Gestational Diabetes

The clinic RN reviews Amanda's prenatal record prior to performing a nursing assessment. Amanda has given birth twice, once at 35-weeks (twins) and once at 39-weeks (singleton). All of these children are alive and well. She has had one spontaneous abortion at 9-weeks gestation.
1.
How should the nurse record Amanda's obstetrical history using the G-T-P-A-L designation?
A) 3-2-0-1-3.
B) 3-1-1-1-2.
C) 4-1-1-1-3.
D) 4-2-1-0-2.
Correct answer(s): C

The nurse notes that Amanda's fasting 1 hour glucose screening level, which was done two days previously, is 158 mg/dl.
2.
The nurse recognizes that what information in the client's history supports a diagnosis of gestational diabetes?
A) Maternal great-aunt has
When questioned further, Amanda tells the CNM that the infant has seemed to "slow down" a little the last few days. After consultation with the perinatologist, a biophysical profile (BPP) is scheduled and Amanda is admitted to the hospital's antepartum unit. The antepartum RN performs a nonstress test (NST) as part of the BPP.
8.
The nurse recognizes which fetal heart rate (FHR) changes indicate a reactive nonstress test?
A) Persistent late decelerations associated with three uterine contractions, lasting 40 to 60 seconds each in a 10 minute period.
B) An increase in the FHR baseline to 170 beats per minute, lasting for at least 20 minutes.
C) Marked, long term FHR variability in response to contractions caused by nipple stimulation.
D) Two episodes of acceleration (> 15 beats/minute, lasting > 15 seconds) related to fetal movement in a 20 minute period.
Correct answer(s): D

Amanda has a non-reactive Non-stress Test. She is taken to the ultrasound department for completion of the BPP and her total score is 6 (Fetal Breathing Movements = 2, Gross Body Movements = 0, Fetal Tone = 2, Reactive Non-stress Test = 0, and Qualitative Amniotic Fluid Volume = 2). Based on this score, the perinatologist recommends an amniocentesis be completed to assess for lung maturity prior to making a decision whether to induce delivery for Amanda the next day.
9.
Prior to the amniocentesis, which action should the nurse take first?
A) Administer Rh immune globulin