Review Practice Exercise 7

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Practice Exercise 7

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Total Questions : 5

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Question 1:

A nurse is educating a patient about hypoglycemia symptoms. Which symptom should the patient report?

A. Increased thirst B. Shakiness C. Weight gain D. Constipation

Answer and Explanation

Choice A:

Increased thirst is a hallmark of hyperglycemia, not hypoglycemia. Elevated serum glucose causes osmotic diuresis, leading to dehydration and polydipsia. In hypoglycemia, fluid balance is typically unaffected unless comorbid conditions exist. This symptom reflects high glucose, not low.

Choice B:

Shakiness is a classic adrenergic response to falling glucose levels. The sympathetic nervous system releases epinephrine, causing tremors and palpitations. This symptom is often the earliest and most noticeable sign, especially in patients with intact autonomic function. The question stem asks what symptom should be reported, and shakiness directly reflects acute hypoglycemia.

Choice C:

Weight gain is a chronic metabolic effect, not an acute symptom. It may occur with insulin therapy due to anabolic effects or reduced glycosuria, but it is not a warning sign of hypoglycemia. The question targets immediate symptoms, not long-term outcomes.

Choice D:

Constipation is unrelated to glucose levels. It may result from low fiber intake, dehydration, or medications like opioids, but it is not a neurogenic or adrenergic symptom of hypoglycemia. It lacks temporal association with glucose fluctuations.

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Question 2:

A nurse is counseling a postpartum client with a history of Gestational Diabetes Mellitus about long-term health. What is the most important recommendation for preventing Type 2 Diabetes Mellitus?

A. Avoid all carbohydrates indefinitely. B. Maintain a healthy weight and engage in regular physical activity. C. Take oral hypoglycemic agents for life. D. Limit fluid intake to prevent fluid retention.

Answer and Explanation

Choice A:

Avoiding all carbohydrates indefinitely is neither practical nor physiologically sound. Carbohydrates are essential for glucose homeostasis and energy metabolism. The focus should be on complex carbohydrates with low glycemic index, not total elimination. Long-term restriction may lead to nutrient deficiencies and poor adherence.

Choice B:

Maintaining a healthy weight and engaging in regular physical activity directly improves insulin sensitivity and reduces visceral adiposity, both critical in preventing T2DM. Exercise enhances glucose uptake independent of insulin, while weight control reduces inflammatory cytokines that impair insulin action. This is the most evidence-based and sustainable recommendation for postpartum women with prior GDM.

Choice C:

Taking oral hypoglycemic agents for life is not recommended for prevention. These drugs are used for glycemic control, not risk reduction in normoglycemic individuals. Metformin may be considered in high-risk cases, but lifestyle changes remain first-line. Lifelong pharmacotherapy without indication exposes patients to unnecessary side effects.

Choice D:

Limiting fluid intake to prevent fluid retention is unrelated to diabetes prevention. Fluid retention is influenced by renal function and sodium balance, not glucose metabolism. In fact, adequate hydration supports renal glucose clearance and overall metabolic health. This recommendation lacks scientific basis in diabetes prevention.

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Question 3:

A nurse is assessing a patient’s understanding of GDM. Which statement indicates a need for further education?

A. “I need to check my blood sugar four times a day.” B. “I can eat as many sweets as I want if I take insulin.” C. “Exercise can help control my blood sugar.” D. “My baby may need glucose checks after birth.”

Answer and Explanation

Choice A:

Checking blood sugar four times daily is standard in GDM management. Typically, this includes fasting and postprandial readings to guide therapy. Frequent monitoring allows timely insulin adjustments and dietary modifications. This statement reflects accurate understanding.

Choice B:

The statement reflects a misunderstanding of dietary management in GDM. Even with insulin, excessive intake of simple sugars causes unpredictable glycemic excursions, increasing risk of macrosomia and neonatal hypoglycemia. Insulin dosing is calibrated to controlled intake, not unrestricted consumption. Patient education must emphasize carbohydrate quality and portion control.

Choice C:

Exercise improves insulin sensitivity and promotes glucose uptake by skeletal muscle. Moderate activity like walking after meals helps reduce postprandial spikes. This is a cornerstone of non-pharmacologic management and is correctly stated.

Choice D:

Neonates of mothers with GDM are at risk for hypoglycemia due to fetal hyperinsulinemia. Glucose checks post-delivery are essential to detect and treat early hypoglycemia. This reflects correct understanding of neonatal monitoring protocols.

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Question 4:

Which of the following are signs of hypoglycemia a nurse should teach a patient with GDM? Select all that apply

A. Shakiness B. Sweating C. Increased thirst D. Confusion E. Weight gain

Answer and Explanation

Choice A:

Shakiness is an adrenergic symptom triggered by epinephrine release in response to falling glucose. It reflects autonomic activation and is often the earliest sign. Patients with intact sympathetic response will notice tremors during hypoglycemia.

Choice B:

Sweating is another adrenergic symptom caused by sympathetic stimulation. It reflects autonomic dysregulation and typically accompanies tremors and palpitations. It is a reliable early warning sign in insulin-treated GDM.

Choice C:

Increased thirst is a symptom of hyperglycemia, not hypoglycemia. It results from osmotic diuresis due to elevated glucose levels causing dehydration. It does not occur in low glucose states and reflects a different pathophysiology.

Choice D:

Confusion is a neuroglycopenic symptom due to inadequate glucose delivery to the brain. It reflects cerebral dysfunction and may progress to seizures or coma if untreated. It is a late but critical sign of hypoglycemia.

Choice E:

Weight gain is a chronic metabolic effect, not an acute symptom. It may occur with insulin therapy due to anabolic effects, but it is unrelated to hypoglycemia. The question targets immediate signs, not long-term outcomes.

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Question 5:

Which of the following are components of patient education for GDM? Select all that apply

A. Understanding GDM implications B. Self-monitoring blood glucose techniques C. Adherence to medical nutrition therapy D. Avoiding all physical activity E. Recognizing hypoglycemia symptoms

Answer and Explanation

Choice A:

Understanding GDM implications is essential for informed decision-making. Patients must grasp risks such as macrosomia and neonatal hypoglycemia, and long-term maternal risk for Type 2 Diabetes. This knowledge supports adherence and postpartum follow-up.

Choice B:

Self-monitoring blood glucose techniques are foundational in GDM management. Patients must learn proper glucometer use and timing of checks—typically fasting and postprandial. Accurate monitoring guides therapy and prevents complications.

Choice C:

Adherence to medical nutrition therapy is the cornerstone of GDM control. Diet plans focus on carbohydrate distribution and glycemic index. Registered dietitian input ensures individualized, sustainable plans that stabilize glucose levels.

Choice D:

Avoiding all physical activity is incorrect and harmful. Moderate exercise improves insulin sensitivity and reduces postprandial glucose. Walking after meals is recommended. Sedentary behavior worsens glycemic control and increases insulin requirements.

Choice E:

Recognizing hypoglycemia symptoms is critical, especially for insulin-treated patients. Symptoms like shakiness and confusion must prompt immediate glucose intake. Education prevents severe neuroglycopenic events and supports safe insulin use.

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Practice Exercise 7

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