Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
40. A client, who is 38 years old, gravida 5, para 0, with type 1 diabetes, is 13 weeks pregnant. Her hemoglobin A1c level is 8.2%. She is attending a prenatal class for clients with high-risk pregnancies. Which possible complications should a nurse anticipate in this client? Select all that apply.
Test-Taking Tip
Look at two opposite complications (too much . . . too little amniotic fluid) and eliminate one (i.e., too little). Remember that, if the maternal glucose is poorly controlled, the fetus is at greater risk than with well-controlled blood glucose. In this case, the hemoglobin A1c is elevated, meaning the blood sugar has been poorly controlled.
Content Area: Maternity, Antepartum; Integrated Process: Nursing Process, Analysis; Cognitive Level: Analysis; Client Need/Subneed: Physiological Integrity/Reduction of Risk Potential/Potential for Alterations in Body Systems
Pre-Test 1 and 2: Introduction to Special Questions Based on Official NCLEX-RN[®]
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Answer 1 is incorrect because oligohydramnios is too little amniotic fluid, and is not a complication of type 1 diabetes. Answer 2 is correct because polyhydramnios, or too much amniotic fluid, is a condition resulting from poor glycemic control during pregnancy, which causes hyperglycemia of the fetus and fetal polyuria (fetal urine is a major source of amniotic fluid). This client's hemoglobin A1c is elevated at 8.2% (the normal is less than 6.0%), indicating poor glycemic control during early pregnancy. Answer 3 is correct because macrosomia, a fetus who is oversized, is a condition resulting from poor glycemic control during pregnancy. The fetus produces too much insulin in response to the maternal hyperglycemia; insulin acts as a growth hormone during fetal development, producing a large fetus. Answer 4 is correct because this client's hemoglobin A1c is elevated at 8.2% (the normal is less than 6.0%), indicating poor glycemic control during early pregnancy, which is highly correlated with spinal anomalies. Answer 5 is correct because preeclampsia is more commonly found in clients with preexisting diabetes. Rates of preeclampsia in women with type 1 diabetes are two to four times higher than in normal pregnancies.
