Gestational diabetes Questions and
Answers
A 32 year old multigravida at 28 weeks comes in to the clinic. She has given birth
three times, once at 35 weeks (twins), once at 38 weeks (singleton), and once at 41
weeks (singleton). All children are alive and well. She had one spontaneous abortion
at 10 weeks. How should the nurse record her obstetrical history using GTPAL
designation?
a. 3-2-0-1-3
b. 4-1-1-1-2
c. 5-2-1-1-4
d. 4-2-1-0-2
✓ ~~~c (G is for gravidity, the number of times she was pregnant, including the current
pregnancy. T is for term, meaning babies born at 37 weeks or older. P refers to any births
between 20 and 37 weeks, both term and preterm describe live births. A is abortion for
any fetal loss whether spontaneous or elective, up to 20 weeks gestation. L is for living,
referring to all living children.)
A 32 year old multigravida at 28 weeks comes into the clinic. The nurse notes her
fasting 1 hour glucose screening level is 164 mg/dL. Which information does the
nurse recognize in the client's history to support a diagnosis of gestational diabetes?
a. maternal great-aunt has non-insulent Type-2 diabetes
b. Child weighed 9 lbs (4.08 kg) at 41 weeks gestation
c. Trace of protein noted in the urine
,d. client is 64 in tall and weighs 134 prior to pregnancy
✓ ~~~b (family history is not a risk factor unless it is first-degree. Birth weight over 9 lbs,
maternal age over 25, history of unexplained stillborn, family history of type 1, strong
family history of type 2, and history of gdm in previous pregnancy are all risk factors. D is
within the normal BMI range.)
A 32 year old multigravida at 28 weeks comes into the clinic. The nurse notes her
fasting 1 hour glucose screening level is 164 mg/dL. She is scheduled for a 3 hour
oral glucose tolerance test. Which special instructions in addition to fasting 8 hour
before the appointment should the nurse give?
a. only coffee or tea is allowed once the fasting level has been drawn
b. follow an unrestricted diet and exercise pattern for 3 days before the test
c. write down questions and call the lab the day before the test
d. smoking in moderation is allowed up to the time the test begins
✓ ~~~b (caffeine in any form should be avoided because it increases glucose levels.
smoking should be avoided at least 12 hours before the test. Smoking shouldnt be done
during pregnancy at all)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for
GDM are positive. The patient asks why she wasnt tested until 28 weeks. The
nurse's response should be based on the understanding of which normal physiologic
change of pregnancy?
a. maternal insulin crosses the placenta to regulate fetal glucose levels throughout
the pregnancy
, b. in the first trimester, estrogen and progesterone cause an increase in fasting
glucose levels
c. hormonal changes in the second and third trimester increase the maternal insulin
resistance
d. fetal insulin increases each trimester, forcing the mother's body to produce more
glucose
✓ ~~~c (maternal insulin does not cross the placenta. increased estrogen and progesterone
stimulate the pancreas to increase insulin production, decreasing glucose levels.
Increasing hormones in the second and third trimester act as insulin antagonists. Most
pregnant bodies are able to handle this, but some are not as tolerant. Fetal insulin starts
around 10 weeks gestation and is adequate for the glucose the baby gets from the
mother.)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for
GDM are positive. The patient asks how she will know if she has high blood sugar.
Which response should the nurse give? (select all)
a. hyperglycemia often presents as increased thirst and urination
b. hyperglycemia causes a headache and flushed, dry skin
c. hyperglycemia causes cool and clammy skin
d. hyperglycemia causes an increased sensation of being hungry
✓ ~~~a, b, and d (hypoglycemia causes cool and clammy skin)
A 32 year old multigravida at 28 weeks comes into the clinic. Her screenings for
GDM are positive. She asks about content and timing of her meals How should the
nurse advice? (select all)
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