HESI Case Studies Gestational Diabetes 2026 – 40 Exam Questions & Answers – Insulin Management, Fetal Monitoring & Shoulder Dystocia

This document contains approximately 40 structured HESI-style case study exam questions and detailed answers focused on gestational diabetes management during pregnancy, labor, delivery, and postpartum care. The case follows a multigravida client and integrates obstetrical assessment using the G-T-P-A-L system, identification of gestational diabetes risk factors (previous macrosomic infant over 9 lbs, maternal age over 25, obesity, family history of diabetes), and physiologic insulin resistance changes in the second and third trimesters. The guide provides in-depth coverage of hyperglycemia assessment (polydipsia, polyuria, headache, flushed dry skin), dietary management (high-fiber complex carbohydrates, avoidance of refined sugars, adequate hydration), fingerstick blood glucose monitoring schedules, and interpretation of a reactive nonstress test (two accelerations ≥15 bpm lasting ≥15 seconds within 20 minutes). It also addresses amniocentesis preparation, priority nursing interventions during fetal monitoring changes, IV insulin infusion calculations (20 units regular insulin in 250 mL NS at 1 unit/hour = 12.5 mL/hour), and the rationale for tight glucose control in labor to prevent neonatal hypoglycemia. Additional maternal-newborn nursing concepts include opioid analgesia precautions (butorphanol/Stadol contraindicated in opioid dependence), chain of command decision-making, emergency management of shoulder dystocia using McRoberts maneuver, newborn complications such as unilateral absence of Moro reflex (possible clavicle injury), early and on-demand breastfeeding to prevent neonatal hypoglycemia and jaundice, Rho(D) immune globulin administration within 72 hours for Rh-negative mothers with Rh-positive infants, postpartum uterine fundal assessment (midline at the umbilicus), return to normal glucose levels after delivery, and contraception teaching for breastfeeding mothers (backup method required if mini-pill is taken more than 3 hours late). This resource is particularly suitable for: Nursing students Maternal-Newborn Nursing students OB Clinical rotation students HESI exam candidates NCLEX preparation students LPN and RN students It is relevant for courses such as: Maternal-Newborn Nursing Obstetric Nursing High-Risk Pregnancy Management Nursing Care of the Childbearing Family HESI Maternal Health Review NCLEX-RN Preparation Keywords: HESI Gestational Diabetes 2026, Obstetric Case Study, GTPAL Calculation, Gestational Diabetes Risk Factors, Hyperglycemia Symptoms, Insulin Infusion Calculation, Reactive Nonstress Test, Fetal Heart Rate Monitoring, Amniocentesis Nursing Care, McRoberts Maneuver, Shoulder Dystocia Management, Neonatal Hypoglycemia, Breastfeeding and Diabetes, RhoGam Injection, Postpartum Fundal Assessment, Mini Pill Contraception, Maternal Insulin Resistance