Persistent maternal hyperglycemia or signs of preeclampsia (severe headache, visual changes, elevated BP) — report.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client who had gestational diabetes is preparing for discharge after delivery. Which teaching point about her long-term health is most accurate?
Answer: B. A history of gestational diabetes substantially increases the lifetime risk of developing type 2 diabetes. Guidelines recommend a 75-g oral glucose tolerance test at 4 to 12 weeks postpartum and ongoing periodic screening. The condition does not always resolve permanently without future risk.
Question 2 of 5
A client with gestational diabetes asks whether breastfeeding is recommended. What is the nurse's best response?
Answer: A. Breastfeeding is encouraged for clients with gestational diabetes. It supports maternal glucose metabolism, can lower the mother's future risk of type 2 diabetes, and benefits the infant. There is no contraindication related to the diabetes history itself.
Question 3 of 5
A client at 28 weeks' gestation should be screened for which condition with a glucose tolerance test?
Answer: B. Around 24–28 weeks, clients are screened for gestational diabetes with a glucose challenge/tolerance test. Untreated gestational diabetes risks a large baby and complications.
Question 4 of 5
A client with gestational diabetes is performing self-monitoring of blood glucose at home. Which technique error should the nurse correct?
Answer: A. Checking glucose only once weekly is insufficient for gestational diabetes; clients are typically taught to check fasting and after meals daily (often four times a day). Washing hands, using the side of the fingertip, and recording results are correct practices.
Question 5 of 5
A client with type 2 diabetes asks how exercise affects blood glucose. Which response by the nurse is most accurate?
Answer: B. Physical activity increases insulin sensitivity and glucose uptake by muscles, generally lowering blood glucose. Clients on insulin or sulfonylureas should monitor glucose and carry a fast-acting carbohydrate because exercise can cause hypoglycemia, which may occur during or several hours after activity. Exercise does not reliably raise glucose in well-controlled diabetes.
Keep the streak going with more questions like these, each with a full rationale.
What is gestational diabetes screening?
Routine screening occurs at 24-28 weeks, with earlier screening for high-risk women. Identifying and controlling GDM reduces complications like macrosomia and neonatal hypoglycemia.
Key points to remember
- Universal screening is performed at 24-28 weeks gestation; high-risk women (obesity, prior GDM, family history) are screened earlier.
- The common two-step approach uses a 1-hour 50 g glucose challenge test (non-fasting); a value ≥130-140 mg/dL leads to a confirmatory test.
- The diagnostic test is a 3-hour 100 g oral glucose tolerance test (fasting); two or more elevated values confirm GDM.
- A one-step 2-hour 75 g OGTT is an alternative, where a single elevated value diagnoses GDM.
- GDM raises risk of macrosomia, shoulder dystocia, neonatal hypoglycemia, preeclampsia, and cesarean birth.
- First-line management is diet and exercise; insulin is the preferred medication if glucose targets are not met.
Nursing priorities
- Ensure the patient is fasting (8 hours) before the 3-hour OGTT and remains seated/restful during testing.
- Teach blood glucose self-monitoring and recommended targets (fasting <95 mg/dL, 1-hour post-meal <140 mg/dL, 2-hour <120 mg/dL).
- Reinforce a consistent carbohydrate-controlled diet and regular moderate exercise.
- Administer or teach insulin when prescribed, as it does not cross the placenta.
- Monitor fetal growth and well-being and assess the newborn for hypoglycemia after birth.
Labs & values
Patient teaching
- Most GDM resolves after delivery, but it raises lifelong risk of type 2 diabetes, so get rescreened postpartum (6-12 weeks) and periodically.
- Follow the carbohydrate-controlled meal plan, eat regular meals/snacks, and stay active as advised.
- Insulin is safe in pregnancy because it does not cross the placenta; report repeated low or high readings.
- Breastfeeding helps glucose control and lowers future diabetes risk for mother and baby.
Red flags: report now
- Persistent maternal hyperglycemia or signs of preeclampsia (severe headache, visual changes, elevated BP) — report.
- Neonatal hypoglycemia after birth (jitteriness, poor feeding, lethargy) in the infant of a diabetic mother — treat promptly.
- Symptoms of hypoglycemia in a patient on insulin: shakiness, sweating, confusion — treat immediately.
References
Clinical references for this topic
