Gestational Diabetes Practice Exam

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Exam Mode – Questions and choices are randomly arranged, time limit of 1min per question, answers and grade will be revealed after finishing the exam.

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Text Mode – Text version of the exam

1. Later in pregnancy, which placental hormone causes insulin resistance of the tissues?

1. progesterone
2. estrogen
   
3. human placental lactogen (hPL)

2.The nurse is explaining to a nursing student what conditions occur in the body to cause the development of gestational diabetes in a pregnant mother. Which statement by the nurse is the most accurate pertaining to what causes gestational diabetes?

1. “A decreased level of glucose in the blood cannot get into the cells because there is a decreased level of insulin. This condition in the body causes GDM.”
2. “An excessive level of glucose in the blood cannot get into the cells because there is not enough insulin to carry the high amount of glucose present. This condition in the body causes GDM.”
3. “A decreased level of glucose in the blood cannot get into the cells because there is an excessive level of insulin. This condition in the body causes GDM.”

3.A nurse describes what the diabtogenic effect is to a mother that has been recently diagnosed with gestational diabetes mellitus. Which of the following statements by the nurse BEST describes what the diabtogenic effect is?

1. “The diabotegenic effect occurs when your body uses fat and protein for energy, which causes wasting of these tissues and causes the liberation of ketones. Ketones cannot pass through the placenta and do not cause birth defects.”
2. “The diabotegenic effect occurs when your body uses excess glucose and fat for energy , which causes wasting of these tissues and causes the liberation of ketones. Ketones can pass through the placenta and can cause birth defects.”
3. “The diabotegenic effect occurs when your body uses protein and fat for energy , which causes wasting of these tissues and causes the liberation of ketones. Ketones can pass through the placenta and cause birth defects.”

4.An excessive amount of glucose in the maternal blood that is transported to the fetus through the placenta causes:

1. macrosomia of the fetus and possible damage to arterial walls
2. hypoglycemia of the fetus and possible damage to arterial walls
3. macrosomia of the fetus and no possible damage to arterial walls

5.In the fetus, glycosuria occurs when:

1. there is an increased renal threshold, causing more glucose to be excreted
2. there is a decreased renal threshold, causing less glucose to be excreted
3. there is a decreased renal threshold, causing more glucose to be excreted

6. A nurse is discussing potential health issues that may affect the fetus of a new mother with gestational diabetes mellitus. Which of the following statements by the nurse is the most accurate pertaining to health issues that affect the fetus with a diabetic mother?

1. “Your baby may have birth defects of the heart. This is caused by high levels of glycogen in your body, which is actually a teratogen.”
2. “Your baby may have birth defects of the heart and brain This is caused by high levels of glycogen in your body, which is actually a teratogen.”
3. “Your baby may have birth defects of the heart, brain, neural tube, and extremities. This is caused by high levels of glycogen in your body, which is actually a teratogen.”

7. A nurse is educating her diabetic pregnant client about what fetal hyperinsulinism is. Which of the following statements by the nurse about fetal hyperinsulinism is true?

1. “Fetal hyperinsulinism results before organ development, which causes excess insulin production.”
2. “Fetal hyperinsulinism results after organ development, which causes excess insulin production.”
3. “Fetal hyperinsulinism results after birth, when there is mature organ development, which causes excess insulin production.”

8. A nurse explains to a student that there are two extremes of fetal growth that can occur in advanced diabetes mellitus, depending on the status of the vessels of the placenta. Which of the following statements by the nursing student indicates that she has learned effectively?

1. ” Advanced diabetes mellitus in the pregnant mother can result in the birth of a baby that is classifed as a small for gestational age infant or a preterm infant.”
2. “Advanced diabetes mellitus in the pregnant mother can result in the birth of a baby that is classified as large for gestational age or with macrosomia.”
3. “Advanced diabetes mellitus in the pregnant mother can result in the birth of a baby that is classified with macrosomia or intrauterine growth restriction.”

9. A nurse is educating her pregnant client who has Type 1 DM about the use of antidiabetic drugs during pregnancy. Which of the following responses by the nurse is the most accurate pertaining to antidiabetic drug use during pregnancy?

1. “It is acceptable to use oral antidiabetic drugs, such as glyburide or metformin, because they do not cross the placenta. They also do not cause any additional stress to the pancreas.”
2. “It is not acceptable to use oral antidiabetic drugs, such as glyburide or metformin, because they do cross the placenta. They also cause additional stress to the pancreas.”
3. “It is acceptable to use oral antidiabetic drugs, such as glyburide or metformin, because they do not cross the placenta. However, they do cause additional stress to the pancreas.”

10. A pregnant patient who is at 26 weeks gestation explains to her nurse that she has been eating small meals and skipping breakfast because of morning sickness. The patient also informs the nurse that she has been going to the YMCA to swim everyday for 3 hours straight because she read it is healthy for the baby. The nurse checks the patient’s blood glucose levels because the patient has been complaining of dizziness and headaches. The patient’s blood glucose levels were 120 mg/dL. The nurse knows all this subjective data and objective data indicate the patient is MOST likely:

1. hyperglycemic
2. hypoglycemic
3. anorexia

11. A OB-GYN nurse practitioner is educating her pregnant patient, who has been recently diagnosed with GDM, about the various signs of hyperglycemia. Which of the following are all signs of hyperglycemia that the nurse would discuss with her patient? (select all that apply)

1. cool, clammy skin
2. hot, flushed skin
3. polyuria or increased urine output
4. decreased urine output
5. polydipsia
6. weight gain
7. sudden weight loss
8. excessive use of insulin

12. The onset of which type of diabetes is diagnosed during pregnancy for carbohydrate intolerance:

1. Type 2 diabetes
2. gestational diabetes mellitus
3. Type 1 diabetes

13. A nurse is discussing risk factors of Gestational Diabetes Mellitus with a pregnant patient at 24 weeks gestation. Which of the following are all risk factors for GDM that the nurse would discuss with this patient? (select all that apply)

1. over the age of 25- 30 year old
2. younger than 30 years old
3. family history
4. previous GDM
5. hypotension
6. hypertension and overweight
7. previous large baby, stillborn and pregnancy loss
8. Polycystic ovarian syndrome

14. A pregnant client with Gestational Diabetes Mellitus at 36 weeks gestation is at risk for premature labor. The doctor informs her that he may have to conduct which of the following procedures to ensure that the baby is fit to be delivered?

1. a biophysical profile to determine L/S ratio and maturation of lung tissue prior to labor
2. a contraction stress test to determine L/S ratio and maturation of lung tissue prior to labor
3. an aminocentesis to determine L/S ratio and maturation of lung tissue prior to labor

15. Preconception goals for a mother’s blood glucose levels include:

1. a fasting glucose of greater than 95 mg/dL and 2 hours after eating (postprandial) a blood glucose level of greater than 120 mg/dL
2. a fasting glucose of less than 95 mg/dL and 3 hours after eating (postprandial) a blood glucose level of less than 120 mg/dL
3. a fasting glucose of less than 95 mg/dL and 2 hours after eating (postprandial) a blood glucose level of less than 120 mg/dL

16. Before conception, a nurse recommends to a women planning to get pregnant to check her A1C levels and ensure that they are:

1. greater than 6.5-8% 
2. less than 6.5-7% 
3. greater than 6.5-7%

17. A nurse is educating a pregnant women with Type 1 diabetes about the glucose levels that she needs to maintain preprandial or before a bedtime meal. The nurse knows the patient has benefitted from effective learning when she tells the nurse that her preprandial glucose levels should be:

1. 70-110 mg/dL
2. 60-99 mg/dL
3. 80-99 mg/dL

18. A nurse is educating a pregnant women with Type 1 diabetes about the glucose levels that she needs to maintain postprandial or after a meal. The nurse knows the patient has benefitted from effective learning when she tells the nurse that her postprandial glucose levels should be:

1. 100-129 mg/dL
2. 100-110 mg/dL
3. 100-130 mg/dL

19. A 50-year-old widower is admitted to the hospital with a diagnosis of diabetes mellitus and complaints of rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the gerontology nurse should anticipate which of the following secondary medical diagnoses?

1. Impaired glucose tolerance
2. Gestational diabetes mellitus
3. Pituitary tumor
4. Pancreatic tumor

20. Nurse Shey is educating a pregnant client who has gestational diabetes. Which of the following statements should the nurse make to the client? Select all that apply.

1. Cakes, candies, cookies, and regular soft drinks should be avoided.
2. Gestational diabetes increases the risk that the mother will develop diabetes later in life.
3. Gestational diabetes usually resolves after the baby is born.
4. Insulin injections may be necessary.
5. The baby will likely be born with diabetes
6. The mother should strive to gain no more weight during the pregnancy.

Answer and Rationale

1. C. human placental lactogen (hPL)
2. B. “An excessive level of glucose in the blood cannot get into the cells because there is not enough insulin to carry the high amount of glucose present. This condition in the body causes GDM.”
3. C. “The diabotegenic effect occurs when your body uses protein and fat for energy , which causes wasting of these tissues and causes the liberation of ketones. Ketones can pass through the placenta and cause birth defects.”
4. A. macrosomia of the fetus and possible damage to arterial walls
5. C. there is a decreased renal threshold, causing more glucose to be excreted
6. C. “Your baby may have birth defects of the heart, brain, neural tube, and extremities. This is caused by high levels of glycogen in your body, which is actually a teratogen.”  Glycogen is a teratogenic factor. That can cause birth defects of the HEART, BRAIN, NEURAL TUBE, and EXTREMITIES.
7. B. “Fetal hyperinsulinism results after organ development, which causes excess insulin production.”
8. C. “Advanced diabetes mellitus in the pregnant mother can result in the birth of a baby that is classified with macrosomia or intrauterine growth restriction.”
9. B. “It is not acceptable to use oral antidiabetic drugs, such as glyburide or metformin, because they do cross the placenta. They also cause additional stress to the pancreas.”
10. B. hypoglycemic
11. B. hot, flushed skin
    C. polyuria or increased urine output
    E. polydipsia
    G. sudden weight loss
12. B. gestational diabetes mellitus
13. A. over the age of 25- 30 year old
    C.family history
    D. previous GDM
    F. hypertension and overweight
    G. previous large baby, stillborn and pregnancy loss
    H. Polycystic ovarian syndrome
14. C. an aminocentesis to determine L/S ratio and maturation of lung tissue prior to labor
15. C. a fasting glucose of less than 95 mg/dL and 2 hours after eating (postprandial) a blood glucose level of less
    than 120 mg/dL
16. B. less than 6.5-7%
17. B. 60-99 mg/dL
18. A. 100-129 mg/dL
19. D. Pancreatic tumor. The onset of hyperglycemia in the older adult can occur more slowly. When the older adult reports rapid-onset weight loss, elevated blood glucose levels, and polyphagia, the healthcare provider should consider pancreatic tumor.
20. A, B, C, D. Gestational diabetes can occur between the 16th and 28th week of pregnancy. If not responsive to diet and exercise, insulin injections may be necessary. Concentrated sugars should be avoided. Weight gain should continue, but not in excessive amounts. Usually, gestational diabetes disappears after the infant is born. However, diabetes can develop 5 to 10 years after the pregnancy.