Obstetric Nurse Test Obstetric Nurse High-Risk Pregnancy Management 1 — Questions and Answers
Question 1: A patient's 1-hour glucose challenge test (GCT) result is 152 mg/dL. What is the appropriate next step?
- Diagnose gestational diabetes and start insulin immediately
- Perform a 3-hour 100g oral glucose tolerance test (OGTT) (Correct answer)
- Repeat the 1-hour GCT in 2 weeks
- Counsel on diet modifications and recheck in 1 month
Correct answer: Perform a 3-hour 100g oral glucose tolerance test (OGTT)
A 1-hour GCT result ≥140 mg/dL (some use ≥130 mg/dL) is abnormal and requires a diagnostic 3-hour 100g OGTT to confirm or rule out gestational diabetes.
Question 2: What is the fasting blood glucose target for a patient with gestational diabetes managed with diet and exercise?
- Less than 95 mg/dL (Correct answer)
- Less than 110 mg/dL
- Less than 120 mg/dL
- Less than 130 mg/dL
Correct answer: Less than 95 mg/dL
ACOG recommends a fasting glucose target of less than 95 mg/dL for women with gestational diabetes to reduce the risk of macrosomia and perinatal complications.
Question 3: A neonate born to a mother with poorly controlled gestational diabetes is at highest immediate risk for which complication?
- Neonatal hypoglycemia (Correct answer)
- Neonatal hyperglycemia
- Neonatal hyperthyroidism
- Neonatal anemia
Correct answer: Neonatal hypoglycemia
Maternal hyperglycemia causes fetal hyperinsulinemia; after delivery and removal of the maternal glucose source, the elevated insulin causes neonatal hypoglycemia.
Question 4: Macrosomia in infants of mothers with gestational diabetes is primarily caused by:
- Fetal hyperinsulinemia secondary to maternal hyperglycemia (Correct answer)
- Maternal hypoglycemia causing compensatory fetal growth
- Excess maternal caloric intake unrelated to blood sugar
- Placental insufficiency causing catch-up growth
Correct answer: Fetal hyperinsulinemia secondary to maternal hyperglycemia
Maternal glucose crosses the placenta, stimulating the fetal pancreas to produce excess insulin, which acts as a growth factor and results in macrosomia.
Question 5: Which insulin type is traditionally preferred for use during pregnancy due to its established safety profile?
- NPH and regular human insulin (Correct answer)
- Insulin glargine (Lantus) only
- Insulin detemir (Levemir) only
- Insulin lispro (Humalog) only
Correct answer: NPH and regular human insulin
NPH and regular human insulin have the longest safety records in pregnancy; however, insulin lispro and detemir are also considered acceptable per recent guidelines.
Question 6: A patient with gestational diabetes whose blood glucose normalized during delivery should be scheduled for which postpartum test?
- Fasting glucose only at 1 week postpartum
- 75g OGTT at 6–12 weeks postpartum (Correct answer)
- HbA1c at 3 months only
- No testing is required if glucose normalized during delivery
Correct answer: 75g OGTT at 6–12 weeks postpartum
ACOG recommends a 75g 2-hour OGTT at 6–12 weeks postpartum to screen for persistent glucose intolerance or type 2 diabetes, as GDM significantly increases long-term risk.
Obstetric Nurse Test Obstetric Nurse High-Risk Pregnancy Management 1
A patient's 1-hour glucose challenge test (GCT) result is 152 mg/dL.
What is the appropriate next step?