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Nurs 354 Exam 3 Questions with Complete Solutions
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Nurs 354 Exam 3 Questions with Complete Solutions
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Nurs 354 Exam 3 Questions with Complete SolutionsWhat are the three possible types of diabetes in pregnancy? Correct Answer-1. pre-existing type 1 diabetes (insulin dependent); typically diagnosed in childhood
2. pre-existing type 2 diabetes (insulin resistant); typically diagnosed in adulthood
3. gestational diabetes; occurs only in pregnancy; usually goes away once the baby is born; typically doesn't develop until halfway through the pregnancy
What are maternal effects of pre-existing diabetes? Correct Answer--
higher risk for spontaneous abortion, hypertension, preeclampsia, UTIs
-hydramnios
-labor dystocia (dysfunctional labor)
-ketoacidosis develops earlier
What are fetal effects of pre-existing diabetes? Correct Answer--
congenital malformations
-fetal size (macrosomia - fetus size over 4000g (8lbs.13oz) or SGA - small for gestational age)
What effects can display on newborns of diabetic mothers? Correct Answer--hypoglycemia (insulin doesn't cross placenta but oral diabetic meds do); fetal pancreas is producing insulin to combat maternal hyperglycemia, which still happens after the fetus is born, causing hypoglycemia
-hypocalcemia
-hyperbilirubinemia
-respiratory distress syndrome
What is gestational diabetes? What is a primary cause? Correct Answer-
diabetes diagnosed in the second or third trimester of pregnancy that was
not clearly overt diabetes before gestation
cause:
-placental hormones can cause increased insulin resistance
What are some risk factors for gestational diabetes? Correct Answer--
over age 35
-obesity
-multiple gestation (more than one fetus)
-prior gestational diabetes
-history of large infants
T/F: Gestational diabetes can cause congenital malformations in the fetus Correct Answer-False; because gestational diabetes develops after the first trimester (after 20 weeks), it is NOT associated with major congenital malformations of the fetus When are gestational diabetes screenings typically done during pregnancy? What are the types of screenings? Correct Answer-done between 24-28 weeks of gestation
glucose challenge test (GCT or 1-hour test) is done first, then oral glucose tolerance test (OGTT or 3-hour test)
What is the glucose challenge test (GCT)? Correct Answer-screening tool for gestational diabetes; aka 1 hour test (will be the initial test given)
fasting is not necessary before testing; 50g of oral glucose solution is given to the client and a blood sample is taken 1 hour later
if blood glucose is 140 mg/dL, 3-hour OGTT is recommended
What is the oral glucose tolerance test (OGTT)? Correct Answer-gold standard screening for diagnosing gestational diabetes; fasting is required from midnight on the day prior to the test
fasting blood glucose level is drawn; then client ingests 100g of oral glucose solution and plasma glucose levels are determined at 1, 2, and 3 hours
What implementations for gestational diabetes should be done during pregnancy? Postpartum? Correct Answer-during pregnancy: -monitor blood glucose levels
-maintain stable glucose levels (insulin drip as needed)
postpartum:
-rarely is there a need to monitor maternal glucose levels postpartum
-re-evaluate insulin needs
What are signs/symptoms we can assess for cardiac disease in pregnant patients? Correct Answer--higher levels of fatigue
-coughing/shortness of breath
-s/s of congestive heart failure (dependent edema, crackles)
-factors that may increase cardiac workload
What implementations can be made to help treat pregnant patients with cardiac disease? What implementations during labor? Correct Answer-
pregnant patients:
-limit physical activity
-avoid excessive weight gain
-prevent anemia (iron supplements, vitamin C)
-prevent infection
during labor:
-shorten 2nd stage (pushing)
-minimize vagal nerve stimulation (valsalva)
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