# A pregnant client at 32 weeks gestation with gestational diabetes mellitus is admitted for blood glucose management. Her fasting blood glucose is 140 mg/dL and postprandial glucose is 180 mg/dL. Which nursing intervention should be the priority?

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> language: ko  
> subject: Maternal Newborn Health

## 문제

A pregnant client at 32 weeks gestation with gestational diabetes mellitus is admitted for blood glucose management. Her fasting blood glucose is 140 mg/dL and postprandial glucose is 180 mg/dL. Which nursing intervention should be the priority?

## 보기

1. Administer insulin as prescribed and monitor for hypoglycemic episodes
2. Assess fetal movement patterns and schedule non-stress test immediately **✔ 정답**
3. Implement strict bed rest and monitor for signs of preterm labor
4. Increase dietary carbohydrate intake and monitor weight gain patterns

**정답: 2**

## 해설

Fetal surveillance is the priority intervention when maternal blood glucose levels are poorly controlled in gestational diabetes. Other options are important but not immediate priorities compared to assessing fetal well-being.

## 심화 해설

Understanding the Clinical Scenario

The client is at 32 weeks gestation with gestational diabetes mellitus (GDM) and presents with a fasting blood glucose of 140 mg/dL and a postprandial glucose of 180 mg/dL. These values are significantly elevated above the typical GDM targets (fasting

## 임상 시나리오

Clinical Scenario

A 32-week pregnant client with gestational diabetes mellitus (GDM) is admitted with a fasting blood glucose of 140 mg/dL and a postprandial glucose of 180 mg/dL. Both values significantly exceed target ranges (fasting ≤95 mg/dL, 1-hour postprandial ≤140 mg/dL), indicating poorly controlled GDM.

Priority Nursing Intervention

The immediate priority is to assess fetal well-being. Poorly controlled GDM increases the risk of placental insufficiency, fetal hypoxia, and stillbirth. A non-stress test (NST) is a non-invasive method to evaluate fetal oxygenation and neurological status by monitoring fetal heart rate reactivity.

Rationale for Prioritization

- Fetal assessment takes precedence over medication administration in this scenario because the elevated glucose levels pose a direct threat to the fetus, and the NST provides immediate data on fetal status.

- Insulin administration will be necessary but follows the initial fetal evaluation to ensure the fetus is not already in distress.

- Bed rest and increased carbohydrate intake are not indicated; bed rest has no proven benefit for GDM, and more carbohydrates would exacerbate hyperglycemia.

Clinical Practice Guidelines

- **Fetal Surveillance:** For GDM with poor glycemic control, antenatal testing (NST or biophysical profile) typically begins at 32-34 weeks or earlier if indicated.

- **Glycemic Targets:** Aim for fasting

## 핵심 개념

- **Non-Stress Test (NST)** — A prenatal test assessing fetal heart rate in response to fetal movement to evaluate oxygenation and neurological status, commonly indicated in high-risk pregnancies like poorly controlled GDM.
- **Gestational Diabetes Mellitus (GDM)** — Glucose intolerance with onset or first recognition during pregnancy, associated with increased risks of fetal macrosomia, stillbirth, and neonatal hypoglycemia.
- **Fasting Blood Glucose Target in GDM** — Typically recommended to be ≤95 mg/dL; a value of 140 mg/dL indicates significant hyperglycemia requiring immediate intervention and fetal evaluation.
- **Postprandial Glucose Target in GDM** — Usually targeted at ≤120-140 mg/dL 1-2 hours after meals; a level of 180 mg/dL suggests poor glycemic control and potential fetal risk.

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