Gestational Diabetes (10 Questions)

1. Mme Boucher, a 26-year-old G2P1 at 26 weeks gestation, arrives at the clinic for her scheduled glucose screening. The physician has ordered a "50g Glucose Challenge Test (GCT)." Mme Boucher tells the nurse, "I had a large bowl of oatmeal and a banana for breakfast an hour ago. Should I reschedule?"

Question:
What is the correct nursing response regarding the protocol for this test? *

"Yes, we must reschedule because you need to be fasting for at least 8 hours for this test."

"No, it is fine. This screening test does not require fasting. You will drink the solution now, and we will draw your blood in one hour."

"We can proceed, but we will need to draw your blood immediately to get a baseline before you drink the sugar solution."

We will wait 2 hours for your breakfast to digest, and then we will start the test."

2. Mme Gagnon, 32 weeks gestation with insulin-dependent GDM, calls the nurse to her room. She is trembling, pale, and sweating (diaphoretic). She says, "I feel really dizzy and strange." You perform a capillary blood glucose check, which reads 3.2 mmol/L.

Question:
What is the priority nursing intervention? *

Administer her scheduled dose of Insulin Lispro immediately.

Give her a chocolate bar or a peanut butter sandwich to stabilize her sugar.

Recheck the blood glucose in 15 minutes to confirm the result before treating.

Provide 15g of fast-acting carbohydrate, such as 125 mL of orange juice.

3. Mme Roy, 28 weeks gestation, has just been diagnosed with Gestational Diabetes. She is resistant to the dietary changes and asks, "Why does it matter if my sugar is a little high? I feel fine, and babies need sugar to grow."

Question:
What is the best physiological explanation for why strict glucose control is necessary to protect the fetus? *

"High sugar causes the baby's lungs to mature too fast, leading to early labor."

"The sugar blocks the baby from getting enough oxygen."

"High sugar will cause the baby to develop Type 1 Diabetes immediately at birth."

"Your high blood sugar crosses the placenta, causing the baby to produce high levels of insulin, which acts as a growth hormone and leads to excessive size (macrosomia)."

4. Mme Lefebvre, 30 weeks gestation, is starting insulin therapy. You are teaching her how to self-administer the injection. She holds the syringe and asks, "Where is the safest place to give this shot so I don't hurt the baby?"

Question:
What is the correct teaching regarding injection sites? *

"You must inject it into your thigh only, as the needle could puncture the uterus if you use your stomach."

"The abdomen is the best site for absorption, the needle is too short to reach the baby."

"Inject it into the deltoid muscle of your arm for the fastest action."

"Inject it as close to the belly button as possible."

5. You are caring for Baby Tremblay, born 1 hour ago to a mother with poorly controlled Gestational Diabetes. The baby weighed 4.5 kg (LGA). Upon assessment, the baby is jittery, has poor muscle tone, and a weak cry.

Question:
What is the underlying physiological cause of these symptoms? *

The baby is experiencing hyperglycemia because the mother's sugar is still in his system.

The baby is withdrawing from the maternal insulin.

The baby has hyperinsulinemia; causing a rapid drop in blood glucose.

The baby has suffered a brachial plexus injury during delivery.

6. Mme Dubois, newly diagnosed with GDM, is planning her dinner. The dietician has recommended a balanced carbohydrate intake. Mme Dubois asks, "I am really hungry. What can I eat that won't spike my blood sugar?"

Question:
Which food choice indicates a correct understanding of "free foods" or low-glycemic options? *

"I can eat as many fruits as I want because the sugar is natural."

"I can add an extra portion of green leafy vegetables or a piece of cheese to curb my hunger."

"I should switch to white bread instead of whole wheat."

"I will just skip dinner so my morning number is good."

7. Mme Caron is being discharged 2 days postpartum. Her GDM was managed with diet alone. Her blood sugars in the hospital have been normal. She asks, "So, am I diabetic for life now?"

Question:
What is the correct discharge teaching regarding her long-term prognosis? *

"Yes, you now have Type 1 diabetes and will need insulin."

"Since your sugars are normal now, you have no higher risk than anyone else."

"You should continue checking your blood sugar 4 times a day for the next year."

"The diabetes usually resolves after birth, but you have a 50% lifetime risk of developing Type 2 Diabetes.

8. Mme Poirier, 38 weeks gestation with GDM on insulin, is scheduled for a Non-Stress Test (NST) twice a week. She asks, "Why do I have to come in so often? The baby moves fine."

Question:
What is the primary rationale for frequent fetal surveillance in insulin-treated GDM? *

To check if the baby is getting too small (IUGR).

To check if the mother is in labor.

To monitor for placental insufficiency and prevent sudden intrauterine fetal death (stillbirth).

To ensure the mother is taking her insulin correctly.

9. Mme Vachon is in active labor at 5 cm dilation. She has GDM and is on an insulin drip (infusion) and IV fluids containing Dextrose. Her blood glucose is being checked hourly. The current reading is 6.5 mmol/L.

Question:
What is the goal of tight glucose control (euglycemia) during the active labor process? *

To prevent the mother from getting tired.

To reduce the risk of the baby producing excess insulin, which would cause severe hypoglycemia immediately after birth.

To increase the strength of the contractions.

To prevent maternal ketoacidosis.

10. Mme Tessier, 33 weeks gestation, calls the clinic. She reports, "I am incredibly thirsty all the time, I have to pee every 30 minutes, and I have a headache." She has not been checking her sugars regularly.

Question:
Which cluster of symptoms suggests her Gestational Diabetes is poorly controlled (Hyperglycemia)? *

Polydipsia (thirst) and Polyuria (frequent urination).

Diaphoresis (sweating) and tremors.

Peripheral edema and blurred vision.

Epigastric pain and nausea.