Question SCENARIO: O.H. is a 28-year-old who gave birth to a 4800-gram… SCENARIO:O.H. is a 28-year-old who gave birth to a 4800-gram infant three years ago at 36 weeks gestation. Her daughter spent a week in the Neonatal Intensive Care Unit (NICU) with unstable blood glucose levels, breathing, and feeding problems. She is currently 28 weeks pregnant with her second child. She is 5ft 3 inches tall, and her pregnancy weight was 170 pounds. She has an O+ blood type, is human immunodeficiency virus (HIV) negative, rubella immune, and is venereal disease research laboratory test (VDRL) non-reactive. She is married to J.H. her husband of six years. Both O.H.’s mother and grandmother have type 2 diabetes.O.H. comes to the health care provider for a prenatal visit and glucose challenge test. The provider notes that she had gained 8 pounds since her last appointment two weeks ago. O.H. says she fasted the night before coming to the clinic, and typically eats a diet of rice, beans, tortillas, and some meat, prepared by her mother and grandmother.1. Evaluate the information in the case above and determine the Top 3 Priority concerns or cues.a. b.c.2. Based on the priority concerns, which action(s) should the nurse perform? Select all that apply.A. Complete a glucose challenge test.B. Obtain a blood pressure.C. Complete a 3-hour oral glucose challenge test.D. Obtain a finger sample blood glucose level.E. Complete a 24-hour food recall.3. The nurse is administering the glucose challenge test. Which instruction(s) should be given to O.H.? Select all that apply.A. Serum blood sample will be drawn in 1, 2, and 3-hour intervals.B. Client will be provided 100 grams of oral glucose.C. Client will be provided 50 grams of oral glucose.D. Serum blood sample will be drawn after 1 hour has passed.E. Based on the results additional testing may be needed.F. Client will not need to fast when the screen is done.OBSTETRIC RECORDJul. 15Blood Pressure (MAP)108/65 (79)Pulse85Respirations15Temperature98.6F (37.1C)Pain0/10Hemoglobin (12-17 g/dL)13Platelets (150,000-350,000 µL)243,000White Blood Cells (4,000-10,000 µ/L)15,000Glucose (70-100mg/dL)154 HBlood Urea Nitrogen (-20 mg/dL)15Creatinine (0.7-1.3 mg/dL)0.44. Based on the information in the electronic record, what action should the nurse take?A. Instruct O.H. that her test indicates she has gestational diabetes.B. Educate O.H. on a gestational diabetic diet.C. Instruct O.H. that the test was negative and no further testing is needed.D. Inform O.H. that it is likely that additional tests are indicated on another day.5. O.H. asks the nurse about the 3-hour glucose challenge test. What information should the nurse provide O.H.? Select all that apply.A. She will need to fast the night before and during the test.B. Blood will be drawn at the start of the test, and at 1, 2, and 3 hours.C. She may have a cup of coffee the morning of the test.D. She will drink a 100 grams oral glucose solution after the first blood draw.E. O.H. will drink a 50 grams oral glucose solution after the second blood draw.LAB RESULTSGlucose Challenge TestFasting Glucose (<95 mg/dL)100 HColor of Vacutainer to Draw Lab Work1-Hour Glucose (<180 mg/dL)200 H2-Hour Glucose (<155 mg/dL) 180 H3-Hour Glucose (<140 mg/dL)155 H6. Explain the rationale for each of these post-procedure prescriptions.A. Dietary instructions__________________________________________________B. Moderate exercise program____________________________________________C. Instructions for self-monitoring of blood glucose___________________________D. Daily dietary log and record all blood glucose levels. Bring these to the next appointment_____________________________________________________________________7. O.H. meets with the diabetes nurse educator about her diet before leaving the clinic. She identifies that her preference is a plant-based diet, preferring beans and grains to meat. She is counseled using the Latin American Diet Food Pyramid. Plan an appropriate meal for her based on her preferences and the Latin American Diet Food Pyramid.O.H. returns to the clinic four weeks later for her prenatal visit with her food and blood glucose diary. She says she is having a hard time following the diet because her mother and grandmother insist on cooking for her and continue cooking food that is high in fat, salt, and sugar. Her blood glucose levels are persistently greater than 95 mg/dL fasting, and 2-hours post-meal levels are consistently higher than 120 mg/dL.8. The provider places O.H. on lispro injections. Explain the rationale for each of these insulin instructions.A. Reason for the medication_______________________________________________B. Administration 5-10 minutes before meals__________________________________C. Need to eat immediately after injection_____________________________________D. Instructions for O.H.'s husband about insulin administration and symptoms of hypoglycemia_____________________________________________________________________________9. Evaluate the information in the case provided and pick the Top 3 Priority education needs about insulin administration.a. ________________________________________________________________________b. ________________________________________________________________________c. ___________________________________________________________________________10. The provider orders a nonstress test to assess fetal status. What should the nurse expect to find if the results are normal. What should the nurse expect to find if the results are normal?A. Two accelerations of fetal heart rate (FHR) within 20 minutes that are least 15 beats per minute above the baseline rate and last for a minimum of 15 seconds each.B. Three contractions that last at least 40 seconds within 10 minutes without the presence of late or significant variable decelerations.C. The absence of two fetal heart rate acceleration within 20 minutes.D. Three uterine contractions within a 10-minute period with late fetal heart decelerations.11. To prepare for the nonstress test, which action(s) should the nurse take? Select all that apply.A. Place client in a side-lying position.B. Record vital signs.C. Apply electronic fetal monitor.D. Record baseline FHR and monitor for 20-30 minutes.E. Instruct O.H. to mark the paper with each perceived fetal movement.F. Stimulate uterine contractions until three contractions occur within 10 minutes.Olivia experiences no further complications with her pregnancy. She is able to maintain her glucose levels within an acceptable range with insulin therapy. At 40 weeks gestation, she goes into labor and reports to triage in the labor and delivery department.12. Which prescription(s) should the admitting nurse anticipate from the health care provider? Select all that apply.A. Monitor blood glucose levels every 1 to 2 hours.B. Administer IV fluid of D10W at 125 mL/hr.C. Monitor fetal heart rate patterns throughout labor.D. Monitor urinary output closely.E. Assess maternal vital signs every 2 hours.13. Olivia is connected to a fetal monitor, and early decelerations are noted. What action should the nurse take first?A. Continue to monitor the client.B. Change maternal position to side-lying.C. Increase the rate of maintenance IV fluid.D. Administer oxygen at 8 to 10 L/minute.14. O.H.'s labor is progressing, her membranes rupture, with clear amniotic fluid and an epidural catheter is placed. Use THIN (T-Top 3, H- Help Quick, I- Identify Risk to Safety, N- Nursing Process) Thinking to prioritize her care during an epidural block.T-__________________________________________________________________H-__________________________________________________________________I-___________________________________________________________________N-__________________________________________________________________15. Six hours later, O.H. successfully delivers a baby girl, vaginally. The infant is crying and is vigorous. What action should the nurse take first?A. Place the infant on the mother's chest.B. Dry and stimulate the infant.C. Obtain vital signs of the infant.D. Obtain measurements of the infant.O.H.'s baby's Apgar Scores are 8 at 1 minute of age and 9 at 5 minutes of age and the infant weighs 8 lbs.5 oz. The initial blood glucose level of the infant is 52 mg/dL. She successfully breastfeeds for 15 minutes. After the feeding, the infant's blood glucose is 72 mg/dL. Four hours have passed, and O.H. and her baby girl are ready to be transferred to the mother/baby/unit. O.H.'s blood glucose has remained stable.16. Prepare the SBAR handoff report for the accepting nurse?S-______________________________________________________________________B-______________________________________________________________________A-______________________________________________________________________R-______________________________________________________________________17. Based on the SBAR report, what are postpartum nurse's Top 3 Concerns?a._______________________________________________________________________b._______________________________________________________________________c._______________________________________________________________________18. Upon assessment, the nurse notices the uterus is flaccid and displaced to the right. What action should the nurse take first?A. Check bladder status and encourage voiding.B. Notify the health care provider.C. Place an indwelling urinary catheter.D. Perform fundal massage.19. Olivia is successfully breastfeeding her infant but is concerned about her baby getting enough fluids. She says, "My mother says I should be giving her water and formula." What is the nurse's best response?A. "Let me consult with the lactation specialist and see what can be done."B. "Your infant will receive all the nutrition and water she needs from your breastmilk."C. "I will bring you some water and formula for the baby."D. "This is an old wives' tale, and you need to tell your mother that it's not true."20. Olivia experiences no further complications and is breastfeeding her daughter without difficulties. The nurse provides discharge teaching to O.H. For each potential post-delivery complication, write the symptoms O.H. should report to her health care provider.Condition Symptoms to ReportInfection Uterine subinvolutionSigns of deep vein thrombosisSigns of postpartum depression Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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