Review Practice Exercise 4

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Practice Exercise 4

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Total Questions : 5

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Question 1:

A nurse is assessing a patient with GDM for signs of preeclampsia. Which symptom should be reported immediately?

A. Increased appetite B. Epigastric pain C. Mild fatigue D. Frequent urination

Answer and Explanation

Choice A:

Increased appetite is not a feature of preeclampsia. It may occur in GDM due to fluctuating glucose levels or insulin adjustments but does not indicate organ dysfunction. It lacks correlation with vascular compromise or hepatic involvement.

Choice B:

Epigastric pain in a patient with gestational diabetes mellitus (GDM) raises concern for hepatic capsular distension due to periportal necrosis, a hallmark of severe preeclampsia. This symptom reflects liver involvement and may precede HELLP syndrome. Immediate reporting is essential to prevent progression to eclampsia or placental abruption.

Choice C:

Mild fatigue is nonspecific and common in pregnancy due to increased metabolic demand and hormonal shifts. It does not reflect end-organ damage or signal an acute complication. It lacks diagnostic specificity for preeclampsia.

Choice D:

Frequent urination is typical in pregnancy due to uterine pressure on the bladder and increased glomerular filtration rate. It is not associated with preeclampsia unless accompanied by oliguria or proteinuria. It does not indicate systemic compromise.

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Question 2:

A client with Gestational Diabetes Mellitus is found to have polyhydramnios during a routine ultrasound. This finding increases her risk for which of the following obstetric complications?

A. Oligohydramnios B. Preterm labor C. Placenta previa D. Vasa previa

Answer and Explanation

Choice A:

Oligohydramnios is the opposite of polyhydramnios and involves reduced amniotic fluid volume (AFI <5 cm). It is associated with placental insufficiency and renal anomalies, not maternal diabetes. It does not result from excess fluid and is not a complication of polyhydramnios.

Choice B:

Preterm labor is a direct consequence of uterine overdistension caused by excessive amniotic fluid. The stretched myometrium increases contractility, leading to cervical effacement and dilation before 37 weeks. In gestational diabetes mellitus, poor glycemic control contributes to fetal polyuria and fluid accumulation, increasing this risk.

Choice C:

Placenta previa involves abnormal placental implantation over the cervical os. It is linked to prior cesarean delivery and multiparity, not fluid volume abnormalities. Polyhydramnios does not affect placental location or increase risk for previa.

Choice D:

Vasa previa is a rare condition where fetal vessels traverse the membranes over the cervical os. It is associated with velamentous cord insertion and accessory lobes, not polyhydramnios. Excess fluid does not predispose to abnormal vessel placement.

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Question 3:

Which fetal complication is associated with uncontrolled gestational diabetes?

A. Microsomia B. Macrosomia C. Oligohydramnios D. Anemia

Answer and Explanation

Choice A:

Microsomia refers to fetal growth restriction, typically <10th percentile for gestational age. It results from placental insufficiency, hypertensive disorders, or maternal malnutrition. It is not associated with hyperglycemia or insulin excess. GDM promotes overgrowth, not restriction.

Choice B:

Macrosomia occurs due to fetal hyperinsulinemia secondary to maternal hyperglycemia. Insulin acts as a growth hormone, promoting adipose tissue accumulation and somatic overgrowth. This increases risk for birth trauma, shoulder dystocia, and cesarean delivery. The question stem specifies uncontrolled GDM, which directly drives this pathophysiology.

Choice C:

Oligohydramnios is defined as amniotic fluid index <5 cm. It is linked to renal agenesis, uteroplacental insufficiency, and post-term pregnancy. GDM more commonly causes polyhydramnios due to fetal polyuria. It does not reduce fluid volume unless vascular compromise occurs.

Choice D:

Anemia in the fetus is caused by alloimmunization, parvovirus B19, or fetal-maternal hemorrhage. GDM does not impair erythropoiesis or cause hemolysis. There is no mechanism linking maternal hyperglycemia to fetal anemia.

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Question 4:

A nurse is providing education to a pregnant client newly diagnosed with Gestational Diabetes Mellitus regarding potential fetal complications. Which of the following complications should the nurse include? Select all that apply

A. Macrosomia B. Neonatal hypoglycemia C. Respiratory Distress Syndrome (RDS) D. Microcephaly E. Spina bifida

Answer and Explanation

Choice A:

Macrosomia results from fetal hyperinsulinemia triggered by maternal hyperglycemia. Insulin acts as a growth hormone, promoting adipose tissue deposition and organomegaly. Fetal weight >4,000 g or >90th percentile defines macrosomia. This increases risk for shoulder dystocia and cesarean delivery.

Choice B:

Neonatal hypoglycemia occurs due to persistent fetal insulin secretion after birth, in the absence of maternal glucose supply. Blood glucose <40 mg/dL in the first 24 hours is diagnostic. Symptoms include jitteriness, apnea, and poor feeding. Early feeding and glucose monitoring are essential.

Choice C:

Respiratory distress syndrome (RDS) is more common in infants of diabetic mothers due to delayed surfactant synthesis. Hyperinsulinemia inhibits type II pneumocyte maturation. RDS presents with grunting, nasal flaring, and retractions. Risk is highest before 37 weeks gestation.

Choice D:

Microcephaly is defined as head circumference <2 standard deviations below mean for gestational age. It results from genetic syndromes, intrauterine infections, or teratogen exposure. GDM does not impair brain growth or cause cranial hypoplasia. It is not a recognized complication of maternal hyperglycemia.

Choice E:

Spina bifida is a neural tube defect caused by folate deficiency, valproate exposure, or genetic mutations. It occurs during early embryogenesis before 6 weeks gestation. GDM develops later and does not affect neural tube closure. There is no mechanistic link between GDM and spina bifida.

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Question 5:

Which of the following are maternal complications of GDM? Select all that apply

A. Preeclampsia B. Increased risk of cesarean delivery C. Hypoglycemia D. Type 2 diabetes risk postpartum E. Chronic renal failure

Answer and Explanation

Choice A:

Preeclampsia is more common in GDM due to endothelial dysfunction and vascular inflammation. Hyperglycemia promotes oxidative stress and impairs nitric oxide-mediated vasodilation. This leads to hypertension, proteinuria, and organ ischemia. Risk increases with poor glycemic control and obesity.

Choice B:

Increased risk of cesarean delivery results from macrosomia and labor dystocia. Excess fetal growth due to maternal hyperglycemia leads to shoulder dystocia and failed labor progression. Cesarean rates are higher in GDM pregnancies, especially when fetal weight exceeds 4,000 g.

Choice C:

Hypoglycemia is not a typical maternal complication of GDM. It occurs in type 1 diabetes due to insulin overdose or missed meals. In GDM, maternal glucose levels are elevated, and insulin therapy is titrated to avoid hypoglycemia. It is rare unless overtreatment occurs.

Choice D:

Type 2 diabetes risk postpartum is elevated due to persistent insulin resistance and beta-cell dysfunction. Up to 50% of women with GDM develop T2DM within 10 years. Risk increases with obesity, family history, and elevated postpartum glucose. Annual screening is recommended.

Choice E:

Chronic renal failure is not directly caused by GDM. It results from long-standing hypertension, diabetic nephropathy, or glomerular disease. GDM is transient and typically resolves postpartum. Renal failure may occur in preexisting diabetes but is not a complication of gestational diabetes alone.

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Practice Exercise 4

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