Aliamen, Jasmine M.

January 20, 2022

CMCA Theory

Instruction: Choose the correct answer and provide rationale for each chosen answer. You may
copy or use this questionnaire for the activity, just show you answer by encircling the letter or
highlight the entire option statement or use color code for your answer. Below each answered
question, write the rationale and reference.

PREGNANT WOMEN with DIABETES MELLITUS

SITUATION:
Mrs. Tess Bon, a 35-year-old G8P6, arrives at the clinic for her first prenatal visit during her 6th
week of pregnancy. She reports to the nurse that she has class D diabetes and takes regular
insulin and NPH insulin daily. Questions 1 to 5 refer to this situation.

1. Mrs. E.’s nursing care plan for this initial visit should include:
A. Client teaching regarding the probable need for increased insulin dosage and for stricter
control of her blood glucose level.
B. Genetic counseling regarding the fetus’s risk of inheriting diabetes
C. Patient teaching regarding the complications of diabetic pregnancy, including the risk of
preterm labor and pregnancy-induced hypertension
D. Explanations of antepartal tests, such as the non-stress test and biophysical profile

Rationale: It is advantageous for an individual concerned with the possibility of transmitting a

disease to his or her children to ask for genetic counseling at a preconception health visit for
advice on the inheritance of disease.
Reference: Pg 158

2. During the first trimester, Mrs. E. should maintain a caloric intake of:
A.10 to 20 calories/kg C. 30 to 35 calories/kg
B.20 to 25 calories/kg D. 45 to 50 calories/kg
3. Common complications of pregnancy in clients with diabetes include:
A. Polyhydramnios, fetal macrosomia, and preeclampsia
B. Hypotension, fatigue, and urinary tract infection
C. Mitral valve prolapse, diabetic coma, and stillbirth
D. Placenta previa, diabetic ketoacidosis, hypoglycemia
4. The following measures would help Mrs. E., to prevent exercise-induced hypoglycemia,
EXCEPT:
A. Scheduling exercise before a meal
B. Carrying hard candy while exercising
C. Discussing her plans to exercise with physician beforehand
D. Monitoring the effect of exercise on her blood glucose level
5. Mrs. E.’s insulin requirements probably will:
A. Decrease during the entire pregnancy
B. Decrease during the first half of the pregnancy and increase during the last half
C. Increase during the entire pregnancy
 D. Increasing during the first half of pregnancy and decrease in the last half

SITUATION:
Mrs. F. continues taking her insulin throughout her pregnancy. She arrives at the clinic t
34 weeks’ gestation for a routine check-up. Question 6 to 10.

6. Which diagnostic study is the most valuable in evaluating long term management of a
diabetic client?
A. A two-hour postprandial test C. A glycosylated hemoglobin test
B. A six-hour glucose tolerance test D. The diary of glucometer test results

Rationale: The measurement of glycosylated hemoglobin test (HbA1c) a measure of the amount
of glucose attached to hemoglobin, is used to detect the degree of hyperglycemia present.
Reference pg 515

7. Mrs. E. receives Humulin Regular insulin 8 “u” subcutaneously at 7:30 AM. The nurse
would be most alert to signs of hypoglycemia at what time during the day?
A. 9:30 to 11:30 am B.11:30 to 1:30 pm C. 1:30 to 3:30 pm D. 3:30 to 5:30 pm
8. Mrs. E reports to the nurse that she has a headache and feels shaky and cold. What would be
the first action by the nurse?
A. Check blood sugar level. C. Provide a warm blanket
B. Give a carbohydrate snack D. Take her blood pressure
9. After examining Mrs. E., the physician administers a non-stress test (NST). The NST
indicates nonreactive results. Which procedure will the physician probably order next?
A.Serum estriol level assessment C. Oxytocin contraction test
B.Amniocentesis D. Utrasonography

Rationale: Estriol tests are used to monitor high-risk pregnancies and screen for problems with
the fetus [5]. Estriol can be measured in the blood or in saliva. The advantage of saliva tests over
blood tests, is that saliva tests actually measure the amount of free hormones, while in blood
these hormones are mostly bound to proteins (SHBG and albumin) In addition, a saliva test is
easy to do and noninvasive. On the other hand, accurate measurement of hormones in the saliva
depends on proper sample collection and proper analyses [9]. It makes sense to repeat the test or
do a blood hormone test to confirm any abnormal findings 

Reference: https://labs.selfdecode.com/blog/estriol-blood-test-high-low-levels-normal-range/
#:~:text=Estriol%20tests%20are%20used%20to,the%20blood%20or%20in%20saliva.

10. Mrs. E’s physician schedules an amniocentesis and a cesarean delivery at 37 weeks’
gestation. In this situation, amniocentesis is performed primarily to:
A. Assess for congenital anomalies commonly associated with diabetic pregnancies.
B. Check the fetus’s glucose status before delivery
C. Determine the fetus’s lung maturity, which is commonly delayed in diabetic pregnancies
D. Assess for meconium-stained amniotic fluid
Rationale: A lecithin/sphingomyelin ratio by amniocentesis is usually performed by week 36 of
pregnancy to asses fetal maturity. In pregnancies complicated by diabetes, this ratio tends not
to show maturity as early as in other pregnancies probably because the synthesis of
phosphatidyllycerol, the compound that stabilizes surfactant, is delaed if hyperglycemia is
present. (Pg. 519)
The CVS and amniocentesis are diagnostic tests that assess the karyotype. When fetsl
chromosomes are photographed and displayed, which can provide a definite answer about the
presence or absence for chromosomal disorders.
Reference: Pg 155

SITUATION:
Mrs. C., a 38-year-old G3P0111, is diagnosed with gestational diabetes mellitus at 30 weeks’
gestation. Questions 11 to 15 refer to this situation.

11. The nurse assessing Mrs. C. for signs and symptoms of hyperglycemia. Which symptoms
does NOT indicate hyperglycemia?
A.Lethargy B. Polyuria C. Thirst D. Sweating
12. Mrs. C. asks whether she will have to use insulin. The nurse’s best response would be:
A. “Yes, you’ll definitely need to use insulin to control your glucose level”
B. “No, only people with diabetes mellitus type II need to use insulin; you only need to
regulate your diet.”
C. “That depends on how well your glucose level is controlled by diet.”
D. “No, you’ll be able to take another medication to control your glucose level”
13. Mrs. C.’s weight is within ideal range for her height. The chance of Mrs. C. developing
diabetes mellitus sometime in the future is:
A. 0% B. 5% C. 25% D. 90%

Rationale:
14. When planning dietary management for Mrs. C. with diabetes, the nurse considers perinatal
insulin requirements. Which statement about perinatal insulin needs is most accurate?
A. Insulin requirements in the first trimester are increased due to the influence of anterior
pituitary hormones.
B. In the second and third trimesters, insulin needs increase as placental hormone production
increases.
C. During labor, additional insulin is needed to provide energy for delivery.
D. Loss of placental hormones after delivery rapidly increases insulin needs.
15. When providing postpartum discharge instructions for Mrs. C., who has gestational diabetic,
what information should the nurse include?
A Breastfeeding will increase insulin requirements for the mother but is recommended for
the health of the infant.
B If she was taking insulin during the pregnancy, she will need to take insulin for the rest of
her life.
C Low-dose combined oral contraceptives are not recommended for family planning
D Maintaining a normal weight will decrease the risk of developing type 2 diabetes later in
life.
SITUATION:
Mrs. K, 36-years-old, G2P1 , 28 weeks gestation diagnosed with gestational diabetes is in the
emergency room. On her admission, she has the following presenting signs and symptoms: skin
warm and dry; acetone breath, polyuria, polyphagia, polydipsia, hypotension, tachycardia and
nausea and vomiting. Her laboratory results are as follows: Capillary Blood Glucose:644mg/dL;
urine (+), CHO (+) ketone.
16. The nurse’s positive confirmation that Mrs. K has hyperglycemia is performing what
diagnostic procedures?
A. Urine testing for Ketones, FBS, OGTT, 2 hour PPBS or Blood Sugar Series
B. Urine testing for protein, capillary blood glucose, blood sugar series
C. Urine testing of albumin, hemoglucotest, oral glucose test
D. Urine testing for potassium, gluocockeck blood, glucose challenge test
17. Mrs. K first visit to the clinic in her 24th week of gestation, upon her doctor’s order and to
confirm the diagnosis, the nurse has started the one hour oral glucose challenge test
procedure with 50 g oral glucose load taken by her. After an hour of ingesting 50g glucose,
venous blood sample was taken and the result reveals 155 mg/dl. What will be the next step
after this finding?
A. Schedule a 100 mg. oral glucose load to be taken orally by the patient, then collect urine+
blood after 3 days
B. Schedule a 100mg oral glucose to be taken orally by the patient, then collect a urine +
blood after 1,2, and 3 hours
C. Schedule a 100mg oral glucose to be taken orally by the patient, then collect another
urine + blood after 30 mins.
D. Schedule a 100mg oral glucose to be taken orally by the patient, then collect another
urine + blood after 1 hour.
Rationale: Because diabetes is such a serious complications in pregnancy, all women should be
screened during pregnancy for gestational diabetes. A fasting plasma glucose greather than or
equal to 126 mg/dl or a nonfasting plasma glucose greater than or equal to 200 mg/dl meets the
threshold for the diagnosis of diabetes and does not need confirmation. It is recommended that
all pregnant women receive a 50-g glucose challenge test between 24 and 28 weeks gestation to
determine if they are at risk for gestational diabetes (Pg. 514)
18. Most pregnant with gestational diabetes like that of Mrs. K are among the 90% of having
what type of gestational diabetes?
A. Gestational Diabetes with abnormal GTT C. Diabetes with calcified pelvic vessels
B. Frank (overt) diabetes D. Class C: Onset of diabetes
C. Gestational diabetes

Rationale: if your blood glucose level is higher than 140 mg/dL (7.8 mmol/L) after the one-hour
test, your doctor will recommend the three-hour test. If your blood glucose level is higher than
190 mg/dL (10.6 mmol/L) after the one-hour test, you'll be diagnosed with gestational diabetes.

(https://www.mayoclinic.org/tests-procedures/glucose-tolerance-test/about/pac-
20394296#:~:text=Gestational%20diabetes,-If%20you're&text=At%20Mayo%20Clinic%2C
%20if%20your,be%20diagnosed%20with%20gestational%20diabetes)
19. Mrs. K’s curiosity is evident concerning the risk of diabetes mellitus on her fetus. The nurse
is aware that among risks of certain conditions are the following, EXCEPT:
A. Hyperbilirubinemia and macrosomia C. Neonatal hypoglycemia and
hypocalcemia
B. Mental agitation and nervousness D. Fetal death, spontaneous abortion

Rationale: Neonatal hypocalcemia usually occurs within the first 2 days of life and is most
often caused by prematurity, being small for gestational age, maternal diabetes or
hyperparathyroidism, and perinatal asphyxia.

Reference: https://www.google.com/search?
q=Neonatal+hypoglycemia+and+hypocalcemia&sxsrf=AOaemvIun9SUGW-
5R_HPsJ65IIIp0SxWbw%3A1642665664269&ei=wBbpYdTxD5jN-
QaykLGABQ&ved=0ahUKEwjU0Zy77r_1AhWYZt4KHTJIDFAQ4dUDCA4&uact=5&oq=Neo
natal+hypoglycemia+and+hypocalcemia&gs_lcp=Cgdnd3Mtd2l6EAMyBQghEKABMgUIIRCg
AToHCCMQ6gIQJ0oECEEYAEoECEYYAFDpBVjpBWDDCWgBcAJ4AIABwAKIAcACkgEDMy
0xmAEAoAEBoAECsAEKwAEB&sclient=gws-wiz

20. When Mrs. K delivers at 39 weeks of gestation. What nursing intervention for the newborn
would be most important shortly after birth?
A. Assess jaundice C. Evaluate for hypocalcemia
B. Elicit Moro reflex D. Initiate early feedings