GESTATIONAL DIABETES MELLITUS

Question 1

What causes gestational diabetes?

Answer 1

During pregnancy, the body produces a larger amount of certain hormones that help maintanin a healthy pregnancy and provide nutrients to the baby. These increase in hormones can interfere with insulin, causing high blood sugar level, which is normal in pregnancy, as this extra glucose is needed to support the baby. However, when the amount of insulin produced is less than the amount needed to handle blood sugar levels and the amount of glucose in the blood stream is very high, GDM happens.

Question 2

Risk factors of GDM

Answer 2

• Previous diagnosis of gestational diabetes or prediabetes, poor impaired glucose tolerance, or impaired fasting glycemia
• Family history of type 2 diabetes
• Advanced maternal age
• Previous birthed a baby that is macrosomic
• High blood pressure & pre-eclampsia
• Polyhydramnios
• Significant weight gain before or during the first 18-24 weeks of pregnancy
• Medical conditions associated w/ risk for diabetes

Question 3

Signs and Symptoms of GDM

Answer 3

• Blurred vision
• fatigue
• frequent infections
• increased urination & thirst
• nausea
• high blood sugar
• tingling limbs

Question 4

How is Gestational diabetes diagnosed?

Answer 4

• Routine prenatal testing & screening

Question 5

Why does gestational diabetes places mothers in the high risk pregnancy category?

Answer 5

Poses and increased risk for complications during pregnancy, labor & delivery

Question 6

Effects of diabetes in pregnancy for mother

Answer 6

• Polyhydramnios
• Preterm birth
• Kidney infection
• Problems with labor
• Cesarean birth risks
• Damage to the retinas
• Increased risk of metabolic syndrome

Question 7

Effects of Diabetes in Pregnancy for Baby

Answer 7

• Poor orga development
• Increased risks of spontaneous abortion or stillbirth and intrauterine death
• Abnormalities such as enlarged, liver, pancreas, or heart
• Lifelong risk for obesity, high blood pressure and diabetes
• Skeletal and limb abnormalities
• Abnormal growth patterns
• Birth problems or trauma

Question 8

Baby being too large

Answer 8

Macrosomic

Question 9

A macrosomic baby has increased risk of a…

Answer 9

traumatic birth

Question 10

Babies with macrosomia are most safely delivered via

Answer 10

C-Section

Question 11

Why does neonatal hypoglycemia happen?

Answer 11

When Babies from a gestational diabetes pregnancy is born, the amount of insulin they produces does not drop as quickly as their glucose supply does, since they are used to a larger supply of glucose in utero. If they don’t take in enough energy as newborns, their blood sugars drop dangerously low.

Question 12

What happens if low blood sugar persists?

Answer 12

Brain cells begin to die, causing seizures & permanent brain damage

Question 13

How does neonatal jaundice happen?

Answer 13

Mother with gestational diabetes can sometimes have poor placental perfution which affects the flow of blood to the baby through the umbilical cod. This can cause the baby to be deprived of oxygen in the uterus (chronic intrauterine hypoxia). These conditions can cause the baby to produce too many RBCs releasing bilirubin into blood. When too much bilirubin is released, baby’s skin and eyes can turn yellowish

Question 14

Recommended time all pregnant patients receive an oral glucose tolerance test

Answer 14

24-28th week of pregnancy

Question 15

Goal of treatmen

Answer 15

Keep blood glucose levels within normal limits during pregnancy and to make sure the growing baby is healthy.

Question 16

A 34-year-old female is currently 16 weeks pregnant. You’re collecting the patient’s health history. She has the following health history: gravida 5, para 4, BMI 28, hypertension, depression, and family history of Type 2 diabetes. Select below all the risk factors in this scenario that increases this patient’s risk for developing gestational diabetes?

A. 34-years-old
B. 16 weeks pregnant
C. Gravida 5, para 4
D. BMI 28
E. Hypertension
F. Depression
G. Family history of Type 2 diabetes

Answer 16

A, C, D , G

Question 17

You’re providing an educational class for pregnant women about gestational diabetes. You discuss the role of insulin in the body. Select all the CORRECT statements about the role and function of insulin:

A. “Insulin is a type of cell that provides glucose to the body from the blood.”
B. “Insulin is a hormone secreted by the beta cells of the pancreas.”
C. “Insulin influences cells by causing them to uptake glucose from the blood.”
D. “Insulin is a protein that helps carry glucose into the cell for energy.”

Answer 17

B and C

Question 18

A 32-year-old female is diagnosed with gestational diabetes. As the nurse you know that what test below is used to diagnose a patient with this condition?

A. 1 hour glucose tolerance test
B. 24 hour urine collection
C. Hemoglobin A1C
D. 3 hour glucose tolerance test

Answer 18

D. 3 hour glucose tolerance test

Question 19

A 36-year-old pregnant female is diagnosed with gestational diabetes at 28 weeks gestation. You’re educating the patient about this condition. Which statement by the patient demonstrates they understood your teaching about gestational diabetes?

A. “Once I deliver the baby, it will go away, and I will not need any further testing.”
B. “It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals.”
C. “There are no risks or complications related to gestational diabetes other than hyperglycemia.”
D. “I’m at risk for delivering a baby that is too small for its gestational age due to this condition.”

Answer 19

B. “It is important I try to get my fasting blood glucose around 70-95 mg/dL and <140 mg/dL 1 hour after meals.”

Question 20

Your patient is 36 weeks pregnant and has gestational diabetes. Which lab result below is euglycemic?

A. Blood glucose 55 mg/dL
B. Blood glucose 82 mg/dL
C. Blood glucose 148 mg/dL
D. Blood glucose 325 mg/dL

Answer 20

B. Blood glucose 82 mg/dL

Question 21

A patient has gestational diabetes and is currently 34 weeks pregnant. Which assessment findings below should you immediately report to the physician? Select all that apply:

A. Blood glucose 129 mg/dL
B. Blood pressure 190/102
C. Proteinuria
D. Linea nigra
E. Negative glycosuria

Answer 21

B. Blood pressure 190/102
C. Proteinuria

Question 22

A patient is 35 weeks pregnant. She has gestational diabetes and uncontrolled hyperglycemia. Her current blood glucose is 290 mg/dL. You administer insulin per physician’s order and recheck the blood glucose level per protocol. It is now 135 mg/dL. Which statement by the patient requires you to notify the physician?

A. “It burns when I urinate.”
B. “My back is hurting.”
C. “I feel tired.”
D. “I feel the baby kick about 10 times an hour.”

Answer 22

A. “It burns when I urinate.”

Question 23

A baby is born at 37 weeks gestation to a mother with gestational diabetes. As the nurse you know at birth that the newborn is at risk for? Select all that apply:

A. Hyperglycemia
B. Hypoglycemia
C. Respiratory distress
D. Jaundice
E. Hypertherm

Answer 23

B. Hypoglycemia
C. Respiratory distress

Question 24

You educate a pregnant patient with gestational diabetes that she should try to have a blood glucose level of 1 hour after a meal.
A. <70 mg/dL
B. <250 mg/dL
C. >160 mg/dL
D. <140 mg/dL

Answer 24

The answer is D: <140 mg/dL

Question 25

Nurse Jessica is discussing with a pregnant client who has gestational diabetes mellitus at 36 weeks gestation about the risks of premature labor. The doctor has mentioned that a specific procedure may be necessary to ensure the baby's lungs are mature enough for delivery. Which procedure is most appropriate? A. An amniocentesis to determine L/S ratio and maturation of lung tissue prior to labor. B. An ultrasound to assess the baby’s weight and position prior to labor. C. A biophysical profile to determine L/S ratio and maturation of lung tissue prior to labor. D. A contraction stress test to determine L/S ratio and maturation of lung tissue prior to labor.

Answer 25

A. An amniocentesis to determine L/S ratio and maturation of lung tissue prior to labor.

Question 26

Nurse Laura is explaining fetal hyperinsulinism to her pregnant client who has diabetes. She clarifies when this condition typically develops and its effects on the fetus. Which statement by Nurse Laura is true? A. "Fetal hyperinsulinism results before birth, when organ development stops, leading to a decrease in insulin production." B. "Fetal hyperinsulinism results before organ development, which causes excess insulin production." C. "Fetal hyperinsulinism results after organ development, which causes excess insulin production." D. "Fetal hyperinsulinism results after birth, when there is mature organ development, which causes excess insulin production."

Answer 26

C. "Fetal hyperinsulinism results after organ development, which causes excess insulin production."

Question 27

Nurse Claire is advising a woman who is planning to get pregnant to monitor her A1C levels before conception to ensure a healthy pregnancy. What should her A1C levels be? A. Greater than 6.5-7% B. Greater than 6.5-8% C. Less than 8-9% D. Less than 6.5-7%

Answer 27

D. Less than 6.5-7%

Question 28

Nurse Lauren is counseling a pregnant patient recently diagnosed with gestational diabetes mellitus (GDM) about recognizing signs of elevated blood sugar levels. During the discussion, which of the following should Nurse Lauren identify as signs of hyperglycemia? (Select all that apply) A. Reduced urine output. B. Sudden and unexpected weight loss. C. Excessive thirst, also known as polydipsia. D. Frequent urination or polyuria. E. Unexplained weight gain. F. Increased insulin usage. G. Skin that appears hot and flushed. H. Skin that feels cool and clammy

Answer 28

B, C, D , G

Question 29

Nurse Carla is educating a pregnant patient about the changes in hormone levels during the later stages of pregnancy. She explains that one particular placental hormone is responsible for causing insulin resistance in the body's tissues. Which hormone is she referring to? A. Human chorionic gonadotropin (hCG) B. Progesterone C. Human placental lactogen (hPL) D. Estrogen

Answer 29

C. Human placental lactogen (hPL)

Question 30

Nurse Taylor is assessing a pregnant patient who is at 26 weeks gestation and has been experiencing dizziness and headaches. After learning about the patient's eating habits, exercise routine, and obtaining a blood glucose level of 120 mg/dL, the nurse considers the most likely cause of the patient's symptoms. What is the patient most likely experiencing? A. Hyperglycemic B. Hypertension due to excessive exercise. C. Hypoglycemic D. Anorexia

Answer 30

C. Hypoglycemic

Question 31

Nurse Sarah is educating her pregnant client with Type 1 diabetes mellitus about the use of antidiabetic medications during pregnancy. Which response by Nurse Sarah is the most accurate regarding the use of these medications? A. "You should switch to oral medications after the first trimester." B. "Oral antidiabetic medications are always safe to use during pregnancy." C. "It's best to stop all antidiabetic medications during pregnancy to protect the baby." D. "Insulin is the preferred medication for managing Type 1 diabetes during pregnancy."

Answer 31

D. "Insulin is the preferred medication for managing Type 1 diabetes during pregnancy."

Question 32

Nurse Amy is explaining the diabetogenic effect to a mother who has been recently diagnosed with gestational diabetes mellitus. She emphasizes how the body compensates for reduced glucose availability by using other sources of energy. Which statement by Nurse Amy best describes the diabetogenic effect? A. "It refers to the placenta's role in lowering blood sugar levels to ensure the baby gets enough glucose." B. "The diabetogenic effect refers to the increased production of glucose by the liver during pregnancy." C. "It describes the body's increased use of fatty acids for energy when glucose is less available." D. "The diabetogenic effect is the body's tendency to decrease insulin production during pregnancy."

Answer 32

C. "It describes the body's increased use of fatty acids for energy when glucose is less available."

Question 33

Nurse Carla is caring for a 51-year-old widower admitted with diabetes mellitus, rapid-onset weight loss, high blood glucose levels, and polyphagia. Given these symptoms, what secondary medical diagnosis should the nurse anticipate? A. Gestational diabetes mellitus B. Pituitary tumor C. Impaired glucose tolerance D. Pancreatic tumor

Answer 33

D. Pancreatic tumor

Question 34

Nurse Mia is teaching a nursing student about the development of gestational diabetes mellitus (GDM) in pregnant mothers. She explains that this condition occurs due to a specific imbalance involving glucose and insulin. Which statement by Nurse Mia is the most accurate regarding the cause of gestational diabetes? A. "Gestational diabetes develops when the body's tissues become more sensitive to insulin during pregnancy." B. "Gestational diabetes occurs because the pancreas produces too much insulin during pregnancy." C. "Gestational diabetes results from the body producing excessive glucose during pregnancy." D. "Gestational diabetes is caused by the pancreas failing to produce enough insulin to overcome the insulin resistance during pregnancy."

Answer 34

D. "Gestational diabetes is caused by the pancreas failing to produce enough insulin to overcome the insulin resistance during pregnancy."

Question 35

Nurse Linda is educating a pregnant patient with gestational diabetes about the potential effects of elevated glucose levels on the baby. She explains that when excessive glucose is transported from the mother to the fetus, it can lead to certain complications. Which statement correctly describes these effects? A. Hypotension in the fetus and increased risk of congenital anomalies. B. Macrosomia of the fetus and no possible damage to arterial walls. C. Macrosomia of the fetus and possible damage to arterial walls. D. Hypoglycemia of the fetus and possible damage to arterial walls.

Answer 35

C. Macrosomia of the fetus and possible damage to arterial walls.

Question 36

Nurse Emily is educating a pregnant woman with Type 1 diabetes about the target glucose levels she should maintain before meals or at bedtime. Which preprandial glucose range indicates that the patient has understood the instructions correctly? A. 180-200 mg/dL B. 60-100 mg/dL C. 80-130 mg/dL D. 140-160 mg/dL

Answer 36

C. 80-130 mg/dL

Question 37

Nurse Ava is discussing fetal glycosuria with a student nurse and explaining the conditions under which it occurs. What is the correct explanation? A. There is an increased renal threshold, causing more glucose to be excreted. B. There is an increased renal threshold, causing less glucose to be excreted. C. There is a decreased renal threshold, causing more glucose to be excreted. D. There is a decreased renal threshold, causing less glucose to be excreted.

Answer 37

C. There is a decreased renal threshold, causing more glucose to be excreted.