The neonate of a mother with diabetes mellitus is prone to developing hypoglycemia because quizlet

Poor glycemic control during the later stages of pregnancy increases the rate of fetal macrosomia, defined as a birth weight of more than 4000 g. The macrosomic fetus of the diabetic mother tends to have a disproportionate increase in shoulder, trunk, and chest size, leading to risk of shoulder dystocia. Failure of fetal descent or labor progress leads to difficult vaginal birth. A vaginal birth may lead to birth injuries in the infant, such as facial nerve injury. Ketoacidosis is a result of uncontrolled glycemia, which affects the mother during pregnancy. Hypoglycemia, not hyperglycemia, is a risk for infants born to diabetic mothers. In the later stages of pregnancy, hypoglycemia may occur as insulin doses are adjusted to maintain a normal blood glucose level. (B,C,D)

A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond?

"A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes."

"A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred."

"Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range."

"Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."

C
Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints, and extremities.
These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered
by dehydration, hypoxia, or acidosis. Women with sickle cell anemia are not iron deficient. Therefore, routine iron
supplementation, even that found in prenatal vitamins, should be avoided in order to prevent iron overload. Women with sickle cell
trait usually are at greater risk for after birth endometritis (uterine wall infection); however, this is not likely to occur in pregnancy
and is not a sign of crisis. These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis.

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with
a. Frequent episodes of maternal hypoglycemia
b. Congenital anomalies in the fetus
c. Polyhydramnios
d. Hyperemesis gravidarum

ANS: B

Feedback
A Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage.
B Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies.
C Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of pregnancy.
D Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 609
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

2. In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states
a. "I will need to increase my insulin dosage during the first 3 months of pregnancy."
b. "Insulin dosage will likely need to be increased during the second and third trimesters."
c. "Episodes of hypoglycemia are more likely to occur during the first 3 months."
d. "Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding."

ANS: A

Feedback
A Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin.
B This statement is accurate and signifies understanding. Insulin resistance begins as early as 14 to 16 weeks of gestation and continues to rise until it stabilizes during the last few weeks of pregnancy.
C This statement is correct. During the first trimester maternal blood glucose levels are reduced and the insulin response to glucose is enhanced therefore this is when an episode of hypoglycemia is most likely to occur.
D For the non-breastfeeding mother insulin levels return to normal within 7 to 10 days. Lactation utilized maternal glucose, therefore the mother's insulin requirements will remain low during lactation. On completion of weaning the mother's prepregnancy insulin requirement is reestablished.

PTS: 1 DIF: Cognitive Level: Application REF: p. 608
OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

3. 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
a. Macrosomia
b. Congenital anomalies of the central nervous system
c. Preterm birth
d. Low birth weight

ANS: A

Feedback
A Poor glycemic control later in pregnancy increases the rate of fetal macrosomia.
B Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies.
C Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes.
D Increased weight, or macrosomia, is the greatest risk factor for this woman.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 609
OBJ: Nursing Process: Planning and Implementation
MSC: Client Needs: Physiologic Integrity

4. In terms of the incidence and classification of diabetes, maternity nurses should know that
a. Type 1 diabetes is most common.
b. Type 2 diabetes often goes undiagnosed.
c. There is only one type of gestational diabetes.
d. Type 1 diabetes may become type 2 during pregnancy.

ANS: B

Feedback
A Type 2, sometimes called adult onset diabetes, is the most common.
B Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe.
C There are 2 subgroups of gestational diabetes. Type GDM A1 is diet-controlled whereas Type GDM A2 is controlled by insulin and diet.
D People do not go back and forth between type 1 and type 2 diabetes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 608 | Box 26-1
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

5. Metabolic changes throughout pregnancy that affect glucose and insulin in the mother and the fetus are complicated but important to understand. Nurses should know that
a. Insulin crosses the placenta to the fetus only in the first trimester, after which the fetus secretes its own.
b. Women with insulin-dependent diabetes are prone to hyperglycemia during the first trimester, because they are consuming more sugar.
c. During the second and third trimesters, pregnancy exerts a diabetogenic effect that ensures an abundant supply of glucose for the fetus.
d. Maternal insulin requirements steadily decline during pregnancy.

ANS: C

Feedback
A Insulin never crosses the placenta; the fetus starts making its own around the tenth week.
B As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia (low levels).
C Pregnant women develop increased insulin resistance during the second and third trimesters.
D Maternal insulin requirements may double or quadruple by the end of pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 608
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

6. Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?
a. Hypoglycemia
b. Hypercalcemia
c. Hypobilirubinemia
d. Hypoinsulinemia

ANS: A

Feedback
A The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother. At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia.
B Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother.
C Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate's circulation, which results in hyperbilirubinemia.
D Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 610
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

7. Which factor is known to increase the risk of gestational diabetes mellitus?
a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of large infant
d. Previous diagnosis of type 2 diabetes mellitus

ANS: C

Feedback
A Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes.
B A woman younger than 25 generally is not at risk for gestational diabetes mellitus.
C Previous birth of a large infant suggests gestational diabetes mellitus.
D The person with type 2 diabetes mellitus already is a diabetic and will continue to be so after pregnancy. Insulin may be required during pregnancy because oral hypoglycemia drugs are contraindicated during pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 613
OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

8. Glucose metabolism is profoundly affected during pregnancy because:
a. Pancreatic function in the islets of Langerhans is affected by pregnancy.
b. The pregnant woman uses glucose at a more rapid rate than the nonpregnant woman.
c. The pregnant woman increases her dietary intake significantly.
d. Placental hormones are antagonistic to insulin, resulting in insulin resistance.

ANS: D

Feedback
A Pancreatic functioning is not affected by pregnancy.
B The glucose requirements differ because of the growing fetus.
C The pregnant woman should increase her intake by 200 calories a day.
D Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance. Insulin also is broken down more quickly by the enzyme placental insulinase.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 607
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by
a. Eating six small equal meals per day
b. Reducing carbohydrates in her diet
c. Eating her meals and snacks on a fixed schedule
d. Increasing her consumption of protein

ANS: C

Feedback
A It is more important to have a fixed meal schedule than equal division of food intake.
B Approximately 45% of the food eaten should be in the form of carbohydrates.
C Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications.
D Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 612, 614
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

10. When the pregnant diabetic experiences hypoglycemia while hospitalized, the nurse should have the patient
a. Eat 6 saltine crackers.
b. Drink 8 oz of orange juice with 2 tsp of sugar added.
c. Drink 4 oz of orange juice followed by 8 oz of milk.
d. Eat hard candy or commercial glucose wafers.

ANS: A

Feedback
A Crackers provide carbohydrates in the form of polysaccharides.
B Orange juice and sugar will increase the blood sugar, but not provide a slow-burning carbohydrate to sustain the blood sugar.
C Milk is a disaccharide and orange juice is a monosaccharide. This will provide an increase in blood sugar but will not sustain to level.
D This provides only monosaccharides.

PTS: 1 DIF: Cognitive Level: Application REF: p. 616
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

11. Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin
a. Increases throughout pregnancy and the postpartum period
b. Decreases throughout pregnancy and the postpartum period
c. Varies depending on the stage of gestation
d. Should not change because the fetus produces its own insulin

ANS: C

Feedback
A Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor.
B Insulin needs increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.
C Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor. They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.
D The insulin needs change during the pregnancy.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 612
OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

12. With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that
a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios occurs approximately twice as often in diabetic pregnancies.
c. Infections occur about as often and are considered about as serious in diabetic and nondiabetic pregnancies.
d. Even mild to moderate hypoglycemic episodes can have significant effects on fetal well-being.

ANS: A

Feedback
A Prompt treatment of DKA is necessary to save the fetus and the mother.
B Hydramnios occurs 10 times more often in diabetic pregnancies.
C Infections are more common and more serious in pregnant women with diabetes.
D Mild to moderate hypoglycemic episodes do not appear to have significant effects on fetal well-being.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 616
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

18. In caring for a pregnant woman with sickle cell anemia the nurse is aware that signs and symptoms of sickle cell crisis include
a. Anemia
b. Endometritis
c. Fever and pain
d. Urinary tract infection

ANS: C

Feedback
A Women with sickle cell anemia are not iron deficient. Therefore routine iron supplementation, even that found in prenatal vitamins should be avoided in order to prevent iron overload.
B Women with sickle cell trait usually are at greater risk for postpartum endometritis (uterine wall infection); however, this is not likely to occur in pregnancy and is not a sign of crisis.
C Women with sickle cell anemia have recurrent attacks (crisis) of fever and pain, most often in the abdomen, joints and extremities. These attacks are attributed to vascular occlusion when RBCs assume the characteristic sickled shape. Crises are usually triggered by dehydration, hypoxia or acidosis.
D These women are at an increased risk for UTIs; however, this is not an indication of sickle cell crisis.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 622
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

19. With regard to anemia, nurses should be aware that
a. It is the most common medical disorder of pregnancy.
b. It can trigger reflex brachycardia.
c. The most common form of anemia is caused by folate deficiency.
d. Thalassemia is a European version of sickle cell anemia.

ANS: A

Feedback
A Iron deficiency anemia causes 75% of anemias in pregnancy. It is difficult to meet the pregnancy needs for iron through diet alone.
B Reflex bradycardia is a slowing of the heart in response to the blood flow increases immediately after birth.
C The most common form of anemia is iron deficiency anemia.
D Both thalassemia and sickle cell hemoglobinopathy are hereditary but not directly related or confined to geographic areas.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 621
OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

20. For which of the infectious diseases can a woman be immunized?
a. Toxoplasmosis
b. Rubella
c. Cytomegalovirus
d. Herpesvirus type 2

ANS: B

Feedback
A There is no vaccine available for toxoplasmosis.
B Rubella is the only infectious disease for which a vaccine is available.
C There is no vaccine available for cytomegalovirus.
D There is no vaccine available for herpesvirus type 2.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 626
OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

21. A woman who delivered her third child yesterday has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?
a. The woman's two children should be treated with acyclovir before she goes home from the hospital.
b. The baby will acquire immunity from the woman and will not be susceptible to chickenpox.
c. The children can visit their mother and sibling in the hospital as planned but must wear gowns and masks.
d. The woman must make arrangements to stay somewhere other than her home until the children are no longer contagious.

ANS: D

Feedback
A Acyclovir is used to treat varicella pneumonia.
B The baby is already born and has received the immunities. If the mother never had chickenpox, she cannot transmit the immunities to the baby.
C Varicella infection occurring in a newborn may be life threatening.
D Varicella (chickenpox) is highly contagious. Although the baby inherits immunity from the mother, it would not be safe to expose either the mother or the baby.

PTS: 1 DIF: Cognitive Level: Application REF: p. 627
OBJ: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment

22. A woman has a history of drug use and is screened for hepatitis B during the first trimester. What is an appropriate action?
a. Provide a low-protein diet.
b. Offer the vaccine.
c. Discuss the recommendation to bottle-feed her baby.
d. Practice respiratory isolation.

ANS: B

Feedback
A Care is supportive and includes bed rest and a high protein, low fat diet.
B A person who has a history of high-risk behaviors should be offered the hepatitis B vaccine.
C The first trimester is too early to discuss feeding methods with a woman in the high-risk category.
D Hepatitis B is transmitted through blood.

PTS: 1 DIF: Cognitive Level: Application REF: p. 628
OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

23. A woman has tested human immunodeficiency virus (HIV)-positive and has now discovered that she is pregnant. Which statement indicates that she understands the risks of this diagnosis?
a. "Even though my test is positive, my baby might not be affected."
b. "I know I will need to have an abortion as soon as possible."
c. "This pregnancy will probably decrease the chance that I will develop AIDS."
d. "My baby is certain to have AIDS and die within the first year of life."

ANS: A

Feedback
A The fetus is likely to test positive for HIV in the first 6 months until the inherited immunity from the mother wears off. Many of these babies will convert to HIV-negative status.
B With the newer drugs, the risk for infection of the fetus has decreased.
C The pregnancy will increase the chance of converting.
D With the newer drugs, the risk for infection of the fetus has decreased. Also, the life span of an infected newborn has increased.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 629
OBJ: Nursing Process: Evaluation MSC: Client Needs: Physiologic Integrity

24. Toxoplasmosis is a protozoal infection transmitted through organisms in raw and undercooked meat or through contact with contaminated cat feces. While providing education to the pregnant woman, the nurse evaluates the learning and understands that the patient requires further instruction when she states
a. "I will be certain to empty the litter boxes regularly."
b. "I won't eat raw eggs."
c. "I had better wash all of my fruits and vegetables."
d. "I need to be cautious when cooking meat."

ANS: A

Feedback
A The patient should avoid contact with materials that are possibly contaminated with cat feces while pregnant. This includes cat litter boxes, sand boxes, and garden soil. She should wash her hands thoroughly after working with soil or handling animals.
B The patient should avoid undercooked eggs and unpasteurized milk.
C All fruits and vegetables should be washed thoroughly before eating.
D Meat should be cooked thoroughly to an internal temperature of at least 160° F or as high as 180° F for poultry. All surfaces should be washed after they come into contact with uncooked meat. The patient should be instructed not to use the same utensils or cutting board for meat and produce.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 630
OBJ: Nursing Process: Evaluation MSC: Client Needs: Health Promotion and Maintenance

1. Diabetes refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin action, insulin secretion or both. Over time diabetes causes significant maternal changes in the microvascular and macrovascular circulations. These complications include (select all that apply)
a. Atherosclerosis
b. Retinopathy
c. IUFD
d. Nephropathy
e. Neuropathy

ANS: A, B, D, E

Feedback
Correct These structural changes are most likely to affect a variety of systems, including the heart, eyes, kidneys, and nerves.
Incorrect Intrauterine fetal death (stillbirth) remains a major complication of diabetes in pregnancy; however, this is a fetal complication.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 607
OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

1. The leading cause of life threatening perinatal infections in the United States is ________ (GBS).

ANS:
group B streptococcus
This gram-positive bacteria is colonized in the rectum, anus, vagina, and urethra of pregnant and non-pregnant women. UTI, chorioamnionitis, and endometritis can occur during pregnancy. Transmission to the fetus can cause the most serious of infections. GBS testing of all women should be performed at 35 to 37 weeks of gestation and treatment with antibiotics should be initiated if indicated.

PTS: 1 DIF: Cognitive Level: Application REF: p. 630
OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

1. Diabetes mellitus is a medical condition that could adversely affect pregnancy. It's frequency is increasing along with obesity and abnormal lipid profiles. Women who have GDM in pregnancy have no greater risk of developing type 2 diabetes. Is this statement true or false?

ANS: F
Women who develop GDM have a 35% to 60% likelihood of developing diabetes in the next 10 to 20 years. About 7% of all pregnancies are affected by GDM with higher rates among African Americans, Latinas, and American Indians.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 608
OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity