Review Practice Exercise 5

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Practice Exercise 5

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Total Questions : 5

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Question 1:

A nurse is educating a patient with GDM about medical nutrition therapy. What percentage of total calories should come from carbohydrates?

A. 20-30% B. 40-50% C. 60-70% D. 70-80%

Answer and Explanation

Choice A:

A carbohydrate intake of 20–30% is too low and may lead to ketosis and inadequate caloric intake. Ketone production from fat metabolism can impair fetal neurodevelopment. This range does not meet the energy demands of pregnancy and contradicts standard GDM dietary guidelines.

Choice B:

Carbohydrates should provide 40–50% of total daily calories in GDM to ensure adequate fetal growth while minimizing postprandial glucose spikes. This range supports glycemic control and prevents ketosis. Complex carbohydrates with low glycemic index are preferred. The question stem focuses on medical nutrition therapy, which prioritizes balanced macronutrient distribution.

Choice C:

A carbohydrate intake of 60–70% is excessive and increases the risk of postprandial hyperglycemia. High carbohydrate loads can overwhelm insulin response, especially in insulin-resistant states like GDM. This range is not recommended as it compromises glycemic control.

Choice D:

A carbohydrate intake of 70–80% is dangerously high and leads to poor glucose regulation. It promotes frequent hyperglycemic episodes and increases the likelihood of fetal macrosomia and neonatal hypoglycemia. This percentage is inconsistent with evidence-based GDM nutrition therapy.

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Question 2:

Which of the following is considered the gold standard pharmacological treatment for Gestational Diabetes Mellitus due to its efficacy and minimal placental transfer?

A. Glyburide B. Metformin C. Insulin D. Acarbose

Answer and Explanation

Choice A:

Glyburide is a sulfonylurea that stimulates pancreatic insulin release but crosses the placenta and may cause neonatal hypoglycemia. Its pharmacokinetics are unpredictable in pregnancy, and it has a higher failure rate in achieving glycemic targets compared to insulin.

Choice B:

Metformin improves insulin sensitivity and reduces hepatic glucose output but crosses the placenta and accumulates in fetal tissues. Long-term fetal safety data are limited. It is less effective than insulin in controlling postprandial spikes and is often used as adjunct therapy, not first-line.

Choice C:

Insulin is the gold standard pharmacologic treatment for GDM due to its high efficacy and minimal placental transfer. It does not cross the placenta in significant amounts, making it safe for fetal development. It allows precise titration to maintain euglycemia and prevents complications such as macrosomia and neonatal hypoglycemia.

Choice D:

Acarbose is an alpha-glucosidase inhibitor that delays carbohydrate absorption in the intestine. It has minimal systemic absorption but is not widely studied in pregnancy and lacks robust data on fetal safety and efficacy. It is not recommended as first-line therapy for GDM.

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Question 3:

A nurse is instructing a patient on self-monitoring blood glucose. How many times daily should glucose levels be checked?

A. Once B. Twice C. Three times D. Four times

Answer and Explanation

Choice A:

Once daily monitoring is insufficient to detect glycemic variability. It misses postprandial spikes and fasting trends. This frequency cannot guide therapy adjustments or ensure glucose targets are met.

Choice B:

Twice daily checks may capture fasting and one postprandial value but miss meal-related excursions. It underestimates hyperglycemia risk and limits therapeutic precision.

Choice C:

Three times daily omits one postprandial value, reducing detection of post-meal hyperglycemia. It may be used in stable patients but is inadequate for initial management or insulin therapy.

Choice D:

Four times daily monitoring includes fasting and postprandial checks after each meal. This pattern captures glucose fluctuations and ensures tight control. It aligns with clinical guidelines for gestational diabetes and insulin-treated patients. Frequent monitoring reduces risk of fetal macrosomia and maternal complications.

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Question 4:

Which of the following are components of medical nutrition therapy for GDM? Select all that apply

A. 40-50% of calories from carbohydrates B. Emphasis on simple sugars C. Distribution across three meals and 2-3 snacks D. High-fat diet E. Caloric intake based on BMI

Answer and Explanation

Choice A:

Carbohydrates should provide 40–50% of total daily calories to support fetal growth while minimizing postprandial hyperglycemia. This proportion ensures adequate energy without triggering excessive glucose excursions. Complex carbohydrates with low glycemic index are preferred.

Choice B:

Emphasis on simple sugars is contraindicated in GDM due to rapid glucose absorption and high glycemic index. Simple sugars cause postprandial spikes and compromise glycemic control. Medical nutrition therapy prioritizes complex carbohydrates and fiber-rich foods.

Choice C:

Distributing intake across three meals and 2–3 snacks stabilizes blood glucose levels and prevents ketosis. This pattern reduces glycemic variability and supports consistent insulin response. It also prevents prolonged fasting, which can elevate ketone levels.

Choice D:

A high-fat diet increases insulin resistance and promotes dyslipidemia. Saturated fats impair glucose metabolism and elevate triglycerides. GDM nutrition should include moderate fat intake (25–35% of total calories), emphasizing unsaturated fats.

Choice E:

Caloric intake must be based on prepregnancy BMI to avoid excessive weight gain and fetal macrosomia. For BMI <18.5, recommend 30–35 kcal/kg/day; for BMI 18.5–24.9, 25–30 kcal/kg/day; for BMI >25, 20–25 kcal/kg/day. This ensures individualized energy needs are met.

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Question 5:

Which of the following are important teaching points for insulin administration? Select all that apply

A. Rotate injection sites to prevent lipodystrophy. B. Insulin vials can be stored at room temperature indefinitely. C. Dispose of needles in a regular trash can. D. Gently pinch the skin before injecting. E. Understand how to recognize and treat hypoglycemia.

Answer and Explanation

Choice A:

Rotating injection sites prevents lipodystrophy and ensures consistent absorption. Repeated injections at the same site cause fatty tissue changes, leading to erratic insulin uptake. Teaching patients to rotate sites systematically improves glycemic control and reduces tissue damage.

Choice B:

Insulin vials cannot be stored at room temperature indefinitely. Room temperature storage is acceptable for only 28 days. Beyond this, insulin loses potency and may become ineffective. Refrigeration is necessary for unopened vials to maintain stability.

Choice C:

Disposing of needles in regular trash is unsafe and violates biohazard protocols. Used needles must be placed in puncture-resistant sharps containers to prevent injury and contamination. Improper disposal poses risks to sanitation workers and the public.

Choice D:

Gently pinching the skin before injecting ensures subcutaneous delivery and avoids intramuscular administration. Intramuscular injections can alter insulin absorption rates, increasing the risk of hypoglycemia. Pinching lifts the fat layer, optimizing depth and reducing pain.

Choice E:

Recognizing and treating hypoglycemia is critical in insulin therapy. Symptoms include sweating, tremors, confusion, and palpitations. Immediate treatment involves consuming 15 g of fast-acting carbohydrates like glucose tablets or juice. Delayed recognition can lead to seizures or coma.

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Practice Exercise 5

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