NCM 109: Nursing Care of the Pregnant Client - Pregestational Conditions Quiz

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18 Questions

Which of the following is a pregestational condition that can affect pregnancy?

Rheumatic heart Disease

Infants of diabetic women are how many times more likely to be born with heart anomalies compared to others?

5 times

What is the most frequent type of glycosuria?

Glucosuria

Which of the following is a characteristic of Type 1 diabetes mellitus?

Both b and c

Which of the following is NOT a pregestational condition listed in the text?

Pseudocyesis

What is the main reason that, due to insulin insufficiency, serum glucose levels continue to rise in diabetic patients?

Because body cells cannot use the glucose

What is the fasting plasma glucose level that meets the threshold for the diagnosis of diabetes?

140 mg/dl

What type of blood sample is taken 60 minutes after ingesting a 50-g oral glucose load to assess for diabetes?

Venous blood sample

What does the glycosylated hemoglobin measurement reflect?

Blood sugar level over the past 4 to 6 weeks

When should an ophthalmic examination be done during pregnancy for a woman with gestational diabetes?

Once during pregnancy

What is the upper normal level of HbA1c?

6%

In a woman with diabetes, how often should ophthalmic examinations be conducted during pregnancy?

At each trimester

What is the most common medical complication of pregnancy mentioned in the text?

Iron deficiency anemia

What is the main cause of iron deficiency anemia during pregnancy mentioned in the text?

Inadequate supply or low intake of dietary iron

What is the recommended timeframe for administering Rhogam to an unsensitized mother after delivery of an Rh-positive infant?

Within 72 hours

Which of the following is NOT mentioned as a symptom of iron deficiency anemia in the text?

Shortness of breath

What is the characteristic appearance of red blood cells in iron deficiency anemia?

Microcytic (small red blood cells) and hypochromic (less hemoglobin)

Which of the following is NOT mentioned as a potential maternal effect of iron deficiency anemia during pregnancy?

Increased risk of gestational diabetes mellitus

Study Notes

Pregestational Conditions

  • Diabetes Mellitus (DM) affects 3-5% of all pregnancies, either developing during pregnancy (gestational diabetes) or existing before pregnancy (pregestational diabetes mellitus).
  • Insulin enables glucose uptake by body cells; insufficient insulin levels lead to hyperglycemia and glycosuria (presence of reducing sugars in urine).
  • Polyuria (excessive urination) is a symptom of DM.

Classifications of Diabetes Mellitus

  • Type 1 (formerly insulin-dependent diabetes mellitus):
    • Characterized by destruction of beta cells in the pancreas, leading to absolute insulin deficiency.
    • Immune-mediated diabetes mellitus results from autoimmune destruction of beta cells.
    • Idiopathic type 1 refers to forms with no known cause.

Risk Factors for Diabetes Mellitus

  • History of large babies (10 lb or more), unexplained fetal or perinatal loss, congenital anomalies in previous pregnancies.
  • Family history of diabetes (one close relative or two distant ones).
  • Member of a population with a high risk for diabetes (Native American, Hispanic, Asian).
  • History of polycystic ovary syndrome.

Assessment and Diagnosis of Diabetes Mellitus

  • Fasting plasma glucose of 126 mg/dl or above, or non-fasting plasma glucose of 200 mg/dl or above, meets the threshold for diagnosis of diabetes.
  • Diagnosis must be confirmed on a subsequent day using a 50-g oral glucose challenge test.
  • Measurement of glycosylated hemoglobin (HbA) reflects average blood glucose levels over the past 4-6 weeks.

Monitoring a Woman with Diabetes Mellitus

  • Ophthalmic examination: once during pregnancy for gestational diabetes, and at each trimester for women with known diabetes.
  • Rhogam injection within 72 hours of delivery for unsensitized RH-positive mothers.

Anemia

  • Inadequate levels of hemoglobin in the blood (less than 12 gm/dL).
  • Causes: smoking, medication, nutritional deficiency in iron and folic acid during pregnancy.
  • Iron Deficiency Anemia: most common anemia of pregnancy, characterized by microcytic and hypochromic red blood cells.
  • Symptoms: cheilosis, headache, easy fatigability, pica, koilonychia, pallor of skin and mucous membranes, and dizziness.
  • Maternal effects: increased risk of infection, preeclampsia, postpartum hemorrhage, and delayed healing of episiotomy.

Test your knowledge on pregestational conditions such as Rheumatic heart Disease, Gestational Diabetes Mellitus, Substance Abuse, RH Sensitization, Anemia, DIC, and Pseudocyesis. Understand the implications of these conditions on pregnant clients and their unborn babies.

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