Your patient has gestational diabetes and she is currently on insulin 24 units in the morning and at night. She is worried about her baby and what will happen after the baby is born. In your education of the patient, you explain what will occur after the baby is born. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

Choice A reason: Taking the medication between meals will help you avoid becoming constipated is incorrect because it is not the reason why the provider instructed that she take the ferrous sulfate between meals. It is a possible benefit of taking the medication between meals, but it is not the main purpose. Iron supplements can cause constipation, but this can be prevented by drinking plenty of fluids, eating high-fiber foods, and exercising regularly.

Choice B reason: The medication can cause nausea if taken with food is incorrect because it is not the reason why the provider instructed that she take the ferrous sulfate between meals. It is a possible side effect of taking the medication with or without food, but it is not the main reason. Iron supplements can cause nausea, but this can be reduced by taking the medication with a small amount of food, such as crackers, or by taking an antiemetic medication.

Choice C reason: Taking the medication between meals will help you absorb the medication more efficiently is correct because it is the reason why the provider instructed that she take the ferrous sulfate between meals. It is the main purpose of taking the medication between meals, as iron absorption is enhanced when the stomach is empty and the pH is low. Iron supplements can interact with food components, such as calcium, phytates, and tannins, and reduce the amount of iron that is absorbed by the body.

Choice D reason: Taking the medication with food increases the risk of esophagitis is incorrect because it is not the reason why the provider instructed that she take the ferrous sulfate between meals. It is a possible complication of taking the medication without enough water, but it is not the main reason. Iron supplements can cause esophagitis, which is inflammation of the esophagus, if they are not swallowed properly or if they get stuck in the throat. This can be prevented by taking the medication with a full glass of water, sitting upright, and not lying down for at least 30 minutes after taking the medication.

Choice A reason: This is not an appropriate response by the nurse, as an ultrasound is not a screening tool for spina bifida. Spina bifida is a birth defect that occurs when the spine and spinal cord do not form properly. It can be detected by a blood test that measures the level of alpha-fetoprotein (AFP) or by a detailed ultrasound that shows the spine and the brain.

Choice B reason: This is not an appropriate response by the nurse, as an ultrasound is not necessary to determine if there is more than one fetus. Multiple fetuses can be detected by other methods, such as listening to the fetal heartbeats, measuring the fundal height, or feeling the fetal movements.

Choice C reason: This is an appropriate response by the nurse, as an ultrasound assists in identifying the location of the placenta and fetus. This is important for an amniocentesis, which is a procedure that involves inserting a needle through the abdomen and the uterus to collect a sample of amniotic fluid. The ultrasound helps to guide the needle and avoid injuring the placenta or the fetus.

Choice D reason: This is not an appropriate response by the nurse, as an ultrasound is not useful for estimating fetal age at 36 weeks of gestation. Fetal age can be estimated by an ultrasound in the first trimester, when the fetus is growing at a predictable rate and has distinct features. However, in the third trimester, the fetus grows at different rates and has more variations in size and shape. Therefore, an ultrasound is less accurate and reliable for estimating fetal age at this stage.