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NCLEX · General

A pregnant client at 28 weeks asks about the gestational diabetes screening. What is the standard screening test?

Correct answer

1-hour glucose challenge test (GCT): the client drinks a 50g glucose solution and blood glucose is measured 1 hour later; a result of 130-140 mg/dL or above (threshold varies by institution) requires follow-up with a 3-hour glucose tolerance test for diagnosis

  1. A Fasting blood glucose only
  2. B 1-hour glucose challenge test (GCT): the client drinks a 50g glucose solution and blood glucose is measured 1 hour later; a result of 130-140 mg/dL or above (threshold varies by institution) requires follow-up with a 3-hour glucose tolerance test for diagnosis
  3. C HbA1c only
  4. D Fasting insulin level

Why this is the answer

GESTATIONAL DIABETES MELLITUS (GDM) SCREENING: WHEN: 24-28 weeks gestation for all pregnant women (earlier if high-risk factors: prior GDM, obesity, family history, prior macrosomic infant); SCREENING TEST: 1-hour GCT (Glucose Challenge Test): 50g oral glucose load; no fasting required; glucose drawn 1 hour later; THRESHOLD: 130 mg/dL (some institutions use 140 mg/dL) — above threshold requires the 3-hour test; DIAGNOSTIC TEST: 3-hour oral glucose tolerance test (OGTT): fasting glucose + glucose draws at 1, 2, and 3 hours after 100g glucose load; GDM diagnosed if 2 or more values meet/exceed thresholds; IMPLICATIONS: GDM increases risk of macrosomia, birth complications, neonatal hypoglycemia, and maternal type 2 diabetes later in life; managed with diet, exercise, and insulin or oral hypoglycemics if needed.
Source: NCLEX-RN Test Plan: Health Promotion — Prenatal, GDM Screening

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