Module 4 Canvas Practice Questions Flashcards
A separate placental lobe attached by blood vessels to the main placenta is called a
A) Circumvallate
B) Battledore
C) Succenturiate
D) Partial
C) Succenturiate
Movement of substances from an area of higher to lower concentration is the definition of which of the following?
A) simple (passive) diffusion
B) facilitated diffusion
C) Pinocytosis
D) Endocytosis
A) simple (passive) diffusion
Immunologic functions of the placenta include protection of the fetus from pathogens and
A) Passage of IgM
B) Prevention from rejection by the mother
C) Active immunity to many diseases
D) Encouraging fetal growth
B) Prevention from rejection by the mother
The earliest system to differentiate in the embryo is the
A) Nervous system
B) Respiratory system
C) Gastrointestinal system
D) Renin/angiotensin system
A) Nervous system
Which of the following is the major source of amniotic fluid?
A) Fetal urine output
B) Fetal lung fluid
C) Fetal swallowing
D) Intramembranous movement
A) Fetal urine output
The most likely etiology for symptoms of dizziness, nausea, and diaphoresis when a pregnant woman is lying in a supine position is:
A) orthostatic hypotension
B) hypoglycemia
C) vena cava compression
D) situational anxiety
C) vena cava compression
Which of the following hormones of pregnancy stimulates the corpus luteum to continue to function?
A) Estrogen
B) Luteinizing hormone
C) Human chorionic gonadotropin
D) Human placental lactogen
C) Human chorionic gonadotropin
T/F: Epigenetic changes may be passed to offspring because these changes are maintained through mitosis and are passed on during meiosis.
True
What structure is located on the fetal side of the placenta and is continuous with the membranes?
A) chorionic plate
B) decidua capsuleris
C) placenta circumvillata
D) fetal blood vessels
A) chorionic plate
A father is heterozygous for brown eyes. A mother is homozygous recessive for blue eyes. All of their children will have a _____% chance of having brown eyes.
50%
Upon reviewing a woman’s routine 28 week lab results, the CNM/WHNP notes that her hemoglobin and hematocrit are lower than in the nonpregnant woman, yet not low enough to diagnose her as being anemic. The CNM/WHNP knows that this is most likely due to physiologic anemia of pregnancy, which is caused by:
A) Increased plasma volume that outpaces the increase in RBC production
B) Decreased RBC production in pregnancy
C) Decreased total blood volume that normally occurs during pregnancy
D) Venous distensibility contributing to increased edema affecting the amount of circulating blood volume
A) Increased plasma volume that outpaces the increase in RBC production
At approximately 4-5 days after fertilization, the morula reaches the uterine cavity and becomes the:
A) blastocyst
B) blastomere
C) zygote
D) pronucleus
A) blastocyst
What causes physiologic anemia of pregnancy?
A) the cellular portion increases more than the plasma portion.
B) the plasma portion increases more than the cellular portion.
C) red blood cells are equal to the plasma portion.
D) white blood cells are equal to the plasma portion.
B) the plasma portion increases more than the cellular portion.
The CNM/WHNP notes mild proteinurea (trace protein) reflected on the urine dipstick of a woman at a prenatal visit. What is the most appropriate response to this finding?
A) Continue providing routine care because this is a normal finding in pregnancy.
B) Draw labs to rule out preeclampsia.
C) Consult a nephrologist for additional screening for glomerular pathology.
D) Draw a catheterized specimen and send it to the lab for microscopic testing.
A) Continue providing routine care because this is a normal finding in pregnancy.
Which of the following maternal positions enhances water excretion?
A) Side lying
B) Sitting
C) Supine
D) Trendelenberg
A) Side lying
The CNM/WHNP is called to the ultrasound room because a woman was reporting feeling short of breath and suddenly became pale and diaphoretic during her ultrasound. What should the provider do first upon arriving in the room?
A) change the woman’s position to side-lying
B) give the woman a drink of juice
C) check the woman’s blood pressure
D) call 911 to have the woman transported to the hospital for further evaluation
A) change the woman’s position to side-lying
Which of the following hormones has thyroid stimulating (TSH)- like properties?
A) Human chorionic gonadotropin (HCG)
B) Estrogen
C) Progesterone
D) Luteinizing Hormone (LH)
A) Human chorionic gonadotropin (HCG)
Which process is unique to oogenesis?
A) Equal distribution of cytoplasm during meiosis I.
B) Meiosis for oogenesis begins after puberty.
C) Separation of chromosome pairs results in an oocyte and a polar body.
D) Oogenesis continues throughout the lifespan for each woman.
C) Separation of chromosome pairs results in an oocyte and a polar body.
The first functional organ in the embryo is the:
A) Brain
B) Liver
C) Intestines
D) Kidneys
A) Brain
Which of the following is responsible for the baseline fetal heart rate gradually becoming lower and lower from 16 weeks until term?
A) Hormonal alterations
B) Increasing size of fetus
C) Parasympathetic regulation
D) Maternal grand multiparity
C) Parasympathetic regulation
During placentation, trophoblastic tissue invades the maternal spiral arteries causing
A) Tightly coiled and elongated vessels
B) Increased responsiveness to adrenergic stimulation
C) Disruption of elastic and muscular properties in the vessel wall
D) Umbilical cord development
C) Disruption of elastic and muscular properties in the vessel wall
The preferred way to assess fundal height in the first trimester is:
A) bimanual exam
B) tape measure
C) finger breadths above the symphysis pubis
D) finger breadths below the umbilicus
A) bimanual exam
If not fertilized, the ovum usually lives for approximately _____ days.
1 day
Endocrine functions of the placenta include which of the following?
A) Synthesize hormones
B) Provide energy for developing fetus
C) Protect the fetus from pathogens
D) Move substances from maternal to fetal circulations
A) Synthesize hormones
During implantation, the products of conception attach to the maternal endometrium via invasion by the
A) Morula
B) Spiral arteries
C) Trophoblastic lacunae
D) Blastocyst
D) Blastocyst
An X-linked recessive disease can skip generations because
A) the disease is transmitted through female carriers.
B) females are hemizygous for the X chromosome.
C) mothers cannot pass X-linked genes to their sons.
D) these diseases need only one copy of the gene in females.
A) the disease is transmitted through female carriers.
Which process is unique to spermatogenesis?
A) Equal distribution of cytoplasm during meiosis I.
B) Synapsis during the zygotene stage.
C) Elongation of chromatids during the diplotene stage.
D) Degeneration of germ cells between fetal life and the onset of puberty.
A) Equal distribution of cytoplasm during meiosis I.
Which structure adheres to the endometrium and leads to the decidual reaction?
A) blastocyst
B) morula
C) zygote
D) zona pellucida
A) blastocyst
Which of the following is accurate regarding round ligament pain?
A) It starts around the 30th week of pregnancy
B) Relief can be obtained by stretching the front of the thigh
C) It often extends into the inguinal area
D) It is caused by the pressure from the broad ligaments impinging on the round ligaments
C) It often extends into the inguinal area
The fall in blood pressure seen in supine hypotensive syndrome is a direct result of:
A) decreased vascular resistance and vasoconstriction
B) decreased cardiac output
C) decreased heart rate
B) decreased cardiac output
Increased respiratory rate is caused by changes in the carbon dioxide threshold brought on by increases in
A) estrogen.
B) progesterone.
C) human chorionic gonadotropin.
B) progesterone.
Which of the following statements regarding nausea and vomiting of pregnancy is correct?
A) N&V of pregnancy rarely affects activities of daily living
B) N&V of pregnancy often resolves spontaneously at 12 to 14 weeks gestation
C) Pharmaceutical treatment is generally the best option for pregnant women
D) N&V of pregnancy can precipitate migraine headaches
B) N&V of pregnancy often resolves spontaneously at 12 to 14 weeks gestation
Which of the following statements is accurate regarding heartburn in pregnancy?
A) It is caused by increased GI motility
B) It is caused by an increase in progesterone
C) It is reduced by drinking cold liquids with a meal
D) It most often occurs at the start of the second trimester
B) It is caused by an increase in progesterone
Pregnant women are more prone to gingivitis because of swelling in their gums. The hormone that causes this is
A) human placental lactogen
B) estrogen
C) human chorionic gonadotropin
B) estrogen
Which of the following is NOT an appropriate relief measure for round ligament pain?
A) Resting in a hot tub
B) Applying warm compresses
C) Sitting down and leaning forward
D) Using Tylenol as needed
A) Resting in a hot tub
During pregnancy, the maternal hematocrit:
A) Increases
B) Decreases
C) Stays at pre-pregnancy levels
B) Decreases
Differential diagnoses to consider when a woman reports first trimester fatigue include:
A) depression and inadequate caloric intake
B) depression and anemia
C) insomnia and overworking herself at home
D) anemia and inadequate caloric intake
B) depression and anemia
Low back pain in pregnancy is exacerbated by?
A) Increasing round ligament pain
B) Dehydration
C) Lax abdominal muscles
D) Long periods of inactivity
C) Lax abdominal muscles
All of the following are appropriate measures to advise pregnant women with first trimester nausea except:
A) Eating sour foods or candies
B) Ginger tea
C) Vitamin B-12 50 mg PO BID
D) Brushing teeth several hours after eating
C) Vitamin B-12 50 mg PO BID
Appropriate advice for relieving leg cramps includes:
A) dorsiflexion of the foot and stretching the calf muscle
B) plantar flexion and increased dietary phosphorus
C) calcium supplements and resting the affected leg
D) applying heat and massage
A) dorsiflexion of the foot and stretching the calf muscle
Which of the following statements about hirsutism in pregnancy is accurate?
A) “If you notice the dark spots on your face increasing, using sun screen will help.”
B) “We don’t know why your nails change during pregnancy, but they usually get back to normal after delivery.”
C) “Stretch marks generally resolve soon after delivery.”
D) “Fine hairs usually go away after you have the baby, but the coarser ones might be there permanently.”
D) “Fine hairs usually go away after you have the baby, but the coarser ones might be there permanently.”
A pregnant woman calls to report her heart racing for several short periods of time today, and that she feels dizzy when this happens. What is the most appropriate advice?
A) Come in to the office for an evaluation
B) Take Tylenol for your symptoms
C) These symptoms are normal and are caused by an increase in blood volume.
D) Call 911 right away
A) Come in to the office for an evaluation
Which of the following is the correct over the counter remedy for nausea and vomiting?
A) Slippery Elm Bark tea
B) Vitamin B6 25 mg QID and ½ Unisom tablet
C) Vitamin B6 26 mg PO BID and 1 Unisom Capsule
D) Ginger 100 mg PO BID
B) Vitamin B6 25 mg QID and ½ Unisom tablet
During pregnancy, gastrointestinal motility is:
A) Unchanged
B) Decreased
C) Increased
B) Decreased
Dependent edema in pregnancy is associated with:
A) Fetal Growth Restriction (IUGR)
B) maternal obesity
C) frequently changing positions of legs
D) increased plasma albumin in pregnancy that increases osmotic pressure
B) maternal obesity
A 20 week pregnant woman presents to clinic reporting urinary frequency. The CNM/WHNP knows that urinary frequency in pregnancy:
A) generally gets progressively worse until delivery
B) is always a result of pressure on the bladder from the growing uterus
C) is worst in the first trimester of pregnancy
D) is diagnosed when the woman has more than 5 daytime voidings
A) generally gets progressively worse until delivery
A pregnant woman presents to clinic reporting constipation. Which of the following is NOT an appropriate first-line relief measure to suggest to her?
A) Take a stimulant laxative like Senekot as directed on the container.
B) Self administer a Fleets enema.
C) Increase intake of water and fruits and vegetables.
D) Take a bulk-forming laxative like Metamucil as directed on the container.
A) Take a stimulant laxative like Senekot as directed on the container.
A woman at 26 weeks gestation is experiencing heartburn. She has never had heartburn prior to this pregnancy and is asking you why this is occurring now. How will you explain the physiologic mechanism that produces heartburn during pregnancy?
A) Decreased gastric acid pH causes increased burning in the esophagus during pregnancy
B) The smaller stomach size delays gastric emptying during pregnancy causing more frequent heartburn
C) Relaxation of the lower esophageal sphincter makes pregnant women more prone to heartburn.
C) Relaxation of the lower esophageal sphincter makes pregnant women more prone to heartburn.
Tess is pregnant, at 26 weeks estimated gestational age, with her first baby. She has started prenatal and childbirth classes and is at a prenatal visit. She feels well, her baby is active, and her pregnancy has been uncomplicated. Her blood pressure is 96/60 mm Hg and the fetal heart rate is 134 beats per minute. The medical assistant has offered Tess 50 g of dextrose for gestational diabetes screening and she declined it. She tells Amy, the midwife, she rarely eats things with added sugar, so she does not think it’s possible for her to have excess sugar in her system. She reports occasional sharp pains in her groin when she’s active and aching in her lower back when she sits for a long time, but thinks it’s probably normal. She asks if her blood pressure is okay because it has never been this low before. She is also interested in recommendations for iron supplements because her childbirth instructor told her she might need one.
What is the best way for Amy to respond to Tess having declined her gestational diabetes screening?
A) Ask Tess to provide a 3-day diet recall and assess whether her intake of other carbohydrates places her at risk for altered glucose metabolism.
B) Explain that the placenta produces a hormone that changes the way she processes carbohydrates, causing more sugar than usual to be in her bloodstream.
C) Tell Tess that this is reasonable because the mother’s sugar consumption is the primary determinant of her metabolic function in pregnancy.
D) Explain that the baby produces its own sugars that cross the placenta, so even a normal amount in her bloodstream can cause her to produce excess insulin.
B) Explain that the placenta produces a hormone that changes the way she processes carbohydrates, causing more sugar than usual to be in her bloodstream.
The position where blood pressure is the lowest for a pregnant woman is:
A) side lying
B) standing
C) sitting
A) side lying
During pregnancy, stomach motility:
A) Is unchanged
B) Changes depending on gestational age
C) Decreases
D) Increases
C) Decreases
A pregnancy is maintained through hormones produced by the:
A) egg sac and placenta
B) corpus luteum and chorion.
C) corpus luteum and placenta.
D) ovary and placenta
C) corpus luteum and placenta.
The sensation of “prickly heat” experienced by some women in pregnancy is related to which of the following:
A) eccrine sweat gland activity
B) palmar erythema
C) the presence of epulis
D) apocrine sweat gland activity
A) eccrine sweat gland activity
Which of the following changes occurs in the cardiovascular system during pregnancy?
A) Decreased blood volume
B) Decreased skin perfusion
C) Increased pulmonary vascular resistance
D) Decreased systemic vascular resistance
D) Decreased systemic vascular resistance
Which of the following physiologic factors influences respiration in late pregnancy?
A) Increased subcostal angle
B) Tightening of the ligaments between the ribs decreasing rib elasticity
C) The major work of respiration is accomplished by the costal muscles in late pregnancy
D) Dropping of the diaphragm to 4 cm below its original position
A) Increased subcostal angle
Every pregnant woman with pruritus should have an evaluation of which of the following:
A) white blood cell count
B) ultrasound of the fetus
C) hemoglobin electorophoresis
D) liver function tests
D) liver function tests
Which of the following is NOT a reason for decreased total body iodine pool in pregnancy?
A) Decreased absorption of iodine by the small intestine
B) Placental transfer of iodine to the fetus
C) Increased renal iodide loss due to increased renal blood flow
D) Increased renal iodide loss due to increased glomerular filtration rate
A) Decreased absorption of iodine by the small intestine
T/F: Immune factors that prevent maternal rejection of the fetus also protect the placenta from infectious agents such as viruses and bacteria.
True
A systolic murmur at the left sternal border, third intercostal space occurs:
A) due to mitral stenosis that is worsened in pregnancy
B) due to damage of the pulmonic valve from the increased blood volume of pregnancy
C) rarely and is usually heard in obese women due to the extra cardiac workload associated with obesity
D) commonly during pregnancy, and expected to be present until delivery
D) commonly during pregnancy, and expected to be present until delivery
Varney p. 651 “Systolic ejection murmur that is loudest along the left sternal boarder is a common finding in pregnant women and is attributed tot he dramatic increase in cardiac output.”
SATA: Inflammation at the maternal-placental interface is most marked in which trimester(s)?
A) First trimester
B) second trimester
C) third trimester
A) First trimester
C) third trimester
Alterations in skin pigmentation during pregnancy are thought to be related to which of the following?
A) cutis marmorata
B) the effects of estrogen and progesterone on melanocytes
C) alterations in the dermal support matrix
D) decreased capillary integrity
B) the effects of estrogen and progesterone on melanocytes
Which of the following statements about iodine deficiency is false?
A) Iodine deficiency is associated with increase risk of miscarriage.
B) Iodine deficiency is the most frequent cause worldwide of preventable mental retardation.
C) Iodine deficiency is associated with increased risk of stillbirth.
D) The United States has more iodine deficient pregnant women than Europe or Southeast Asia.
D) The United States has more iodine deficient pregnant women than Europe or Southeast Asia.
Which of the following is true about thyroid hormones in pregnancy?
A) They decrease by 50%
B) They increase in availability by 40-100%
C) They remain stable until the third trimester
D) They are not essential to fetal growth
B) They increase in availability by 40-100%
Which of the following is the most common contributor to the classification of pregnancy dermatoses called Atopic eruption of pregnancy (AEP)?
A) Eczema in pregnancy
B) Prurigo of pregnancy
C) PUPPPs
D) Pruritic folliculitis of pregnancy
A) Eczema in pregnancy
Changes in hair growth during pregnancy are influenced by which of the following hormones?
A) Estrogen
B) Progesterone
C) Human Chorionic Gonadotroin (HCG)
D) Human Placental Lactogen (HPL)
A) Estrogen
T/F: Thyroid disorders are the most common endocrine disorders seen in pregnancy.
False
T/F: Maternal chemotaxis is increased during pregnancy to allow the mother to quickly respond to infection exposure.
False
Which of the following is the most appropriate advice to give to women who report feeling their heart “flip-flopping” without other accompanying symptoms?
A) “Having palpitations is likely due to the added life stressors associated with being pregnant.”
B) “You need to schedule a cardiology consult as soon as possible.”
C) “The increase in blood volume during pregnancy is likely responsible for this symptom.”
D) “Palpitations are caused by increased estrogen during pregnancy and are normal.”
C) “The increase in blood volume during pregnancy is likely responsible for this symptom.”
Nausea and vomiting in pregnancy has been correlated with which of the following?
A) Increased estrogen levels
B) Decreased prolactin levels
C) Alterations in thyroid hormones
D) Iodine deficiency
C) Alterations in thyroid hormones
T/F: A semiallograft is a foreign tissue from the same species but with a different antigenic makeup.
True
Which placental hormone is responsible for an anti-insulin (diabetogenic) action that leads to increased maternal insulin needs?
A) progesterone
B) Gonadotropin-Releasing Hormone
C) estrogen
D) human placental lactogen
D) human placental lactogen
Pregnancy rhinitis is most appropriately first treated with which of the following?
A) saline nasal spray
B) topical sympathomimetic nasal sprays
C) systemic antihistamines
D) tylenol
A) saline nasal spray
The observable characteristics of an individual are called his/her:
A) phenotype
B) genotype
C) karyotype
D) mitochondrial inheritance
A) phenotype
A 4 year old girl has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present. Her condition is called
A) Down syndrome.
B) Klinefelter syndrome.
C) Turner syndrome.
D) Edward syndrome.
C) Turner syndrome.
Each parent contributes exactly one set of chromosomes to each of their children. These chromosomes:
A) are randomly selected from the parent’s two sets of chromosomes, so each of their children inherit a unique set of chromosomes
B) are selected in an organized fashion that results in a predictable chromosomal inheritance from each parent
C) are randomly selected from the parent’s chromosomes, but this selection process repeats itself so that each child receives a matching set of chromosomes
D) combine to result in children inheriting identical traits as their parents
A) are randomly selected from the parent’s two sets of chromosomes, so each of their children inherit a unique set of chromosomes
A woman presenting for care at 10 weeks gestation says she desires genetic screening for “everything that I can screen for.” Which of the following screening test should the clinician recommend?
A) integrated screen
B) non-invasive prenatal testing (NIPT)
C) quad screen
D) carrier screen
A) integrated screen
Which of the following are examples of types of traits?
A) one’s hair color, eye color, and height
B) an individual’s behavioral characteristics
C) an individual’s risk of getting cancer or certain types of mental illness
D) all of these are types of traits
D) all of these are types of traits
Which of the following statements is TRUE?
A) Chromosomes are comprised of proteins that store DNA.
B) Two sets of 22 chromosomes are contained in each human cell.
C) Females are more likely to inherit X-linked disorders than are males.
D) Each strand of human DNA contains one gene.
A) Chromosomes are comprised of proteins that store DNA.
Which of the following is an accurate statement about cystic fibrosis (CF) screening?
A) All women should be offered CF screening so those with a positive screen can take advantage of prenatal treatment strategies for CF.
B) Carriers of CF are at risk for pyelonephritis.
C) If both a mother and father have the CF gene, the risk of cystic fibrosis disease in the fetus is 50%.
D) CF screening should be offered to all women at the first prenatal visit and is usually done via a blood draw.
D) CF screening should be offered to all women at the first prenatal visit and is usually done via a blood draw.
Which of the following screening tests has the lowest detection rate for Down Syndrome?
A) Integrated screening
B) Cell-free DNA testing (NIPT)
C) First trimester Screening
D) Quad screen
D) Quad screen
A woman has a negative cystic fibrosis (CF) screening test. Which of the following is true?
A) There is no chance that the woman could have a baby with CF.
B) The baby’s father would have to be screened to accurately determine the risk of having a baby with CF.
C) Although the risks are decreased with a negative screening test, there is still a chance that her baby could have CF.
D) There is still an 8% chance that the baby could have CF, even after a negative screening test.
C) Although the risks are decreased with a negative screening test, there is still a chance that her baby could have CF.
A 32 yo G1P0 Caucasian American presents to your office for her first prenatal visit at 8 weeks gestation by LNMP. Appropriate genetic screening tests to discuss and offer to her as choices include:
A) Chorionic villi sampling (CVS) and quad screen
B) Quad screen and hgb electrophoresis
C) HIV testing and nuchal translucency ultrasound
D) Integrated screening and cystic fibrosis screening
D) Integrated screening and cystic fibrosis screening
A woman presents for prenatal care. She informs the CNM/WHNP that she does not want screening for cystic fibrosis (CF) because her other children do not have it and she and her husband are healthy. What is the most appropriate response?
A) “You’re correct- you don’t need testing since your other children have been unaffected and you and your husband are unaffected.”
B) “Each pregnancy carries a 25% chance of having a child with CF if you and your husband are carriers, regardless of whether or not your other children are affected.”
C) “There is a 25% chance that you could have a child who is a CF carrier if you and your husband are CF carriers. You can be carriers of the CF gene and not know it.”
D) “Because your age increases with each pregnancy, your risk of CF increases with each pregnancy also.”
B) “Each pregnancy carries a 25% chance of having a child with CF if you and your husband are carriers, regardless of whether or not your other children are affected.”
A 35 year old G2P1001 at 15 weeks and 5 days by LMP chose to have a quad screen drawn. After speaking with her regarding the elevated AFP value, the CNM/WHNP appropriately orders:
A) supplementation with folic acid and ferrous sulfate
B) an abdominal ultrasound for confirmation of dating
C) a vaginal ultrasound for measurement of nuchal translucency
D) an amniocentesis
B) an abdominal ultrasound for confirmation of dating
An example of a multifactoral disorder that does not follow clear-cut modes of inheritance but does seem to “run is families” is
A) Angelman Syndrome.
B) high blood pressure.
C) cystic fibrosis.
D) Huntington Disease.
B) high blood pressure.
A woman presents for her first prenatal visit at 8 weeks gestation and tells the CNM/WHNP that she has heard that she can have an early ultrasound to “measure the baby’s neck and find out if the baby is normal”. She shares that she would like this test because she is afraid of needles and would like to minimize blood draws in pregnancy. Which of the following is the most appropriate response to this woman?
A) “Being pregnant means that you’ll have to have quite a few blood draws, so what’s one more?”
B) “The chances of detecting an abnormality by first trimester ultrasound measurement of nuchal translucency alone are approximately 75%. If you add blood testing, your chances of detecting a problem can increase to 95%.”
C) “The chances of finding out if your baby has an anomaly by ultrasound alone are high enough that if you decide not to have any additional blood draws, you will still get similar information than if you did choose to have the blood draws.”
D) The chances of seeing an abnormality on ultrasound are 90%. The chances of finding a problem with the ultrasound and blood draw together are 95%.”
B) “The chances of detecting an abnormality by first trimester ultrasound measurement of nuchal translucency alone are approximately 75%. If you add blood testing, your chances of detecting a problem can increase to 95%.”
A woman presents for prenatal care and desires screening for cystic fibrosis (CF). The test results show that she is a CF carrier. She is unsure of the paternity of her baby. Which of the following is the most appropriate management plan?
A) Suggest an amniocentesis since the baby’s father is unavailable for testing.
B) Offer paternity testing for the woman’s past partners to determine paternity so that the father may be screened.
C) Offer an appointment with a genetic counselor.
D) Reassure the patient that she is likely to have an unaffected baby because the chances that both she and the baby’s father have the same genetic CF mutation are slim.
C) Offer an appointment with a genetic counselor.
Which of the following is considered an epigenetic event?
A) predisposition to diabetes mellitus type 1
B) inheritance of autosomal dominant gene
C) genomic imprinting
D) trisomy 21 due to deletion
C) genomic imprinting
All of the following are true statements about non-invasive prenatal testing (NIPT) EXCEPT:
A) NIPT has a detection rate of approximately 98%.
B) NIPT has a false positive rate of approximately 0.5%.
C) NIPT offers the ability to detect multiple aneuploidy conditions.
D) The current standard of practice in all settings is to offer NIPT to all women.
D) The current standard of practice in all settings is to offer NIPT to all women.
To exhibit a recessive phenotype, an individual must generally have:
A) two dominant alleles
B) one dominant and one recessive allele
C) two recessives alleles
D) it is impossible to predict which phenotype a person will have
C) two recessives alleles
Primary prevention is possible for which of the following conditions?
A) Trisomy 13
B) Neural Tube Defects
C) Cystic Fibrosis
D) Down Syndrome
B) Neural Tube Defects
A woman is considering diagnostic prenatal testing and asks the CNM/WHNP about the safety of the procedure. The CNM/WHNP replies: “While the risk of procedure-related fetal loss associated with invasive diagnostic testing can vary by clinic, the most frequently quoted overall risk is”:
A) 1 in 300 to 1 in 500.
B) 1 in 100 to 1 in 200.
C) 1 in 1000.
D) 1 in 500 to 1 in 700.
A) 1 in 300 to 1 in 500.
A person’s karyotype shows 47 autosomes and two X chromosomes. What is the best interpretation of this karyotype? The karyotype is
A) aneuploid and the individual is male.
B) euploid and the individual is male.
C) aneuploid and the individual is female.
D) euploid and the individual is female.
C) aneuploid and the individual is female.
Identical twins have the same genome but often develop differently. For instance, one may develop arthritis and the other does not. The best explanation is:
A) different gene patterns.
B) environmental factors that affect the epigenome.
C) telomere loosening.
B) environmental factors that affect the epigenome.
SATA: Which of the following tests should be offered to all pregnant women?
A) Screening for Down’s Syndrome
B) Hemoglobin electrophoresis
C) Hepatitis B e antigen level (HBeAG)
D) Chorionic villi sampling (CVS)
A) Screening for Down’s Syndrome
B) Hemoglobin electrophoresis
Varney 6 e p. 680 Panethnic screening refers to offering carrier screening to all individuals regardless of race or ethnicity.
Most women who have an abnormal quad screen result:
A) will have a baby with a neural tube defect.
B) will have a normal fetus.
C) should have serial ultrasounds and doppler velocimetry screening in the third trimester.
D) should have a repeat quad screen in 2 weeks.
B) will have a normal fetus.
Which aneuploidy disorder has no noticeable phenotype at birth?
A) Klinefelter Syndrome (47, XXY)
B) Edwards Syndrome (Trisomy 18)
C) Downs Syndrome (Trisomy 21)
D) Turner Syndrome (45, X)
A) Klinefelter Syndrome (47, XXY)
Cystic fibrosis carrier screening should be offered:
A) To all African American women.
B) Ideally at 10-12 weeks gestation.
C) To all women, regardless of ethnicity.
D) Only to Caucasian women.
C) To all women, regardless of ethnicity.
A woman presenting for care at 10 weeks gestation says she desires genetic screening for “everything that I can screen for.” Which of the following screening test should the clinician recommend?
A) integrated screen
B) non-invasive prenatal testing (NIPT)
C) quad screen
D) carrier screen
A) integrated screen
Meiosis results in daughter cells that have:
A) 23 chromosomes
B) 44 genes and 2 sex chromosomes
C) 21 autosomes and 2 sex chromosomes
D) 46 chromosomes
A) 23 chromosomes
What is an allele?
A) Homozygous proteins
B) Genetic information for the form a trait will take
C) Sets of chromosome reactions
B) Genetic information for the form a trait will take
Which of the following statements is true concerning triploidy?
A) triploidy involves an extra copy of one chromosome
B) triploidy involves an extra copy of every chromosome
C) triploidies are never fatal
D) triploidies occur when one ovum is fertilized by one sperm
B) triploidy involves an extra copy of every chromosome
Which of the following is accurate information to give women about first trimester genetic screening?
A) “This screening does not screen for neural tube defects.”
B) “If the alpha-fetoprotein (AFP) component is elevated, an amniocentesis is advised.”
C) “The optimal time for screening is between 8 and 10 weeks gestation.”
D) “This screening has a 70% Down Syndrome detection rate.”
A) “This screening does not screen for neural tube defects.”
Jordan, p. 184. 1st trimester screen includes: NT + PAPP-A+ hCG. (It does not check AFP). The first-trimester screen does not include AFP, and therefore cannot detect NT defects on its own. Jordan, p. 184. The first-trimester screen involves a Blood test at 9 weeks and NT between 11-13. The first-trimester screen detects 82-87% of DS. Jordan, p. 184.
A woman presents for prenatal care and desires screening for cystic fibrosis (CF). The test results show that she is a CF carrier. She is unsure of the paternity of her baby. Which of the following is the most appropriate management plan?
A) Suggest an amniocentesis since the baby’s father is unavailable for testing.
B) Offer paternity testing for the woman’s past partners to determine paternity so that the father may be screened.
C) Offer an appointment with a genetic counselor.
D) Reassure the patient that she is likely to have an unaffected baby because the chances that both she and the baby’s father have the same genetic CF mutation are slim.
C) Offer an appointment with a genetic counselor.
A mother is a carrier for hemophilia (x-linked recessive) and the father is a hemophiliac. What are the chances of an offspring being a hemophiliac? _____%
50%
Why are X-linked recessive disorders expressed in males more frequently than females?
A) Females have more effective DNA repair mechanisms than do males.
B) Expression of genes from the Y chromosome does not occur in females.
C) One X chromosome of a pair is always inactive in all female cells.
D) X chromosomes always carry the trait and males only have one X chromosome.
D) X chromosomes always carry the trait and males only have one X chromosome.
What is a trait?
A) A feature in a person passed generation to generation
B) A gene that has been changed
C) Messenger protein
A) A feature in a person passed generation to generation
When a child inherits an autosomal recessive disorder, it is inherited it from their
A) mother.
B) father.
C) mother and father.
C) mother and father.
A pregnant woman and her husband are both cystic fibrosis (CF) carriers. What is the likelihood and rationale for their having a child without CF?
A) 25%; because 75% have CF
B) 75%; because only 25% have CF
C) 80%; if both parents are in good health
D) 85-90%; if the anatomy ultrasound is negative for CF markers
B) 75%; because only 25% have CF
Which of the following tests is preferred to offer to women who desire to screen for both Down Syndrome and neural tube defects (NTD)?
A) Nuchal translucency ultrasound
B) Quad screen
C) First trimester screening
D) Triple screen
B) Quad screen
Which of the following is the best statement to use when explaining the risk of Down Syndrome to women? (For purposes of this question, assume that the woman has a 1:100 risk of Down Syndrome).
A) “The relative risk that your baby will have Down Syndrome is lower than the risk of it having a Neural Tube Defect.”
B) “The chance that your baby will have Down Syndrome is less than 2 percent.”
C) “The chance that your baby will have Down Syndrome is 1 in 100, and there is a 99% likelihood that your baby will be normal.”
D) “The chance that your baby will have Down Syndrome is 1 in 100, and that he or she will not is 99 in 100.”
D) “The chance that your baby will have Down Syndrome is 1 in 100, and that he or she will not is 99 in 100.”
A low-risk woman and her partner, both of whom have a negative personal and family genetic history, present for prenatal care at 11 5/7 weeks gestation by uterine size and LMP. If the woman and her partner request screening, which of the following would be most appropriate to schedule at that first visit?
A) Neural tube defects (NTDs) screening with Chorionic Villus Sampling (CVS)
B) Down Syndrome screening with an integrated screening method
C) Fragile X Syndrome screening with a blood draw
D) Down Syndrome screening with a quad screen blood draw
B) Down Syndrome screening with an integrated screening method
The integrated screen is a blood test at 10-13 weeks, NT at 11-14 weeks, and a 2nd blood test at 15-22 weeks. This test provides the highest sensitivity with the lowest false positive rate of the universally offered screening choices. 96% detection rate. Jordan p. 184 & 185
What genetic process is likely responsible for the occurrence of asthma in only one of a pair of twins?
A) epigenetic modifications
B) transgenerational inheritance
C) homoplasty
D) genomic imprinting
A) epigenetic modifications
Which of the following conditions is NOT an aneuploidy condition?
A) Turner Syndrome
B) Trisomy 18
C) Down Syndrome
D) Cystic Fibrosis
D) Cystic Fibrosis
Imprinting affects gene expression through:
A) Epigenetic control
B) Neural mechanisms
C) Changing DNA structure
D) Meiosis
A) Epigenetic control
Which of the following women has the highest chance of being a cystic fibrosis (CF) carrier?
A) a 20 year old Caucasian woman
B) A 40 year old Hispanic woman
C) A 30 year old African woman
D) All women have the same chance of being a CF carrier
A) a 20 year old Caucasian woman
Pregnancy-associated plasma protein A (PAPP-A) is a:
A) Protein secreted by the trophoblast
B) Genetic substance produced by the placenta
C) Glucose molecule secreted by the maternal decidua
D) Protein secreted by the uterus
A) Protein secreted by the trophoblast
Characteristics of X-linked recessive disorders include which of the following?
A) All daughters of affected fathers are carriers.
B) Boys and girls are equally affected.
C) The son of a carrier mother has a 25% chance of being affected.
D) Affected fathers transmit the gene to all of their sons.
A) All daughters of affected fathers are carriers.
People who have neurofibromatosis will show varying degrees of the disease. This is related to the genetic principle of
A) penetrance.
B) expressivity.
C) dominance.
D) recessiveness.
B) expressivity.
A woman presents for prenatal care at 7 weeks gestation. While taking her family history, the woman mentions that she has a brother who has developmental delays and she does not know the reason. Which of the following would be most important to include in the care plan for this woman at this visit?
A) referral to a genetic counselor
B) scheduling first trimester nuchal translucency and serum screening
C) scheduling an ultrasound for genetic anatomy screening
D) reinforcing the need to attend all prenatal visits so she can get the appropriate lab tests at the appropriate time
A) referral to a genetic counselor
During a 20 week anatomy ultrasound a meningomyelocele is found. The clinician explains that this is a type of spina bifida where
A) a sac of spinal fluid with part of the spinal cord or nerve root and meninges herniates through an opening in the baby’s back.
B) a sac of spinal fluid containing meninges herniates through an opening in the baby’s back. The sac doesn’t contain the spinal cord or nerve roots.
C) there is a small gap in the spine but no opening or sac on the baby’s back.
A) a sac of spinal fluid with part of the spinal cord or nerve root and meninges herniates through an opening in the baby’s back.
A 22 year old G1P0 at 11 weeks gestation presents to clinic for her second prenatal visit. Her Cystic Fibrosis (CF) screen came back positive. Which of the following is most appropriate to include in her care plan?
A) Advise her to have an amniocentesis for a definitive diagnosis.
B) Advise her to have the baby’s father tested for CF carrier status.
C) Tell her she has a 1 in 4 chance of having a baby with CF.
D) Schedule an ultrasound.
B) Advise her to have the baby’s father tested for CF carrier status.
Which of the following statements regarding integrated genetic screening is accurate?
A) Women under the age of 25 don’t need to be offered this testing
B) The false positive rate is approximately 15%
C) It is 95% accurate for detecting Down Syndrome in the fetus
D) Its components are 1st trimester fetal anatomy ultrasound and 2nd trimester serum screening
C) It is 95% accurate for detecting Down Syndrome in the fetus
Non-disjunction that leads to trisomy 21 occurs most often among women aged:
A) 35 and older.
B) 20-25.
C) 26-31.
D) Under 20.
A) 35 and older.
The most sensitive traditional screening test for Down Syndrome is:
A) nuchal translucency ultrasound
B) combined first trimester screening
C) integrated screening
D) quad screen
C) integrated screening
BE CAREFUL: There is a test that has a higher rate of detecting DS, that is the NIPT at 99%. However, it wasn’t an option here. So, integrated is the highest, WHEN COMPARED to the other 3 choices there. But not the ABSOLUTE highest! Be careful with memorizing quiz questions as a fact. They are always in relation to the other 3 distractors.
Alpha fetoprotein (AFP) levels in maternal serum is used to screen for:
A) Neural tube defects
B) Down Syndrome
C) Cystic Fibrosis
D) Trisomy 18
A) Neural tube defects
Nuchal translucency measures thickness of the nape of the neck that is due to:
A) Excess accumulated fluid
B) Genetic disorders
C) Placental insufficiency
D) Neural tube malformation
A) Excess accumulated fluid
A 25 year old G2P0010 at 18 weeks gestation presents to clinic for her routine prenatal visit. During the visit she tells you that although she had initially declined genetic screening, she has since changed her mind and would like to have genetic screening done after all. Which of the following tests would you suggest she have?
A) sequential screen
B) non-invasive prenatal testing (NIPT)
C) integrated screen
D) ultrasound
B) non-invasive prenatal testing (NIPT)
10 weeks through term. Trisomy 13, 18, 21. Detection 99%. Highest rate of detection for DS.
A father is affected by an autosomal dominant disease, but the mother does not have the disease gene. One of their children has the disease. What is the risk percentage for future offspring?
A) 50%
B) 33%
C) 25%
D) impossible to determine
A) 50%
An individual’s expression of a single-gene trait is called
A) phenotype.
B) karyotype.
C) genotype.
D) dominant trait.
A) phenotype.
A 5% false positive rate means that:
A) 95% of women who have the test have a normal fetus
B) 5% of women who have the test have a positive test and a normal fetus
C) 5% of women have a positive test and most have an abnormal fetus.
D) 5/1000 women will have a positive test and a normal fetus
B) 5% of women who have the test have a positive test and a normal fetus
A patient presents for a visit reporting infertility. She has one ten year old child born at 28 weeks. In the past ten years, she has lost three pregnancies in the first trimester and given birth to one child at 22 weeks who lived for two days. Her gravida & parity status is:
G5 P0231
A woman had a viable 37 3/7 week infant (currently alive and well), a 26 week infant who was stillborn, a 6-week miscarriage, and a 34 week live infant (currently alive and well). She is currently pregnant with twins. Her gravida and parity status is:
G5P1212
A pregnant woman presents to clinic with her two year old twins born at 35 weeks gestation and her 1 year old son born at 38 weeks gestation. She reports she she had a stillborn infant born at 24 weeks, and reports the death of an infant born at 25 weeks that lived for one day five years ago. She has had one other ectopic pregnancy. What is her G & P status?
G6 P1313
When establishing gravid and parity status, any fetus delivered between 20 0/7 and 36 6/7 weeks is counted in which place of the G/P’s?
P (preterm)
A pregnant woman has had one 2 year old born at 39 weeks gestation, a 4 year old born at 41 weeks gestation and has had one spontaneous loss at 7 weeks gestation. Her gravida & parity status is:
G4P2012
A 33 year old presents to the prenatal clinic with her 5 year old who was born at 38 weeks and one of her twins who was born at 35 weeks (the other one died at 3 days of life). She also reports one spontaneous pregnancy loss at 6 weeks gestation. Her gravida & parity status is:
G4 P1112
A 24 year old woman has just arrived for her first prenatal visit with her 7 year old twins born at 35.6 weeks gestation and her 2 year old born at 38.3 weeks gestation. She had one spontaneous miscarriage at 7 weeks gestation. Her gravida and parity status is:
G4P1113
A woman presents today at the office for her first prenatal visit. She indicates that she had a normal period 8 weeks ago: her periods are regular and occur every 28 days. She voices concern about one episode of intermittent pink spotting that she had for a few hours about 6 weeks ago, with no spotting or symptoms since. How many weeks gestation is she likely to be?
8 weeks gestation
Because her periods are regular and occur every 28 days and she is sure that her last period occurred 8 weeks ago, she is likely 8 weeks pregnant. The spotting she reports was likely implantation spotting.
When discussing pregnancy dating, which is the correct terminology used to describe gestational age?
A) gestational weeks (also called menstrual weeks)
B) trimesters
C) months since conception
D) post conceptual weeks (weeks since conception)
A) gestational weeks (also called menstrual weeks)
A 22 year-old G1P0 arrives to clinic for her 1st prenatal visit. She thinks her last period started “around 7 weeks ago”. What is the most appropriate question for the midwife to next ask her in order to establish the EDB?
A) Were you planning on getting pregnant around this time?
B) Was your last period normal for you?
C) Do you keep track of the dates of your periods on a calendar or in an app?
D) What type of birth control were you using around that time, if any?
C) Do you keep track of the dates of your periods on a calendar or in an app?
It is important to ascertain the exact day that her last period started to accurately establish the EDB. Many women keep track of this on a calendar or in an app. When encountering a woman who does not know the date of her LMP, it may useful to use “memory joggers” to help her recall the date. Although it is important to take a menstrual history, without the date of her LMP the midwife would be unable to establish the EDB at this visit and would order an ultrasound to date the pregnancy. Knowing Tina’s reproductive plans or type of birth control would be useful to discuss after trying to determine the EDB.
The criterion measurement to date a pregnancy during the first trimester is:
crown-rump length
Which of the following things is LEAST likely to confuse the process of dating a first trimester pregnancy?
A) oligohydramnios
B) bladder status
C) uterine position
D) maternal habitus
A) oligohydramnios
A woman is at the clinic today for her first prenatal visit. She does not recall her LMP. Her uterus is approximately 2 finger breadths above the symphysis pubis. Based upon these examination findings, the midwife would estimate her gestational age as:
A) approximately 14 weeks gestation
B) unable to determine until Dee has an ultrasound
C) approximately 16 weeks gestation
D) approximately 12 weeks gestation
A) approximately 14 weeks gestation
At 14 weeks, the uterus is located approximately 2 finger breadths above the symphysis pubis. The uterus becomes an abdominal organ at 12 weeks, and is usually found at the level of the umbilicus at 20 weeks.
In clinic, a woman tells you she thinks her period was about 10 weeks ago. Her menstrual history includes menses interval of 28-29 days, and she occasionally skips several periods a year. What is the best way to date her pregnancy?
A) With presumptive signs and uterine size
B) Vaginal ultrasound
C) Naegele’s rule
D) Serum beta Hcg
B) Vaginal ultrasound
Correct! Because she has an unknown LMP and irregular menses including skipping cycles, a vaginal ultrasound is the appropriate way to date her pregnancy. Presumptive signs of pregnancy may be caused by other conditions; and while uterine size correlates with gestational age, it is most helpful in dating pregnancies in the presence of certain LMP. It is inappropriate to use Naegele’s rule in cases where a woman has irregular periods, which includes skipping periods. Serum beta Hcg is helpful for dating pregnancy only when there are 2 values less than 10,000 collected one week apart and rising appropriately, but this is still less accurate than a first trimester ultrasound.
A woman presents to clinic 7 days after missing her expected menstrual period. She reports using a home pregnancy test the day after she expected her period, but it was negative. The next best step for the CNM/WHNP to take is to:
A) consult the OB for a progesterone prescription to induce menses
B) order an abdominal ultrasound
C) draw a quantitative beta hCG level
D) repeat a urine pregnancy test
D) repeat a urine pregnancy test
She took the pregnancy test 1 day after missing her period. It is possible that it was too early to detect hCG in the urine. The priority action is to repeat the urine hCG. (Varney pg: 699 - A great deal of discrepancy exists in the actual detection rates for specific commercial products. Furthermore, the concentration of beta-hCG in urine can vary within the same woman throughout the day depending on fluctuations in urine concentration. )
A woman presents to clinic today for her first prenatal visit. She thinks her LMP was about 12 weeks ago, but cannot remember a specific date. On bimanual exam, the midwife/WHNP finds her uterus to be slightly enlarged and globular shaped, located below the symphysis pubis. The best way to date her pregnancy is:
A) vaginal ultrasound
B) abdominal ultrasound
C) Naegle’s rule and presumptive signs of pregnancy
D) presumptive and positive pregnancy signs
A) vaginal ultrasound
Based upon the size of her uterus, she is likely in her first trimester. Because she cannot remember her LMP, a vaginal probe ultrasound is indicated for pregnancy dating.
Which of the following is an accurate statement regarding serum beta hCG levels?
A) they peak at 10 weeks and are used primarily to corroborate pregnancy dating
B) they peak between 8.5-10 weeks and double in value every 48 hours
C) they peak between 6-10 weeks and double in value every 24 hours
D) they peak between 9-11 weeks and increase exponentially over the next 6 weeks
B) they peak between 8.5-10 weeks and double in value every 48 hours
Beta hCG is detectable 8-11 days after conception and doubles every 2 days until it peaks at 10 weeks gestation then rapidly declines between 12 and 16 weeks gestation.
A 34 year old G1 being seen in clinic for her first prenatal visit states her LMP was 8 weeks ago and was normal. When performing a bimanual exam, the midwife/WHNP determines that her uterus is enlarged to about 10 week size. Which one of the following is NOT a possible reason for this clinical finding?
A) uterine fibroids
B) fetal position
C) multiple gestation
D) error in dating
B) fetal position
At this gestation, fetal position does not affect uterine size while uterine fibroids, multiple gestation, and errors in dating do.
When deciding whether or not to adopt a clinic-wide policy of routine first trimester ultrasound for dating purposes, the CNM/WHNP should consider:
A) in general, women can’t be relied upon to provide an accurate LMP date.
B) second trimester ultrasounds can provide reasonably accurate dating confirmation along with a fetal anatomic assessment
C) second trimester ultrasounds are not valuable at all for dating purposes
D) since it’s culturally acceptable to have multiple ultrasounds in pregnancy, it’s best to do what the individual woman wants to do
B) second trimester ultrasounds can provide reasonably accurate dating confirmation along with a fetal anatomic assessment
The most common reason for a size/dates discrepancy in the first trimester is:
an uncertain LMP
Williams Obstetrics 26th e p. 247 “If the LMP is certain, the EDD is based on LMP unless the date-measurement discrepancy exceeds set thresholds.”
If the GA is less than 9 weeks and the CRL and LMP dates are off by more than 5 days, you go with the ultrasound.
Between 9 and 14 weeks, if the CRL and LMP dates are off by more than 7 days, you go with the ultrasound.
Which of the following is an accurate statement regarding serum beta hCG?
A) It can be detected 6-7 days after conception.
B) It peaks at 12-13 weeks gestation.
C) It is best to use one sentinel measure.
D) It is used when pregnancy viability is in question.
D) It is used when pregnancy viability is in question.
Beta hCG is used to determine fetal viability and to determine normal fetal development. It is detectable 8-11 days after conception and doubles every 2 days until it peaks at 8.5- 10 weeks gestation then rapidly declines between 12 and 16 weeks gestation. When using beta hCG measurements, it is most useful to compare two measurements taken two days apart to ascertain whether the value has doubled, thus indicating normal development.
The best way to initially measure uterine size in a pregnant woman presenting for care 10 weeks after her LNMP is:
A) vaginal ultrasound
B) bimanual exam
C) waiting another 2-4 weeks
D) fundal height measurement
B) bimanual exam
Bimanual exam is used to determine uterine size in the office between 6 and 11 weeks. After this, the uterus becomes an abdominal organ and finger breadths above the symphysis would be used. Once the woman reaches 20 weeks, uterine size is measured by fundal height measurement (Let’s talk).
Which statement contains appropriate information to tell women about ultrasound dating?
A) An ultrasound for dating pregnancy is best done between 7-10 and 16-18 weeks gestation, and has been documented as safe for mother and baby.
B) An ultrasound for dating pregnancy is best done between 8 and 11 weeks gestation and does not cause maternal harm.
C) Ultrasound use can cause potential heating of fetal cells and is most accurate for dating if done between 16 and 22 weeks gestation.
D) Ultrasound for dating pregnancy is best done between 7-9 weeks gestation and is theoretically linked to right-handedness with multiple exposures.
A) An ultrasound for dating pregnancy is best done between 7-10 and 16-18 weeks gestation, and has been documented as safe for mother and baby.
Ultrasound dating is best done in the first trimester between 7 and 10 weeks. When this is not possible, the ultrasound should be done between 16 and 18 weeks because this allows for dating the pregnancy as well as doing an anatomic survey as long as the woman agrees to this form of genetic screening.Informed consent is ethically required here. Studies on USN safety have been done on a limited number of USN’s (1-2),not multiple USN’s. So we can say that a dating ultrasound has been shown to be safe for mother and fetus.
Which of the following is detectable in maternal serum and urine 8-10 days after fertilization?
A) Human chorionic gonadotropin
B) Oxytocin
C) Human placental lactogen
D) Prolactin
A) Human chorionic gonadotropin
Prior to seeing a woman in clinic, the provider notes that her sure LNMP was May 3, 2017. It is now February 1, 2018. How many weeks pregnant is she?
38 weeks 5 days
A pregnant woman has an ultrasound for dating at 19 weeks gestation. It is most appropriate to advise her that:
A) her EDB is accurate to within plus or minus 5 days
B) her EDB is accurate to within plus or minus 20 days
C) she will need a follow-up ultrasound for comparison in the early third trimester
D) her EDB is accurate to within plus or minus 10 days
D) her EDB is accurate to within plus or minus 10 days
When using vaginal ultrasound to date pregnancy, the criterion measurement is:
crown-rump length
Crown rump length (CRL) is the most accurate predictor of gestational age in the first trimester when a vaginal probe ultrasound would be done.
Two of the criterion measurements used in ultrasound dating of pregnancy in the second trimester are:
biparietal diameter and femur length
Combining measurements of head circumference, biparietal diameter, abdominal circumference and femur length provide an estimation of gestational age by ultrasound in the second trimester.
A woman reports her last normal menstrual period as “about 4 months ago.” Her uterus is approximately 10 week size. Which is the most appropriate next step in dating her pregnancy?
A) advise an abdominal ultrasound
B) obtain a beta hCG level
C) inquire about presence of cramping and/or bleeding
D) advise a vaginal ultrasound
D) advise a vaginal ultrasound
At her first prenatal visit, a woman reports that her last menstrual period was May 21. Her periods are consistently every 28 days and last 5 days. Naegele’s rule indicates which due date?
February 28
A woman is in clinic today for her first prenatal visit. She tells the midwife/WHNP the date of her LMP which was 11 weeks ago. Her uterus is palpable 3 finger breadths above the symphasis. The best way to date her pregnancy is:
A) beta hCG and onset of presumptive signs
B) vaginal ultrasound
C) abdominal ultrasound
D) Naegle’s rule
C) abdominal ultrasound
Correct! Because of the discrepancy between the location of the fundus and the time elapsed since the reported LMP, an ultrasound for dating the pregnancy is indicated. The location of her fundus indicates she is likely in the second trimester; therefore an abdominal ultrasound would be indicated to date her pregnancy.
A 24 year old G3P1011 is here for her regular prenatal visit at 26 weeks gestation. Her prenatal course has been uncomplicated. Her uterus measures 28 centimeters by tape measure. It is most appropriate for the CNM/WHNP to:
A) tell her that her uterus is growing normally
B) advise an ultrasound for size/dates discrepancy
C) determine if the fetus is breech
D) inquire about recent changes in her diet and her weight gain
A) tell her that her uterus is growing normally
A woman’s last normal menstrual period was on July 16th. By that LMP, her EDB is April 23rd.
An ultrasound done on October 10th, when she would be 12 weeks pregnant by her LMP, showed her to be 10 weeks, 3 days pregnant with an EDB of May 6th.
According to ACOG Guidelines, what is her EDB?
May 6th
A woman reports her last normal menstrual period as “about 4 months ago.” Her uterus is approximately 10 week size. Which is the most appropriate next step in dating her pregnancy?
A) inquire about presence of cramping and/or bleeding
B) advise an abdominal ultrasound
C) obtain a beta hCG level
D) advise a vaginal ultrasound
D) advise a vaginal ultrasound
Which of the following is a positive sign of pregnancy?
A) nausea and vomiting
B) visualizing the fetus on ultrasound
C) positive pregnancy test
D) maternal sensation of fetal movement
B) visualizing the fetus on ultrasound
Presumptive: pregnancy discomforts, amenorrhea
Probable: + pregnancy test, Chadwick’s sign
Positive: FHTs, ultrasound
A woman presents to the office today for her first prenatal visit. Her LMP was 10 weeks ago, and was normal. She reports breast tenderness and fatigue. On bimanual exam, her uterus is enlarged and is palpable below the symphysis pubis. A urine pregnancy test done today in the clinic was positive, and the midwife/WHNP and woman hear fetal heart tones with a doppler. A probable sign of pregnancy she presents with is:
A) positive pregnancy test
B) audible FHT’s by doppler
C) fatigue
D) breast tenderness
A) positive pregnancy test
A positive pregnancy test is a probable sign of pregnancy, while breast tenderness and fatigue are presumptive signs, and audible FHTs are a positive sign.
Palpating an enlarged uterus is:
A) useful in conjunction with Goodells sign
B) a probable sign of pregnancy
C) a positive sign of pregnancy
D) a presumptive sign of pregnancy
B) a probable sign of pregnancy
A presumptive sign of pregnancy is:
A) Positive B-Hcg
B) Maternal fatigue
C) Uterine enlargement
D) Palpating the fetal outline
B) Maternal fatigue
Which of the following is a positive sign of pregnancy?
A) Uterine enlargement
B) Palpation of the fetus
C) Report of quickening
D) Auscultation of fetal heart tones
D) Auscultation of fetal heart tones
Presumptive: pregnancy discomforts, amenorrhea
Probable: + pregnancy test, Chadwick’s sign
Positive: FHTs, ultrasound
A 28 year old presents to clinic for her 3rd prenatal visit at 16 weeks gestation. Appropriate anticipatory guidance includes advising her that fetal:
A) eyes are opening
B) hair growth has started
C) skeleton is rapidly growing
D) weight is 0.5-1 lbs
C) skeleton is rapidly growing
A woman presents for care with an unknown LMP. Her fundus is located midway between her symphysis and umbilicus. The midwife/WHNP knows she is most likely how many weeks gestation?
A) 20 weeks
B) it would depend on how many centimeters she measures
C) 12 weeks
D) 16 weeks
D) 16 weeks
At 36 weeks gestation, a woman’s fundal height is 32.5 cm. What should the midwife do first?
A) Schedule a return visit for 1 week later.
B) Order an abdominal ultrasound.
C) Consider alteration of her dates.
D) Consult with a physician.
B) Order an abdominal ultrasound.
Fundal height measurements:
A) measure from the bladder to the fundus.
B) are most accurate when performed by the same examiner.
C) are an accurate indication of fetal weight.
D) are less accurate for monitoring fetal growth than serial ultrasounds.
B) are most accurate when performed by the same examiner.
When evaluating a fetus for macrosomia during the third trimester the midwife is aware that a(n)
A) clinician’s estimated fetal weight (EFW) via Leopold’s is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
B) multiparous women’s prediction of fetal weight is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
C) ultrasound (US) estimated fetal weight (EFW) has a positive predictive value (PPV) of 97-99%.
D) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.
D) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.
A 29-year-old G3P1011 now at 36 weeks gestation is here for her routine visit. In her chart the midwife notes her BMI is 25.3, ultrasound at 10 weeks gestation confirms dates and fundal height at 34 weeks was 36 cms. Today her fundal height is 40 cms and by Leopold’s the fetal lie is oblique. Which of the following is most important to review from her chart?
A) Weight gain pattern
B) Diet interventions
C) 28 week glucose screen
D) Estimated fetal weight on 20 week ultrasound
C) 28 week glucose screen
When evaluating a fetus for macrosomia during the third trimester the midwife is aware that a(n)
A) ultrasound (US) estimated fetal weight (EFW) has a positive predictive value (PPV) of 97-99%.
B) multiparous women’s prediction of fetal weight is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
C) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.
D) clinician’s estimated fetal weight (EFW) via Leopold’s is inaccurate compared to an ultrasound’s (US) estimated fetal weight (EFW).
C) ultrasound (US) may have an error of ± 15% or ± 1 pound in a 7 lb infant.
A woman is 14 weeks gestation and presents for her 2nd visit. Her uterine size is best measured by:
A) tape measure
B) Leopolds maneuvers
C) vaginal exam
D) Fingerbreadth palpation
D) Fingerbreadth palpation
A woman presents for a routine prenatal appointment at 39 weeks gestation. Her fundal height measures 37 cm. At 38 weeks, the fundal height was 38 cm. FHTs by Doppler are 145. Appropriate management would include which of the following:
A) Consulting with the CNM/WHNP’s consultant physician
B) Recommending an induction of labor
C) Offering her an ultrasound to check fetal growth
D) Reassuring her of normalcy and scheduling her next visit in one week
D) Reassuring her of normalcy and scheduling her next visit in one week
The CNM/WHNP desires to estimate the fetal weight. Which of the following is true regarding estimating fetal weight (EFW):
A) An ultrasound is the most accurate way to determine EFW
B) Measuring fundal height is an accurate way to estimate fetal weight
C) Leopold’s maneuvers are more accurate than ultrasound to determine EFW
D) There is no precise tool to accurately determine fetal weight
D) There is no precise tool to accurately determine fetal weight
Which condition may cause asymmetric fetal growth restriction in a newborn?
A) Cytomegalovirus (CMV) infection
B) Preeclampsia
C) Severe chronic maternal malnutrition
D) Chromosomal disorders
B) Preeclampsia
A 36-year-old G2P1001 at 33 weeks gestation presents for her routine prenatal visit. A chart review reveals: smoker- 1ppd, history of cocaine use (prior to pregnancy); Body mass index (BMI) 24.3; a total weight gain of 22 pounds; fundal height at 30 weeks was 28 cms. Fundal height today is 29 cms and the woman reports good fetal movement. APRN management should include
A) encouraging weight gain and smoking cessation, performing random drug screening, and referring to a nutritionist.
B) assessing readiness for smoking cessation, performing drug screening and starting biweekly non-stress tests (NST).
C) ordering an ultrasound and assessing substance use and readiness for smoking cessation.
D) repeating fundal height and starting non-stress test at 36 weeks gestation because she is a smoker.
C) ordering an ultrasound and assessing substance use and readiness for smoking cessation.
A 24 year old G3P1011 is here for her regular prenatal visit at 26 weeks gestation. Her prenatal course has been uncomplicated. Her uterus measures 28 cms by tape measure. It is most appropriate for the CNM/WHNP to:
A) inquire about recent changes in her diet and her weight gain
B) determine if the fetus is breech
C) advise an ultrasound for size/dates discrepancy
D) tell her that her uterus is growing normally
D) tell her that her uterus is growing normally
A woman at 28 weeks gestation presents for a routine prenatal visit. The midwife/WHNP expects her fundal height to be:
between 26 and 30 centimeters
Rho-gam (a gamma globulin) given to a pregnant woman whose red blood cells are Rh negative will give her
A) acquired immunity against negative Rh red blood cells from the fetus.
B) passive immunity against negative Rh red blood cells from the fetus.
C) acquired immunity against positive Rh red blood cells from the fetus.
D) passive immunity against positive Rh red blood cells from the fetus.
D) passive immunity against positive Rh red blood cells from the fetus.
What is the appropriate time in pregnancy to draw an antibody screen for all women?
at the first prenatal visit
A 24 year old G2 P1001 with Rh negative blood is 8 weeks pregnant and is experiencing vaginal bleeding. She presents to clinic for an evaluation. Which plan of action is most appropriate?
A) inform the woman that because she is so early in her pregnancy she will not need to receive Rhogam at this time
B) order an abdominal ultrasound and administer 300 mcg of Rhogam
C) administer 50 mcg of Rhogam and schedule her for a follow up appointment at 12 weeks gestation
D) order a vaginal probe ultrasound and administer 50 mcg of Rhogam
D) order a vaginal probe ultrasound and administer 50 mcg of Rhogam
Why is RhoGAM given to women who are Rh negative?
A) To protect the fetus from neural tube defects.
B) To decrease the risk of miscarriage.
C) To prevent antigen-antibody reactions to any fetal blood cells that may enter the woman’s blood.
D) To prevent the woman from developing anemia in future pregnancies.
C) To prevent antigen-antibody reactions to any fetal blood cells that may enter the woman’s blood.
A 28 year old G4P3003 at 22 weeks gestation with blood type B negative asks the CNM/WHNP when she will receive her Rhogam injection. She is not planning on having more children. Which of the following responses is most appropriate?
A) “Since you are not planning on having more children, you won’t need a Rhogam shot this pregnancy.”
B) “You’ll have an antibody screen drawn at your next visit. Then, if the results are negative, you will need to return to clinic to receive your Rhogam.”
C) “You’ll have an antibody screen drawn and receive your Rhogam dose at your 28 week visit.”
D) “You’ll receive a dose of Rhogam at your next visit and then again if you remain pregnant beyond 40 weeks.”
C) “You’ll have an antibody screen drawn and receive your Rhogam dose at your 28 week visit.”
SATA: In what forms can you order Rh D Immune Globulin?
A) IV
B) SQ
C) PO
D) IM
A) IV
D) IM
When the mother’s immune system becomes sensitized against antigens expressed by the fetus, what type of immune reaction is occurring?
A) Autoimmune type 1 hypersensitivity
B) Allergic, type II hypersensitivity
C) Immune complex, type II hypersensitivity
D) Alloimmune, type II hypersensitivity
D) Alloimmune, type II hypersensitivity
T/F: Administration of Rhogam at 28 weeks should occur even if the antibody screen is not known to be negative at the time of Rhogam administration.
True
How many milliliters of maternal-fetal hemorrhage does a routine dose of Rhogam cover?
15ml
At which point in pregnancy is an Rh negative woman most likely to become Rh alloimmunized?
A) during a first trimester miscarriage
B) during a genetic amniocentesis
C) during an abortion
D) at birth
D) at birth
The lab test that measures the average size of red blood cells is:
A) hemoglobin
B) hematocrit
C) MCHC (mean corpuscular hemoglobin concentration)
D) MCV (mean corpuscular volume)
D) MCV (mean corpuscular volume)
T/F: During review of AP labs, the CNM notes positive IgG anti-HCV. Hepatitis C can be confirmed with a positive IgG anti-HCV.
True
T/F: A Hemoglobin and Hematocrit (H&H) may be ordered in place of a Complete Blood Count (CBC) when routine labs are drawn at the first prenatal visit.
False
When should women who are at high risk for chlamydia and gonorrhea be screened?
At the first prenatal visit and in the third trimester
The lab test that is highly specific in its correlation with total iron stores and is considered the gold standard for the diagnosis of iron deficiency anemia is:
Serum ferritin
Appropriate labs to obtain for all women at the first prenatal visit are:
A) blood type, antibody screen, and HIV test
B) chlamydia and gonorrhea screening and bacterial vaginitis (BV) screening by wet-prep
C) Pap smear and urine culture
D) one hour glucose tolerance test and quad screen
A) blood type, antibody screen, and HIV test
Normal pregnancy hemoglobin and hematocrit levels are
A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.
B) hemoglobin 10 g and hematocrit 31% during the second trimester.
C) adjusted for the African American woman by -0.6 g and -2.0%
D) hemoglobin 9.9 g and hematocrit 30% during the second trimester in African American women.
A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.
A 26 year old at 9 weeks gestation has the following lab values. Hgb = 10.5 and Hct = 31%. It would be appropriate to
A) advise that this is normal due to increasing blood volume
B) advise to eat more nuts and raisins and retest in 4 weeks
C) encourage dietary iron sources and daily iron supplementation
D) advise Feso4 500 mg BID to be taken after meals
E) draw a serum ferritin and Hgb electrophoresis
E) draw a serum ferritin and Hgb electrophoresis
We can’t just offer people iron. We don’t know if this is IDA or a thalassemia. Needs further work up.
The practitioner knows that a “shift to the left” on a differential smear indicates:
A) a pathologic finding in pregnancy
B) an increase in immature white blood cells (WBCs)
C) an increase in mature white blood cells (WBCs)
D) impending anemia
B) an increase in immature white blood cells (WBCs)
The APRN is reviewing a pregnant patient’s prenatal labs obtained at the first prenatal visit. The hepatitis panel showed a positive HBsAg and a positive IgM anti-HBc. This indicates
A) acute Hepatitis B infection.
B) chronic Hepatitis B infection.
C) acute Hepatitis C infection.
D) immunity to Hepatitis B.
A) acute Hepatitis B infection.
T/F: All women should be screened for trichomonas and bacterial vaginitis at the first prenatal visit.
False
A reactive RPR result with a titer of 1:16 most likely indicates:
A) active syphilis
B) a history of syphilis
C) the absence of syphilis
D) concurrent HIV infection
A) active syphilis
Prenatal lab results are hemoglobin 10; hematocrit 30; MCV 77; MCH 26; platelets 152,000. These values indicate:
A) iron deficiency anemia
B) macrocytic anemia
C) pernicious anemia
D) thalassemia
A) iron deficiency anemia
Normal pregnancy hemoglobin and hematocrit levels are
A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.
B) hemoglobin 10 g and hematocrit 31% during the second trimester.
C) adjusted for the African American woman by -0.6 g and -2.0%
D) hemoglobin 9.9 g and hematocrit 30% during the second trimester in African American women.
A) hemoglobin 11 g and hematocrit 33% during the first and third trimester.
Hemoglobin Electrophoresis is useful in identifying which of the following conditions?
A) hemoglobinopathies
B) iron deficiency anemia
C) the presence of infection
D) pernicious anemia
A) hemoglobinopathies
Laboratory testing for HIV commonly includes which of the following test(s):
A) ELISA followed by Western Blot
B) DNA sequencing
C) Western Blot
D) ELISA
A) ELISA followed by Western Blot
The CNM/WHNP is discussing OB lab results with a pregnant woman at her second prenatal visit. The results of the labs are as follows: Urine culture: E. Coli >100,000 colonies; H&H 11.2/33.5; RPR: nonreactive; Rubella titer: 1:12; Platelets: 205,000, HBsAg: nonreactive, HIV: negative. Which of the following information is most appropriate to give this woman?
A) Her prenatal labs are normal.
B) She should start taking iron supplements.
C) She needs a prescription for antibiotics.
D) Avoid contact with ill children.
C) She needs a prescription for antibiotics.
At 8 weeks gestation, hCG levels should ______ approximately every 48 hours.
Double
T/F: All women should be screened for Hepatitis C in pregnancy.
True
When is a routine prenatal urine culture most appropriately ordered?
A) At the first OB visit.
B) At any time during pregnancy.
C) At 28 weeks gestation.
D) At 36 weeks gestation.
A) At the first OB visit.
Varney 6e P. 706 and 707. Untreated bacteriuria increases the risk a woman will develop pyelonephritis; Treatment of bacteriuria is per standard guidelines.
A 27-year-old woman at 12 weeks gestation is diagnosed with alpha thalassemia. Review of her labs reveal
RBC 5.8 (high)
RDW% (Red Cell Distribution Width) 11.5% (normal)
Hemoglobin 11.0 g/dL
Hematocrit 33.0%
MCV (Mean Corpuscular volume) 73 fL (low)
MCH (Mean Corpuscular hemoglobin) 22 pg (low)
Ferritin 50 mg/dL (normal)
Reticulcyte count normal
The most appropriate management plan includes
A) increased folate supplementation.
B) iron supplementation.
C) prenatal vitamin supplementation.
D) vitamin B12 supplementation.
C) prenatal vitamin supplementation.
This client doesn’t need anything but a PNV. Look at the H/H. It is normal. Varney p. 179: When the diagnosis of thalassemia is established, folic acid supplementation may be employed but iron therapy is inappropriate. From Up To Date 2021- The possibility of folate deficiency may be evaluated in individuals not receiving folic acid Links to an external site. who develop worsening of anemia, especially if associated with an increase in mean corpuscular volume (MCV) and a decrease in reticulocyte count.)
A woman’s initial prenatal lab results are: hemoglobin 9.8; blood type O positive; antibody screen negative; 10,000 colony forming units of Escherichia coli on urine culture; hemoglobin A1c 5.0. A concern in this case is:
A) anemia
B) diabetes
C) hemolytic disease
D) urinary tract infection
A) anemia
A woman presenting for her first prenatal visit reports a history of treatment for primary syphilis 10 years prior to this pregnancy. The CNM/WHNP expects the VDRL/RPR titer to be:
A) normal
B) increased
C) decreased
D) equivocal
A) normal
An African woman presents for prenatal care. The CNM/WHNP knows that the most appropriate sickle cell anemia screening test to order for this woman is:
A) Sickledex and Hemoglobin & Hematocrit (H&H)
B) Hemoglobin Electrophoresis and Complete Blood Count (CBC)
C) Complete Metabolic Panel (CMP) and Hemoglobin SC
D) Either a hemoglobin/hematocrit (H&H) or Complete Blood Count (CBC)
B) Hemoglobin Electrophoresis and Complete Blood Count (CBC)
Which of the following women should NOT be routinely screened for GBS at 35 to 37 weeks of pregnancy?
A) A woman who had any amount of GBS on her initial urine culture.
B) A woman who screened positive for GBS in her last pregnancy.
C) A woman who had a negative vaginal swab for GBS when she was having preterm contractions at 28 weeks gestation.
D) A woman who is allergic to Penicillin.
A) A woman who had any amount of GBS on her initial urine culture.
Which of the following is the lab test used for the routine prenatal antibody screen?
A) Indirect Coombs
B) Direct Coombs
C) Kleihauer Betke
D) Rosette test
A) Indirect Coombs
A CBC is routinely obtained at what point(s) in pregnancy?
A) The first prenatal visit
B) With any sign or symptom of anemia
C) The first prenatal visit and at 28 weeks
D) At 18 and 36 weeks
C) The first prenatal visit and at 28 weeks
A “shift to the left” indicates:
A) the presence of more mature WBCs
B) the presence of more immature WBCs
C) infection
D) leukemia
B) the presence of more immature WBCs
Which of the following CBC results would the CNM/WHNP be most likely to see in cases of iron deficiency anemia?
A) Increased MCHC, Decreased MCV, Decreased MCH
B) Decreased MCHC, Decreased MCV, Increased MCH
C) Increased MCHC, Increased MCV, Increased MCH
D) Decreased MCHC, Decreased MCV, Decreased MCH
D) Decreased MCHC, Decreased MCV, Decreased MCH
Women are most likely to be found to be anemic in the late second/early third trimester because:
A) this is the point of maximum maternal hemodilution
B) their bodies are not able to keep up with the baby’s need to create blood cells
C) fetal use of iron stores increases at this time
D) plasma expansion is beginning at this time
A) this is the point of maximum maternal hemodilution
The term “physiologic anemia” describes which of the following:
A) the greater rise in plasma volume as compared to red blood cells
B) iron deficiency anemia in pregnancy
C) the physiologic increase of plasma and RBCs during early pregnancy
D) the normal decrease in WBCs during pregnancy
A) the greater rise in plasma volume as compared to red blood cells
Which of the following anemias is most frequently diagnosed during pregnancy?
A) Iron Deficiency Anemia
B) Sickle Cell Anemia
C) Pernicious Anemia
D) Vitamin Deficiency Anemia
A) Iron Deficiency Anemia
All people should be offered which of the following tests in pregnancy to screen for hemoglobinopathy:
A) CBC
B) Hemoglobin electrophoresis
C) Sickledex
D) CBC and hemoglobin electrophoresis
D) CBC and hemoglobin electrophoresis
Which of the following women is more likely to transmit Hepatitis B to her fetus?
A) A woman who screens HBsAg positive and HBeAg negative
B) A woman who screens HBsAg positive and HBeAg positive
C) A woman who screened HCsAg positive
D) A woman who is known to have chronic hepatitis B prior to pregnancy
B) A woman who screens HBsAg positive and HBeAg positive
Which of the following is a true statement about serum pregnancy testing?
A) the detection of leutenizing hormone improves reliability
B) results are dependent upon beta hCG
C) false positives are very common
D) testing is best done between 9 and 12 weeks gestation
B) results are dependent upon beta hCG
A 24 year old G3P1011 presents to clinic for her regular prenatal visit at 28 weeks gestation. Her prenatal course has been uncomplicated. She is Rh negative. Appropriate labs to obtain at this visit are:
A) antibody screen and hemoglobin & hematocrit (H&H)
B) gonorrhea and chlamydia culture and HBeAG
C) urine culture and RPR
D) urinalysis and repeat HIV screening
A) antibody screen and hemoglobin & hematocrit (H&H)
A woman at 15 weeks gestation stepped on a rusty nail that punctured the skin. Her last tetanus injection was over 10 years ago. It is most appropriate to tell her that:
A) tetanus immunoglobulin should be given rather than a booster
B) she will be referred to infectious disease for the next step
C) she needs serum testing before any further tetanus vaccination
D) it is safe to get a tetanus booster in pregnancy
D) it is safe to get a tetanus booster in pregnancy
Which is TRUE regarding the Tdap vaccine during pregnancy?
A) The ideal time for administration is between 27 and 36 weeks gestation, but any trimester is acceptable.
B) The ideal time for administration is between 12 and 15 weeks gestation to provide adequate coverage.
C) If the woman was vaccinated within 4-6 months before pregnancy, administration in the current pregnancy is not necessary.
A) The ideal time for administration is between 27 and 36 weeks gestation, but any trimester is acceptable.
Which of the following should pregnant women avoid?
A) Tetanus vaccine
B) Hepatitis B vaccine
C) Influenza nasal spray vaccine.
D) Hepatitis A vaccine
C) Influenza nasal spray vaccine.
Which of the following is accurate information to provide to a pregnant woman who asks about receiving the flu vaccine?
A) “You may receive either the flu vaccine or flu mist to help prevent you from getting the flu.”
B) “You should wait until after your first trimester to receive the flu vaccine.”
C) “Infants of women who receive a flu vaccine during pregnancy have less illness and infection after they are born.”
D) “Pregnant women have less risk of morbidity and mortality from the flu virus than do non-pregnant women.”
C) “Infants of women who receive a flu vaccine during pregnancy have less illness and infection after they are born.”
Mothers and children get the most benefit from stopping smoking
A) prior to 15 weeks gestation
B) in the second trimester
C) anytime during pregnancy
D) immediately prior to delivery
A) prior to 15 weeks gestation
Which of the following statements about Tdap vaccination in pregnancy is accurate?
A) Pregnant women should only receive Tdap between 27 and 32 weeks gestation
B) Women who do not receive Tdap during pregnancy should be vaccinated after delivery if they are due
C) A woman who is pregnant with her second baby in 2 years does not need Tdap as long as she received it during her first pregnancy
D) Tdap vaccination during pregnancy is safe because it is a live vaccine
B) Women who do not receive Tdap during pregnancy should be vaccinated after delivery if they are due
