HESI Case Studies–Obstetric/Maternity-Gestational Diabetes (Amanda Garrison)

1. How should the nurse record Amanda’s obstetrical history using the G-T-P-A-L designation?
2. The nurse recognizes that what information in the client’s history supports a diagnosis of gestational diabetes?
Youngest child weighed 4300 grams at 39 weeks’ gestation
3. Amanda asks if there are any special instructions for the test in addition to fasting for 8 hours immediately prior to the test. Which instruction should the nurse give the client?
Follow an unrestricted diet and exercise pattern for at least 3 days before the test.
4. The nurse’s response should be based on the understanding of which normal physiologic change of pregnancy?
Hormonal changes in the second and third trimesters result in increased maternal insulin resistance
5. After the perinatologist and CNM leave, Amanda appears confused and asks the RN, “Does this mean I will always have diabetes?” Which response should the nurse give to the client?
“You will need to be periodically evaluated for Type 2 diabetes for the rest of your life”

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6. She asks the nurse to clarify what the RD told her about the content and timing of her meals. Which response (s) should the nurse give to the client? (Select all)
-Choose complex carbohydrates that are high in fiber content
-Drink between 8-10 cups of fluids daily.
7. Which fingerstick blood glucose (FSBG) testing protocol should the diabetes educator recommend for Amanda?
Prior to breakfast (fasting) and 2 hours after each meal
8. The nurse recognizes which fetal heart rate (FHR) changes indicate a reactive nonstress test?
Two episodes of acceleration (>15 beats/minute, lasting >15 seconds) related to fetal movement in a 20-minute period
9. Prior to the amniocentesis, which action should the nurse take first?
Assist the client to the bathroom and ask her to empty her bladder
10. While the antepartum nurse is in the room, Amanda’s membranes rupture spontaneously. Which action by the nurse takes priority?
Reapply the external fetal monitor to evaluate the fetal heart rate
11. At what rate should the nurse initially set the intravenous pump?
10 mL/hr
12. The nurse’s response should be based on what information?
An elevated glucose in labor increases the risk of neonatal hypoglycemia
13. What assessment information is most important for the nurse to validate with the laboring client before giving the medication?
Past or present history of opioid dependence
14. Amanda tells the nurse that she would like to receive one-half of the prescribed dose of butorphanol tartrate (Stadol) because the last time she was given that medication she felt like she was floating and then experienced some confusion. What should the nurse do?
Request that the provider change the prescription
15. The charge nurse refuses, telling the nurse that “there just isn’t anyone else.” What should the nurse do next?
Contact the nursing supervisor
16. The nurse and perinatologist recognize these signs as an indication of shoulder dystocia. What should the nurse do immediately?
Reposition the client using McRobert’s maneuver
17. The nurse should recognize that which newborn behavior indicates that the infant has suffered a complication from the shoulder dystocia?
Unilateral absence of the Moro reflex
18. What should the nurse recommend to Amanda in regard to infant feeding?
Breastfeeding should be initiated immediately and done on demand
19. Which client should the charge nurse assign the LPN?
A multigravida who had an uncomplicated term delivery and is breastfeeding
20. As the charge nurse is going down the hall to tell the nurses about the new admissions, she hears one nurse giving misinformation about the Rubella vaccine to a client and her husband. What action should the charge nurse take?
Speak to the nurse in the hall so the nurse can correct the information for the client
21. Where will the nurse expect to palpate the uterine fundus?
Midline at the umbilicus
22. Amanda asks the nurse why the insulin was discontinued after the baby was born and asks if she will have to take the medication as a “shot” or a “pill” now. The nurse’s response should be based on which information?
Most women with gestational diabetes return to normal glucose levels after birth
23. Which information is most important for the nurse to discuss concerning the use of contraception while breastfeeding? (Select all)
-If a dose is taken more than 3 hours late, a backup method of birth control must be used for the next 48 hours.
-It is important to use another method of contraception prior to starting the Mini Pill
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