Chapter 26 Concurrent Disorders during Pregnancy

Chapter 26  Concurrent Disorders during Pregnancy

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. 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
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. 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. Hydramnios occurs about 10 times more often in diabetic
pregnancies than in nondiabetic pregnancies. Typically, it is seen in the third trimester of
pregnancy. 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: Knowledge/Remembering
REF: p. 550 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
Insulin needs are reduced in the first trimester due to increased insulin production by the
pancreas and increased peripheral sensitivity to insulin. Also the woman may be
experiencing nausea, vomiting, and anorexia that would decrease her insulin needs. The
other statements show good understanding of this topic.

PTS: 1 DIF: Cognitive Level: Evaluation/Evaluating
REF: p. 553 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
Poor glycemic control later in pregnancy increases the rate of fetal macrosomia. Poor
glycemic control during the preconception time frame and into the early weeks of the
pregnancy is associated with congenital anomalies. Preterm labor or birth is more likely to
occur with severe diabetes and is the greatest risk in women with pregestational diabetes.
Increased weight, or macrosomia, is the greatest risk factor for this woman.

PTS: 1 DIF: Cognitive Level: Comprehension/Understanding
REF: p. 554 OBJ: Nursing Process: Planning
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
Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not
severe. Type 2, previously called adult onset diabetes, is the most common. There are 2
subgroups of gestational diabetes. Type GDM A1 is diet-controlled whereas type GDM A2
is controlled by insulin and diet. People do not go back and forth between type 1 and type 2
diabetes.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 550 OBJ: Nursing Process: Assessment
MSC: Client Needs: Physiologic Integrity

5. A nurse in labor and delivery learns about metabolic changes that occur throughout

pregnancy in diabetes. What information does the nurse know?
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

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

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 549 OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Physiologic Integrity