Final Exam NUR 439 OB UPDATED ACTUAL Questions and
CORRECT Answers
Pregestational vs Gestational Diabetes Mellitus Pregestational Diabetes Mellitus is a label given to type 1 or 2 diabetes that
existed prior to pregnancy.
Gestational Diabetes Mellitus would be women whose glucose intolerance was
diagnosed during pregnancy but who do not meet the criteria defining type 1 or
type 2 diabetes.
Treatment Intrapartum: monitor for dehydration (decreased fetal movement),
blood glucose; Continuous Electronic Fetal Monitoring; IV infusion; possible C/S
for macrosomnia (large)
Treatment Postpartum: first 24hrs, insulin requirements drop substantially; risk of
hemorrhage d/t uterine distention
Gestational Diabetes Mellitus (GDM) Care Management Antepartum: diet (1500-2000kcal/day, carbs 50% of cals, "watch out for excess
fruit"), exercise, self-monitoring of blood glucose, pharm, fetal surveillance
Intrapartum: blood glucose monitored hourly in labor; infusion of regular insulin
by continuous infusion, piggybacked into the main IV line
Postpartum: will return to normal glucose lvls after birth; likely to recur in future
pregnancies
Risk factors for the maternal and fetal patient with Age: Maternal age over 25 (older moms)
diabetes Hx: Previous infant, unexplained IUFD (stillbirth) or pregnancy with GDM
Genes: Strong family hx of GDM or T2 Diabetes
Obesity
Already insulin resistant: Fasting blood glucose >140
Education to patient on diabetes Obese women prior to conception and develop GDM are at higher risk of giving
birth to infants with CNS defects
Hy perglycemia in 1st trimester correlated with birth defects (CV & neuro); no
increase in incidence in birth defects has been found w/ GDM after 1st trimester
Screen for GDM 24-28 wks
,Hyperemesis severe N/V; may lead to wt loss, electrolyte imbalance, nutritional deficiencies,
ketonuria (ketones are present in the urine)
Hyperemesis: Diagnosis and management Cause not well understood; may be d/t relaxation of smooth muscle of stomach &
increased estrogen & hCG
Hyperemesis: Initial care IV fluids/elec, meds, enteral/parenteral nutrition as last resort
Hyperemesis: Nursing interventions Goal: decrease N/V
Interventions: encourage PO hydration, bedrest, feedings are started in small
amounts at frequent intervals. In the beginning limited amounts of oral fluids and
bland foods such as crackers, toast, or baked chicken are offered. Diet progresses
slowly as tolerated until the woman is able to consume a nutritionally sound diet.
Hyperthyroidism Typically caused by Graves (expect heat intolerance, tachycardia, wt loss,
sweating, fatigue, anxiety, low TSH, high T4); primary tx during preg is drug
therapy
Meds = Propylthiouracil (PTU) or Methimazole (MM)
Hypothyroidism Associated w infertility & risk of miscarriage; iodine deficiency; expect wt gain,
lethargy, cold intol, decreased exercise capacity, high TSH & low T4;
Med = Levothyroxine (synthroid/T4)
, CPR in the Pregnant patient: Modifications Uterine displacement in 2nd half of pregnancy
Defib paddles must be placed one rib space higher
CPR in the Pregnant patient: Complications Lacerations of liver or spleen
Fracture of sternum or ribs
If CPR is not effective within 4-5 mins, consider perimortem C/S
Biophysical profiles (BPP): a test to assesses fetal wellbeing in high risk pregnancies
Non-Stress Test (NST) w/ ultrasound
Components of the BPP 5 values: fetal breathing movement, fetal movements, fetal tone, amniotic fluid
volume, non-stress test
(Each scored 0 or 2 on a 0-10 scale, evens only)
8-10: Normal
Under 6: Abnormal (baby may be compromised → suspect chronic asphyxia)
Chronic HTN in Pregnancy HTN present in pt diagnosed before 20 weeks pregnant; women may acquire
preeclampsia or eclampsia
Gestational HTN Onset of HTN w/o proteinuria after 20th wk of preg (>140 SBP, >90 DBP)
Diagnosis of onset during pregnancy based on two measurements that meet
criteria for gestational BP elevation within a one week period
CORRECT Answers
Pregestational vs Gestational Diabetes Mellitus Pregestational Diabetes Mellitus is a label given to type 1 or 2 diabetes that
existed prior to pregnancy.
Gestational Diabetes Mellitus would be women whose glucose intolerance was
diagnosed during pregnancy but who do not meet the criteria defining type 1 or
type 2 diabetes.
Treatment Intrapartum: monitor for dehydration (decreased fetal movement),
blood glucose; Continuous Electronic Fetal Monitoring; IV infusion; possible C/S
for macrosomnia (large)
Treatment Postpartum: first 24hrs, insulin requirements drop substantially; risk of
hemorrhage d/t uterine distention
Gestational Diabetes Mellitus (GDM) Care Management Antepartum: diet (1500-2000kcal/day, carbs 50% of cals, "watch out for excess
fruit"), exercise, self-monitoring of blood glucose, pharm, fetal surveillance
Intrapartum: blood glucose monitored hourly in labor; infusion of regular insulin
by continuous infusion, piggybacked into the main IV line
Postpartum: will return to normal glucose lvls after birth; likely to recur in future
pregnancies
Risk factors for the maternal and fetal patient with Age: Maternal age over 25 (older moms)
diabetes Hx: Previous infant, unexplained IUFD (stillbirth) or pregnancy with GDM
Genes: Strong family hx of GDM or T2 Diabetes
Obesity
Already insulin resistant: Fasting blood glucose >140
Education to patient on diabetes Obese women prior to conception and develop GDM are at higher risk of giving
birth to infants with CNS defects
Hy perglycemia in 1st trimester correlated with birth defects (CV & neuro); no
increase in incidence in birth defects has been found w/ GDM after 1st trimester
Screen for GDM 24-28 wks
,Hyperemesis severe N/V; may lead to wt loss, electrolyte imbalance, nutritional deficiencies,
ketonuria (ketones are present in the urine)
Hyperemesis: Diagnosis and management Cause not well understood; may be d/t relaxation of smooth muscle of stomach &
increased estrogen & hCG
Hyperemesis: Initial care IV fluids/elec, meds, enteral/parenteral nutrition as last resort
Hyperemesis: Nursing interventions Goal: decrease N/V
Interventions: encourage PO hydration, bedrest, feedings are started in small
amounts at frequent intervals. In the beginning limited amounts of oral fluids and
bland foods such as crackers, toast, or baked chicken are offered. Diet progresses
slowly as tolerated until the woman is able to consume a nutritionally sound diet.
Hyperthyroidism Typically caused by Graves (expect heat intolerance, tachycardia, wt loss,
sweating, fatigue, anxiety, low TSH, high T4); primary tx during preg is drug
therapy
Meds = Propylthiouracil (PTU) or Methimazole (MM)
Hypothyroidism Associated w infertility & risk of miscarriage; iodine deficiency; expect wt gain,
lethargy, cold intol, decreased exercise capacity, high TSH & low T4;
Med = Levothyroxine (synthroid/T4)
, CPR in the Pregnant patient: Modifications Uterine displacement in 2nd half of pregnancy
Defib paddles must be placed one rib space higher
CPR in the Pregnant patient: Complications Lacerations of liver or spleen
Fracture of sternum or ribs
If CPR is not effective within 4-5 mins, consider perimortem C/S
Biophysical profiles (BPP): a test to assesses fetal wellbeing in high risk pregnancies
Non-Stress Test (NST) w/ ultrasound
Components of the BPP 5 values: fetal breathing movement, fetal movements, fetal tone, amniotic fluid
volume, non-stress test
(Each scored 0 or 2 on a 0-10 scale, evens only)
8-10: Normal
Under 6: Abnormal (baby may be compromised → suspect chronic asphyxia)
Chronic HTN in Pregnancy HTN present in pt diagnosed before 20 weeks pregnant; women may acquire
preeclampsia or eclampsia
Gestational HTN Onset of HTN w/o proteinuria after 20th wk of preg (>140 SBP, >90 DBP)
Diagnosis of onset during pregnancy based on two measurements that meet
criteria for gestational BP elevation within a one week period
