enough fluids and replacing electrolytes.

Choice C reason: Vascular volume increases during pregnancy to provide adequate perfusion of the placenta, which is the main organ of gas exchange and nutrient delivery for the fetus. The placenta receives about 10% of the maternal cardiac output at term.

Choice D reason: Vascular volume increases during pregnancy to support the growth and development of the fetus and the maternal tissues, not to eliminate metabolic wastes of the mother. Metabolic wastes are eliminated by the kidneys, lungs, skin, and gastrointestinal tract.

Choice A: February 6-7 is incorrect. This is too late for the woman's fertile period, which occurs around the time of ovulation. Ovulation usually happens about 14 days before the next period starts, which would be around January 22 for a 28-day cycle¹.

Choice B:In a 28-day menstrual cycle, ovulation typically occurs around day 14 (counting from the first day of the last menstrual period). Since the first day of the last period is January 8, day 14 falls on January 22. The fertile window consists of the five days leading up to ovulation and the day of ovulation (January 17–22), as sperm can survive in the reproductive tract for up to 5 days, and the egg remains viable for about 24 hours after ovulation.January 22-23 is the most fertile period, with ovulation occurring around January 22 and the egg remaining viable for fertilization on January 23.

Choice C: January 30-31 is incorrect. This is after the woman's fertile period, which ends about a day after ovulation. Ovulation usually happens about 14 days before the next period starts, which would be around January 22 for a 28-day cycle.

Choice D: January 14-15 corresponds to cycle days 7-8, which is too early for ovulation in a typical 28-day cycle. Ovulation generally occurs around day 14 (January 22). The follicular phase (the first half of the cycle) is when the follicles in the ovary mature, and estrogen levels rise to trigger ovulation. At this point (January 14-15), the egg is not yet released, and the uterus is still preparing for ovulation, making conception unlikely.