Module 4 Kelsey Chapter 6

Question 1

When considering the use of fetal movement counting for a particular patient, it is important to know that:

A) fetuses move constantly, so the counting can be done at any time.
B) fetal movement is strongest at 29–38 weeks.
C) most women do not feel the fetus move before 24 weeks.
D) there is only one way to perform fetal movement counts.

Answer 1

B) fetal movement is strongest at 29–38 weeks.

Fetal movement counting is a safe, simple, no-cost, noninvasive fetal assessment technique. Research has demonstrated that fetal activity is a good predictor of well-being. A dramatic decrease or cessation of such movement is cause for concern.

Question 2

On physical examination at an initial prenatal visit of a 25-year-old woman who is at 14 weeks’ gestation, you feel a 1-cm, mobile, well-defined, nontender mass in the upper, outer quadrant of her right breast. Your plan is to:

A) explain that this is normal with the hormonal changes of pregnancy.
B) advise the patient that you will watch this mass at each visit to assess for any change.
C) schedule a mammogram to be done in the third trimester.
D) refer the patient for further evaluation with biopsy.

Answer 2

B) advise the patient that you will watch this mass at each visit to assess for any change.

This well-defined, nontender mass has benign characteristics, and watching it would be an acceptable approach. A malignant breast mass is usually nontender, firm, irregularly shaped, and fixed to underlying tissue.

Question 3

The trophoblast will ultimately become the:

A) placenta.
B) embryo.
C) blastocyst.
D) umbilical cord.

Answer 3

A) placenta.

The trophoblast is an essential component of the placenta.

Question 4

The effect of pregnancy on the cardiovascular system is most clearly seen in:

A) lower diastolic blood pressure in the third trimester.
B) a 10% cardiac volume increase that peaks in midpregnancy.
C) a resting pulse increase of 10–15 beats in the first trimester.
D) a slight decrease in cardiac output in the second trimester.

Answer 4

B) a 10% cardiac volume increase that peaks in midpregnancy.

Cardiac volume increases by approximately 10% and peaks at about 20 weeks, and resting pulse increases by 10–15 beats per minute, with the peak occurring at 28 weeks.

Question 5

Pregnant for the third time, the patient has an obstetric history that indicates two miscarriages at 16 and 18 weeks, respectively, and one twin birth at 36 weeks. One twin died, but the other is alive and well. The four-digit descriptor of this history is:

A) 121
B) 221
C) 2021
D) 2201

Answer 5

A) 121

The patient has not had any term pregnancies, which accounts for the first number, 0. She had a preterm delivery at 36 weeks of twins, which accounts for the second number; even though these were twins, they still count as one number—thus, the 1. The patient had two miscarriages at less than 20 weeks, which accounts for the third number, a 2. The fourth number is the total number of living children. One of the patient’s twins died; therefore, she has only one living child.

Question 6

In an abdominal exam using Leopold’s maneuvers, the first step is to determine fetal:

A) attitude.
B) position.
C) engagement.
D) lie.

Answer 6

D) lie.

The first Leopold’s maneuver palpates for the fetal lie, followed by the presentation, position, and attitude.

Question 7

Contraindications to the CST include:

A) GA greater than 37 weeks.
B) history of ectopic pregnancy.
C) nonreactive NST.
D) placenta previa.

Answer 7

D) placenta previa.

Contraindications for a CST include previous classic cesarean section or myomectomy, placenta previa, the mother is at risk for preterm labor, gestational age less than 37 weeks, and multiple gestation.

Question 8

At the 32-week visit, a patient asks you to explain what you are looking for or feeling when doing her abdominal exam with Leopold’s maneuvers. You respond that you are:

A) determining the placement of the placenta.
B) finding the direction in which the fetus is lying.
C) evaluating the size of the uterus.
D) evaluating adequacy of fetal growth.

Answer 8

B) finding the direction in which the fetus is lying.

Leopold’s maneuvers consist of four abdominal palpation maneuvers used to determine the following fetal characteristics: lie, presentation, position, and attitude.

Question 9

Maternal serum alpha-fetoprotein screening is performed in what time frame during pregnancy?

A) 8–12 weeks
B) 12–15 weeks
C) 15–19 weeks
D) 20–24 weeks

Answer 9

C) 15–19 weeks

Second-trimester screening (also known as multiple marker screening) is performed between 15 and 20 weeks to detect neural tube defects and trisomies 18 and 21. Serologic testing measuring MSAFP, estriol, and hCG is called a triple screen; with the addition of inhibin A, this becomes a quad screen.

Question 10

A pregnant patient presents for her 24-week visit, at which time she relates that she does not feel very interested in sex anymore. Your response is to:

A) tell the patient that this is common and she should not be concerned.
B) reassure the patient that the interest will return in the third trimester.
C) tell the patient to get more rest and the interest will increase.
D) get the patient to talk about how she is feeling and thinking about sex.

Answer 10

D) get the patient to talk about how she is feeling and thinking about sex.

It is the healthcare provider’s role to listen and facilitate the patient’s expression of feelings and to provide a nonjudgmental environment.

Question 11

CVS has an advantage over amniocentesis because:

A) it can be done 3 to 4 weeks earlier.
B) there is less risk for infection.
C) there is less risk for limb deformities.
D) there is greater specificity in test results.

Answer 11

A) it can be done 3 to 4 weeks earlier.

An advantage of CVS over amniocentesis is that CVS can be performed between 10 and 13 weeks’ gestation, which is 3 to 4 weeks earlier than amniocentesis is feasible.

Question 12

Antepartal care for the patient who is HIV positive should focus mainly on:

A) ensuring fetal well-being at all cost.
B) frequent drug testing to ensure that the patient is not using IV street drugs.
C) testing the partner and providing treatment if necessary.
D) maintaining the patient’s health and preventing neonatal transmission.

Answer 12

D) maintaining the patient’s health and preventing neonatal transmission.

Maintaining the health of the patient and preventing vertical transmission to the neonate are the priorities when caring for people with HIV.

Question 13

The CDC recommends screening for GBS:

A) at the first visit.
B) when labor starts.
C) at 20 weeks.
D) at 35–37 weeks.

Answer 13

D) at 35–37 weeks.

GBS screening is performed at 35–37 weeks by swabbing the vaginal introitus and rectal specimens.

Question 14

During the embryonic stage, all major organ systems are formed except the:

A) heart.
B) reproductive organs.
C) liver.
D) lungs.

Answer 14

D) lungs.

All major organ systems are formed during the embryonic stage except for the lungs.

Question 15

The RDAs of calories and protein, respectively, during pregnancy are:

A) 3000 kcal and 50 g/day.
B) 3500 kcal and 60 g/day.
C) 3800 kcal and 60 g/day.
D) 2500 kcal and 60 g/day.

Answer 15

D) 2500 kcal and 60 g/day.

The Recommended Dietary Allowances for pregnancy are 2500 kcal/day and 60 g/day of protein.

Question 16

Exercise guidelines for healthy pregnant people include suggestions to:

A) discontinue exercise at 20 weeks.
B) begin an intense program of exercise, especially if prepregnant weight was high.
C) modify the existing program if symptoms occur.
D) limit fluids before exercising.

Answer 16

C) modify the existing program if symptoms occur.

In the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise per day on most, if not all, days of the week is recommended for pregnant women.

Question 17

Leg cramps during pregnancy may be relieved by:

A) pointing the toes.
B) hot compresses.
C) flexion of the foot.
D) hot tub baths.

Answer 17

C) flexion of the foot.

Leg cramps may be relieved by flexing the ankle to stretch the calf, decreasing phosphate in the diet, drinking no more than two glasses of milk per day, massaging the affected leg, keeping the legs warm, walking, exercising, and taking calcium tablets and magnesium tablets.

Question 18

Which of the following is an appropriate plan of care for a patient at 40 weeks’ gestation with a BPP score of 8, which includes a score of 2 for AFV?

A) Order a CST.
B) Repeat the BPP in 48 hours.
C) Schedule a return visit after 1 week.
D) Admit for induction of labor and delivery.

Answer 18

C) Schedule a return visit after 1 week.

A BPP score of 8/10 is a reassuring, normal score. BPP scoring interpretation criteria are as follows: 8–10 is normal; 6 is equivocal, repeat testing; 4 or less is considered abnormal and needs further evaluation.

Question 19

The calculation of EDB by Naegele’s rule is based on a(n):

A) 28-day menstrual cycle.
B) average length of pregnancy of 290 days.
C) 32-day cycle.
D) length of pregnancy of 270 days.

Answer 19

A) 28-day menstrual cycle.

The calculation of EDB by Naegele’s rule is based on a 28-day menstrual cycle, assuming the average length of pregnancy to be 280 days, or 10 lunar months.

Question 20

A pregnant patient presents at 32 weeks’ gestation with vaginal bleeding for the past 6 hours, back pain, and irregular abdominal cramping pain. Exam reveals diffuse abdominal tenderness and increased uterine tone. You suspect:

A) marginal placenta previa.
B) placental abruption.
C) preterm labor.
D) pyelonephritis.

Answer 20

B) placental abruption.

Placental abruption is premature separation of the placenta from the uterus; it may be partial or complete. Signs of placental abruption include vaginal bleeding, uterine tenderness and rigidity, contractions or uterine irritability and/or tone, and fetal tachycardia or bradycardia.

Question 21

A patient states that she is trying to get pregnant and had unprotected intercourse on day 14 of her usual 28-day menstrual cycle. However, the pregnancy test was negative 3 days later. Appropriate management would be to:

A) order an ultrasound.
B) prescribe progesterone.
C) repeat the test in a week.
D) order a serum pregnancy test.

Answer 21

C) repeat the test in a week.

The patient performed the test too early, so she needs to repeat the test in 1 week. Sensitive urine pregnancy tests can detect pregnancy approximately 1 week after conception.

Question 22

An NST containing two fetal heart accelerations lasting 15 seconds that are 15 beats per minute above the baseline is considered:

A) negative.
B) positive.
C) nonreactive.
D) reactive.

Answer 22

D) reactive.

A reactive NST constitutes two or more accelerations in FHR of 15 or more beats per minute lasting for 15 seconds or more within a 15- to 20-minute period.

Question 23

A patient presents for her first antepartal visit. She is 10 weeks pregnant and requests to listen for the FHT. You have a handheld Doppler available. Your response would be which of the following?

A) “No, there is no reason to listen because it cannot be heard until 18 weeks.”
B) “We can try to listen today. But we may not hear the heartbeat yet.”
C) “We can surely listen! We can definitely hear the heartbeat as early as 6.5 weeks.”
D) “We do not usually do that at any visit.”

Answer 23

B) “We can try to listen today. But we may not hear the heartbeat yet.”

FHTs can be auscultated by Doppler as early as 10 weeks, but this is done more commonly at 12 weeks.

Question 24

A patient presents for her 36-week visit. Abdominal exam reveals a likelihood of polyhydramnios. In response to her question about where the fluid comes from, you answer that it comes from:

A) the pregnant patient’s blood volume.
B) a combination of maternal serum and fetal urination.
C) amniotic epithelium and fetal functions.
D) fluid ingested by the mother.

Answer 24

C) amniotic epithelium and fetal functions.

Amniotic fluid is produced by the amniotic epithelium. Water transfers across the amnion and through the fetal skin. In the second trimester, the fetus starts to swallow, urinate, and inspire amniotic fluid.

Question 25

On reviewing the record of a currently pregnant patient, you see that she is P1112. What obstetric history can you derive from this information?

A) Two previous pregnancies, of which one infant was term and one was a premature stillbirth
B) You are unable to determine an obstetric history from this information.
C) Three pregnancies with one term birth and premature twins
D) Three pregnancies, of which one was term, one premature, and one an abortion

Answer 25

D) Three pregnancies, of which one was term, one premature, and one an abortion

The numbers represent a patient’s obstetric history, expressed via TPAL: one term delivery, one preterm delivery, one abortion (spontaneous or elective), and two living children.

Question 26

The drop in diastolic blood pressure that occurs during normal pregnancy is partly the result of:

A) plasma volume expansion.
B) progesterone’s effect on the vessel walls.
C) increased cardiac output.
D) pooling of plasma in the tissues.

Answer 26

B) progesterone’s effect on the vessel walls.

Diastolic blood pressure is lower in the first two trimesters because of the development of new vascular beds and the relaxation of peripheral tone by progesterone, which result in decreased flow resistance.

Question 27

Pregnancy loss and the patient’s need for appropriate grieving occur across the reproductive spectrum. Maladaptive grief reactions are best addressed by:

A) telling the patient to put the baby’s things away.
B) listening to whatever the patient has to say.
C) encouraging the patient to be strong so she will get past it.
D) making the patient an appointment with a therapist.

Answer 27

B) listening to whatever the patient has to say.

It is the healthcare provider’s role to listen and facilitate the patient’s expression of feelings and to provide a nonjudgmental environment.

Question 28

Which structure in human reproduction produces the most diverse and greatest quantity of steroid and protein hormones?

A) Trophoblast
B) Blastocyst
C) Chorion laeve
D) Deciduas basalis

Answer 28

A) Trophoblast

Human trophoblasts produce more diverse steroid and protein hormones and in greater amounts than does any endocrine tissue in all of mammalian physiology.

Question 29

A pregnant patient (G1 P0) comes for the 20-week visit. The abdominal exam shows the uterine fundus to be halfway between the symphysis and the umbilicus. This finding leads you to consider:

A) IUGR.
B) nothing, because it is normal.
C) oligohydramnios.
D) that the patient is not eating and gaining enough weight.

Answer 29

A) IUGR.

The fundus is typically found at the umbilicus at 20 weeks.

Question 30

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.

Answer 30

C) corpus luteum and placenta.

The corpus luteum is responsible for the secretion of progesterone to maintain the endometrium and pregnancy until the placenta takes over production.

Question 31

The maternal mortality ratio is defined as the number of maternal deaths that result from the reproductive process per:

A) 1000 live births.
B) 100,000 live births.
C) 100,000 pregnant women.
D) 100,000 reproductive-age women.

Answer 31

B) 100,000 live births.

The maternal mortality ratio is the number of maternal deaths that result from the reproductive process per 100,000 live births.

Question 32

Which of the following statements concerning influenza vaccination for pregnant patient is true?

A) Vaccination is recommended for all women who will be pregnant during the influenza season.
B) Pregnant women with HIV infection should not receive this vaccination.
C) The pregnant patient should be offered the option of either the injection or nasal administration of the vaccine.
D) Vaccination should be given only in the second or third trimester.

Answer 32

A) Vaccination is recommended for all women who will be pregnant during the influenza season.

The TIV is recommended for all pregnant women during influenza season; live attenuated nasal influenza vaccine is contraindicated during pregnancy.

Question 33

Which of the following is a presumptive sign of pregnancy seen in the vagina?

A) Hegar’s sign
B) Piskacek’s sign
C) Goodell’s sign
D) Chadwick’s sign

Answer 33

D) Chadwick’s sign

Chadwick’s sign is a presumptive sign of pregnancy. Presumptive sign of pregnancy refers to signs and symptoms that may be caused by pregnancy. Amenorrhea may be caused by sickness or stress.

Question 34

A primigravida at 13.5 weeks states that she is concerned because she has not felt the baby move yet. Your response should be which of the following?

A) “Most pregnant people with their first pregnancy do not feel movement until around 20 weeks.”
B) “You are worrying too much—just relax.”
C) “I will order an ultrasound just to be sure everything is fine.”
D) “I would like you to return in a week so we can recheck it.”

Answer 34

A) “Most pregnant people with their first pregnancy do not feel movement until around 20 weeks.”

Quickening is the maternal perception of fetal movement, which usually occurs between 18 and 20 weeks for primiparas; it occurs earlier for multigravidas, at about 14 to 18 weeks.

Question 35

The BPP assesses fetal well-being with:

A) a combination of NST and ultrasound evaluation to assess five variables.
B) both a CST and an ultrasound evaluation of AFV.
C) serial ultrasounds to evaluate AFV as well as fetal breathing and body movement and tone.
D) evaluation of fetal movement with kick counts after administration of oxytocin or nipple stimulation.

Answer 35

A) a combination of NST and ultrasound evaluation to assess five variables.

A BPP consists of five parameters: NST, breathing, movement, tone, and AFV.

Question 36

A patient indicates that she is afraid of oxytocin (Pitocin) because her sister had a uterine rupture when she was induced. Your response would be to:

A) reassure the patient because she will not need induction anyway.
B) discuss how oxytocin (Pitocin) is given, and provide assurance that nothing will go wrong.
C) discuss alternative methods to promote uterine readiness and contractions.
D) say that oxytocin (Pitocin) is the best way to get through labor and it is not a problem.

Answer 36

C) discuss alternative methods to promote uterine readiness and contractions.

Oxytocin (Pitocin) may be utilized to help initiate or facilitate labor by stimulating contraction of the uterine smooth muscle. Other methods may also be employed to promote uterine readiness and contractions, such as nipple stimulation.

Question 37

A patient comes in for her first antepartal visit. When asked the date of her last menstrual period, she indicates she has not had one since she has been nursing her 6-month-old daughter. You diagnose that she is pregnant. How would you determine EDB?

A) Determine when she expected to get her period and calculate from there.
B) Document quickening and extrapolate from there.
C) Send the patient to the fetal assessment unit for an ultrasound.
D) Get a good sexual history and use the last coitus as the basis for calculation.

Answer 37

C) Send the patient to the fetal assessment unit for an ultrasound.

If the patient is uncertain about the LMP, ultrasound may be used to calculate estimated GA.

Question 38

The characteristic gait of pregnancy results from:

A) a shift in the center of gravity as the uterus enlarges.
B) the effects of relaxin and estrogen.
C) the effects of relaxin and progesterone.
D) the effects of increasing amounts of estrogen and progesterone.

Answer 38

C) the effects of relaxin and progesterone.

Relaxin and progesterone affect cartilage and connective tissue, resulting in a loosening of the sacroiliac joint and symphysis pubis.

Question 39

A patient comes in for the first antepartal visit at 8 weeks and tells you that she has nausea every morning but is able to eat and drink in the afternoon. Your first step in management at this point would include:

A) a prescription for antinausea medicine.
B) vitamin B6 50 mg twice a day.
C) advising the patient to eat small, frequent meals.
D) advising the patient to drink a carbonated beverage on rising.

Answer 39

C) advising the patient to eat small, frequent meals.

Nausea and vomiting of pregnancy are most common in the first trimester. It is recommended that patients eat small, frequent meals, with no restriction on the kind of food or how often. Education includes discontinuing prenatal vitamins with iron until nausea and vomiting have resolved, but continuing folic acid. Other recommendations may include consuming raspberry tea, peppermint tea, carbonated beverages, or hard candy; using acupressure, including sea bands for wrists; taking ginger 1 g per day in divided doses, pyridoxine (vitamin B6) 25 mg BID or TID orally, doxylamine 12.5 mg BID or QID with pyridoxine orally, metoclopramide 5 to 10 mg g q6–8h orally, or promethazine 25 mg q4h per rectal suppository.

Question 40

Which of the elements of clinical pelvimetry defines the midplane?

A) Diagonal conjugate
B) Intertuberous diameter
C) Ischial spines distance and sacrum
D) Pubic arch

Answer 40

C) Ischial spines distance and sacrum

The distance between the ischial spines normally measures 10 cm, is the smallest diameter of the pelvis, and defines the midplane.

Question 41

The fetal system most closely associated with oligohydramnios is the:

A) GI system.
B) CNS.
C) renal system.
D) cardiovascular system.

Answer 41

C) renal system.

Oligohydramnios is associated with genitourinary abnormalities in the fetus.

Question 42

A pregnant patient comes for a 24-week visit and mentions that her interest in sex has increased greatly. You respond to this concern because you know that increased libido is:

A) a normal variation of response in pregnancy.
B) an abnormal response of changing image.
C) reflective of repressed desire to disrupt the pregnancy.
D) the early sign of a parenting disorder.

Answer 42

A) a normal variation of response in pregnancy.

Increased libido is a normal variation of response in pregnancy.

Question 43

Initial management of constipation in pregnancy should include suggestions for:

A) increased protein intake.
B) limitation of calcium-rich foods.
C) use of a laxative.
D) increased intake of fiber and fluids.

Answer 43

D) increased intake of fiber and fluids.

The first line of treatment for constipation is to increase fluids and fiber. Other strategies are to recommend prune juice or a warm beverage in the morning and to encourage exercise and stool softeners.

Question 44

Normal findings on speculum and pelvic examination of a pregnant person include:

A) bluish color of the cervix.
B) pale vaginal mucosa.
C) an open cervical os.
D) a firm, slightly enlarged cervix.

Answer 44

A) bluish color of the cervix.

A normal finding in pregnancy is Chadwick’s sign—the changing of the color of the cervix to a bluish hue.

Question 45

A patient’s (G2 P1001) initial visit reveals a healthy pregnant patient. The urinalysis and culture and sensitivity (C&S) report indicates a colony count of greater than 100,000 organisms per milliliter. You would:

A) refer the patient to a urologist to evaluate for underlying renal disease.
B) encourage fluids and repeat C&S in 2 weeks.
C) initiate treatment with antibiotics.
D) advise the patient to contact you in case of any UTI symptoms.

Answer 45

C) initiate treatment with antibiotics.

A diagnosis of a UTI can be made by finding 100,000 colonies of pathogenic bacteria in a urinary culture. Treatment with appropriate antibiotics is necessary. Untreated asymptomatic bacteriuria may lead to pyelonephritis, which may lead to serious complications for both mother and baby.

Question 46

The etiology of polyhydramnios is associated with:

A) maternal overhydration.
B) fetal anomalies of the GI tract.
C) fetal anomalies of the cardiovascular system.
D) maternal preeclampsia with edema.

Answer 46

B) fetal anomalies of the GI tract.

The etiology of polyhydramnios may include CNS or GI tract fetal anomalies.

Question 47

A 32-year-old patient (G1 P1001), during a discussion of infant care and breastfeeding, says, “My first baby did not like the breast, then I did not have enough milk, so I stopped breastfeeding after 2 weeks.” What is your response to her statement?

A) Tell the patient that she probably misinterpreted what was going on and should not have stopped nursing.
B) Delve further into what occurred and how the patient came to the conclusions that led her to stop breastfeeding.
C) Let the patient know that she probably was not drinking enough fluids, so she did not have enough milk to feed the baby.
D) Reassure the patient that she was listening to her body and did the right thing for herself and her infant.

Answer 47

B) Delve further into what occurred and how the patient came to the conclusions that led her to stop breastfeeding.

It is the healthcare provider’s role to listen and facilitate the patient’s expression of feelings and to provide a nonjudgmental environment.

Question 48

Diabetes screening recommendations during pregnancy for the obese patient:

A) include fasting blood glucose each trimester.
B) include testing hemoglobin A1c in the first trimester.
C) include routine screening early in pregnancy and at 24–28 weeks.
D) are the same as for the normal-weight patient.

Answer 48

C) include routine screening early in pregnancy and at 24–28 weeks.

High-risk obstetric patients need to be screened for diabetes as soon as possible using standard diagnostic testing.

Question 49

Serial beta hCG levels are done after uterine evacuation for hydatidiform mole to:

A) ensure that the woman is not pregnant in the first year after treatment.
B) monitor for persistent trophoblastic proliferation.
C) identify a pregnancy early so appropriate care can be provided.
D) assess for a possible undetected ectopic pregnancy.

Answer 49

B) monitor for persistent trophoblastic proliferation.

Weekly serial beta hCG levels are recommended after surgical evacuation for hydatidiform mole to monitor for persistent trophoblastic proliferation and identify metastatic disease, including choriocarcinoma.

Question 50

The uterus is palpable at the symphysis pubis at:

A) 6 weeks’ gestation.
B) 8 weeks’ gestation.
C) 12 weeks’ gestation.
D) 16 weeks’ gestation.

Answer 50

C) 12 weeks’ gestation.

The uterus is palpable at the symphysis pubis at 12 weeks. This is also the time that the fetus begins to make spontaneous movements in utero.

Question 51

At the initial visit of a primigravida patient, you heard a Grade I systolic murmur. Your next step in management would be:

A) a cardiology consult.
B) chest radiograph.
C) immediate referral.
D) no intervention.

Answer 51

D) no intervention.

Approximately 90% of pregnant women develop a physiologic systolic heart murmur. They may exhibit exaggerated splitting of S1, an audible third sound, or a soft transient diastolic murmur.

Question 52

Which of the following would not be a normal physical examination finding during pregnancy?

A) Blue color of vaginal mucosa and cervix
B) Hypertrophy of nasal mucosa and gums
C) Mildly enlarged, nodular thyroid
D) Thickening of vaginal mucosa

Answer 52

C) Mildly enlarged, nodular thyroid

A mildly enlarged, nodular thyroid is an abnormal physical exam finding. The other findings are normal findings in pregnancy.

Question 53

During the initial prenatal visit, the patient mentions that she had a rubella immunization 3 weeks before conceiving this baby. Your plan is to:

A) advise the patient to consider termination of the pregnancy.
B) continue regular care.
C) consult with an infectious disease specialist.
D) refer the patient to a perinatologist.

Answer 53

D) refer the patient to a perinatologist.

There are no documented cases of congenital rubella syndrome from vaccination, but it is recommended to give the vaccine at least 4 weeks before attempting a pregnancy or postpartum; the vaccine may be given while breastfeeding.

Question 54

Amniocentesis is used in early pregnancy to:

A) screen for fetal anomalies.
B) diagnose fetal genetic well-being.
C) evaluate maternal genetic problems.
D) determine AFI and muscle tone.

Answer 54

A) screen for fetal anomalies.

Amniocentesis is used in early pregnancy to obtain amniotic fluid to be sent for chromosomal studies.

Question 55

Clinical pelvimetry of a person with an adequate pelvis would provide which of the following findings?

A) Ischial tuberosities of 10 cm and a flat sacrum
B) Convergent sidewalls
C) Pubic arch of 90 degrees with diagonal conjugate of longer than 11.5 cm
D) Protuberant ischial spines

Answer 55

C) Pubic arch of 90 degrees with diagonal conjugate of longer than 11.5 cm

The pubic arch is formed by the descending rami of pubic bones and the inferior margin of the symphysis pubis; the angle should be at least 90 degrees.

Question 56

The determination of an accurate EDB is best accomplished by using:

A) the first day of the LMP.
B) a complete menstrual history.
C) the use of Naegele’s rule.
D) the date when symptoms of pregnancy began.

Answer 56

A) the first day of the LMP.

A complete menstrual history, which includes determining the first day of the LMP and the length of menstrual cycles, allows for a more accurate EDB.

Question 57

A primigravida came in for a visit at 34 weeks, stating that she is having “a lot of vaginal discharge” but no other symptoms or problems. On exam, you see a white, odorless discharge of moderate quantity. Your next step would be to:

A) treat for candida.
B) evaluate for trichomoniasis.
C) reassure the patient that this is normal.
D) send a vaginal culture.

Answer 57

C) reassure the patient that this is normal.

Absent any other symptoms besides increased vaginal discharge in a 34-week pregnant woman, and without odor or other presenting abnormal findings, reassurance may be given to the mother that an increase in vaginal discharge is normal in pregnancy. If there is further concern, rule out pathology.

Question 58

The vessels of the umbilical cord consist of:

A) one vein carrying oxygenated blood and two arteries carrying deoxygenated blood.
B) one vein carrying deoxygenated blood and two arteries carrying oxygenated blood.
C) two veins carrying oxygenated blood and one artery carrying deoxygenated blood.
D) two veins carrying deoxygenated blood and one artery carrying oxygenated blood.

Answer 58

A) one vein carrying oxygenated blood and two arteries carrying deoxygenated blood.

The umbilical cord contains two arteries that carry fetal deoxygenated blood to the placenta and that are smaller in diameter than the vein, and one vein that carries oxygenated blood from the placenta to the fetus and that is characterized by twisting or spiraling to minimize snarling.

Question 59

A patient comes for her 34-week visit, at which time the fundus measures 39 cm. Abdominal palpation reveals a large uterus and difficulty feeling fetal parts. The most likely diagnosis is:

A) multiple gestation.
B) macrosomic fetus.
C) uterine fibroid.
D) polyhydramnios.

Answer 59

D) polyhydramnios.

Polyhydramnios is indicated by uterine size larger than expected for GA, difficulty auscultating FHR and palpating fetal parts, and mechanical pressure exerted by the large uterus.

Question 60

The term conceptus means:

A) the embryo and placenta.
B) the embryo and membranes.
C) the embryo, membranes, and placenta.
D) the embryo, membranes, placenta, and endometrium.

Answer 60

C) the embryo, membranes, and placenta.

A conceptus comprises all tissue products of conception: embryo (fetus), fetal membranes, and placenta.

Question 61

Blood glucose monitoring for an obstetric patient with gestational diabetes should be done:

A) once a week, at the same time each week.
B) two times daily: 1 hour after the smallest and largest meals of the day.
C) four times daily: fasting and 1 or 2 hours after each meal.
D) three times daily: 1 hour before each meal.

Answer 61

C) four times daily: fasting and 1 or 2 hours after each meal.

Based on available data, glucose monitoring for obstetric patients diagnosed with gestational diabetes is to check their blood sugar levels four times daily: fasting, plus 1 or 2 hours after each meal.

Question 62

A person who is pregnant for the second time and whose first pregnancy ended with a spontaneous abortion at 10 weeks is a:

A) multigravida.
B) multipara.
C) primigravida.
D) primipara.

Answer 62

A) multigravida.

A multigravida is a person who has been pregnant two or more times, regardless of the result of the pregnancies.

Question 63

The usual 1-g drop in hemoglobin during pregnancy is due to:

A) a blood volume increase of 30% to 50%.
B) a decrease in iron absorption.
C) decreased production of red blood cells.
D) the increasing iron needs of the fetus.

Answer 63

A) a blood volume increase of 30% to 50%.

Blood volume increases 30% to 50% from nonpregnant levels and plasma volume expands, which result in a physiologic anemia.

Question 64

During the first few weeks of pregnancy, progesterone is secreted by the:

A) placenta.
B) corpus luteum.
C) endometrium.
D) trophoblasts.

Answer 64

B) corpus luteum.

Progesterone is secreted by the corpus luteum. Progesterone is essential in preparing the uterus for implantation of the fertilized ovum and maintaining the pregnancy.

Question 65

A patient at 37 weeks calls to say that she feels as if the fetus is moving less. After further inquiry, you decide to send her for an NST. When the patient asks what this test is, you explain that it is an assessment of fetal well-being based on:

A) evaluation of body movements.
B) breathing movements.
C) FHR response to fetal movement.
D) fetal body tone.

Answer 65

C) FHR response to fetal movement.

An NST is a method to assess fetal well-being by observing the FHR response to fetal movement.

Question 66

A 24-year-old primigravida presents for her initial visit and asks how the fetus has genes from both her husband and herself. Your response is based on which of the following concepts?

A) Mitosis occurs, producing half the number of chromosomes.
B) Meiosis occurs, producing half the number of chromosomes.
C) The egg is a somatic cell.
D) Sperm is a somatic cell.

Answer 66

B) Meiosis occurs, producing half the number of chromosomes.

Meiosis is the process of two successive cell divisions, producing cells, egg, or sperm that contain half the number of chromosomes found in somatic cells.

Question 67

A primigravida patient asks about the value of childbirth preparation classes during a second-trimester visit. You tell the patient that evidence indicates that these classes are associated with:

A) reduced use of analgesics/anesthesia during labor.
B) improved parenting skills.
C) decreased cesarean rates.
D) less use of IVs in labor.

Answer 67

A) reduced use of analgesics/anesthesia during labor.

Preparation for childbearing ultimately aids in reducing the need for analgesics and anesthetics during labor.

Question 68

The value of clinical pelvimetry rests in its ability to:

A) predict successful vaginal birth.
B) identify the characteristics of the person’s pelvis.
C) determine whether the person will have a breech presentation.
D) predict an occiput posterior position.

Answer 68

B) identify the characteristics of the person’s pelvis.

Identifying the characteristics of the person’s pelvis is clinically significant because the pelvis is the bony canal through which the fetus passes.

Question 69

The basis for the NST to assess fetal well-being is that:

A) fetal movement will increase the patient’s heart rate.
B) the fetus responds to an increase in heart rate by accelerating movement.
C) fetal movement should cause no significant change in FHR.
D) FHR accelerates in association with fetal movement.

Answer 69

D) FHR accelerates in association with fetal movement.

The NST is a method to assess fetal well-being by observing the fetal heart rate response to fetal movement.

Question 70

Dating of pregnancy by USG is most accurate in the first trimester using:

A) CRL.
B) HC.
C) AC.
D) FL.

Answer 70

A) CRL.

Question 71

The pelvic planes of obstetric significance are the:

A) inlet, midplane, and outlet.
B) inlet, posterior outlet, and anterior outlet.
C) inlet, posterior midplane, and anterior midplane.
D) linea terminalis, posterior outlet, and anterior outlet.

Answer 71

A) inlet, midplane, and outlet.

Question 72

A patient has experienced three spontaneous abortions and is now pregnant for the fourth time. The term that defines this patient’s obstetric status is:

A) multipara.
B) nullipara.
C) primigravida.
D) primipara.

Answer 72

B) nullipara.

Nullipara is the term for a person who has not carried a baby to 500 g or 20 weeks.

Question 73

Changes in the respiratory system due to pregnancy may cause:

A) tachypnea.
B) cough.
C) increased chest diameter.
D) pale nasal mucosa.

Answer 73

C) increased chest diameter.

Thoracic circumference increases by 5–6 cm, and residual volume decreases.

Question 74

The human zygote has:

A) 46 chromosomes from each parent.
B) 2 pairs of sex chromosomes.
C) 23 chromosomes.
D) 23 pairs of chromosomes.

Answer 74

D) 23 pairs of chromosomes.

The human zygote contains the haploid number of chromosomes: 23 pairs. It possesses half the diploid or normal number of pairs of chromosomes, 46 pairs, found in somatic, or body, cells.

Question 75

A patient who is 11 weeks pregnant calls you from the emergency department to say that she sustained a laceration and the hospital providers want to give her a tetanus booster. You would tell her that:

A) all vaccinations are contraindicated in pregnancy.
B) it is not a problem because she does not need the tetanus booster.
C) the tetanus booster can be given in pregnancy if needed.
D) she should wait until the third trimester.

Answer 75

C) the tetanus booster can be given in pregnancy if needed.

Tetanus vaccination during pregnancy can protect at-risk newborns against neonatal tetanus; in maternal trauma, it may be indicated.

Question 76

A patient comes for the first pregnancy visit. The obstetric history includes one spontaneous abortion, one termination of pregnancy, one infant born at 36 weeks, and one infant born at 41 weeks. Both infants are living. This patient’s parity is:

A) 2022
B) 2122
C) 1212
D) 1122

Answer 76

D) 1122

TPAL represents a patient’s obstetric history. This patient has had one term pregnancy, one preterm pregnancies, two abortions, and two live children.

Question 77

Which of the following statements most accurately reflects the growth of the pregnant uterus?

A) At 14 weeks, it begins to rise out of the pelvis, and at 24 weeks is at the umbilicus.
B) At 14 weeks, it is halfway to the umbilicus, and at 20 weeks is at the umbilicus.
C) At 12 weeks, it begins to rise out of the pelvis, and at 20 weeks is at the umbilicus.
D) At 10 weeks, it begins to rise out of the pelvis, and at 16 weeks is at the umbilicus.

Answer 77

C) At 12 weeks, it begins to rise out of the pelvis, and at 20 weeks is at the umbilicus.

At 12 weeks’ gestation, the uterus becomes an abdominal organ and rises out of the pelvis. At 20 weeks, the uterus is typically found at the umbilicus.

Question 78

Anticipatory guidance concerning sexual activity during pregnancy includes which of the following?

A) Sexual intercourse may continue until the early third trimester in an uncomplicated pregnancy.
B) Sexual intercourse is contraindicated throughout pregnancy if there is a past history of preterm labor.
C) The pregnant person’s sexual desire may change throughout pregnancy.
D) Most pregnant women do not desire sex after the first trimester.

Answer 78

C) The pregnant person’s sexual desire may change throughout pregnancy.

Changes in sexual desire throughout pregnancy are influenced by hormones, energy level, the relationship with the sexual partner, body image, fears of hurting the baby, and cultural beliefs and practices.

Question 79

The fatigue of early pregnancy is best managed by:

A) ruling out a thyroid problem.
B) encouraging increased exercise.
C) encouraging increased amounts of caffeinated drinks.
D) reassurance and rest.

Answer 79

D) reassurance and rest.

Provide patients with reassurance that fatigue is a normal first-trimester problem and will pass. Other recommendations include getting mild exercise and good nutrition, decreasing activities and planning rest periods, and decreasing fluid intake in the evening to decrease nocturia.

Question 80

Appropriate routine screening tests at an 18-week visit include:

A) gestational diabetes testing.
B) chlamydia and gonorrhea tests.
C) CBC or hematocrit.
D) multiple marker screen.

Answer 80

D) multiple marker screen.

Second-trimester screening (also known as multiple marker screening) is performed between 15 and 20 weeks to detect neural tube defects and trisomies 18 and 21.

Question 81

Breastfeeding should be encouraged for:

A) all women whose families strongly support the idea.
B) all pregnant women who are not HIV positive.
C) women with adequate breast tissue.
D) women who desire to do so.

Answer 81

B) all pregnant women who are not HIV positive.

Breastfeeding is recommended for all women except for women who are HIV positive and are untreated, have active tuberculosis (TB), use illicit drugs, or take prescribed cancer chemotherapy agents.

Question 82

Which of the following are parts of the placenta?

A) Trophoblasts, chorion, amnion
B) Trophoblasts, chorion, endometrium
C) Chorion, amnion, umbilical cord
D) Intervillous spaces, endometrium, trophoblasts

Answer 82

A) Trophoblasts, chorion, amnion

arts of the placenta are trophoblasts, chorion, amnion and chorionic villi, intervillous spaces, and decidual plate.

Question 83

The recommended folic acid supplement for a woman with a past history of a baby with a neural tube defect is:

A) 4 mg per day starting before conception.
B) 0.4 mg per day starting with a missed period.
C) 2 mg per day prior to conception.
D) 0.4 mg per day throughout pregnancy.

Answer 83

A) 4 mg per day starting before conception.

A 0.4-mg daily supplement of folic acid is recommended for women of childbearing age, and a 4-mg daily supplement prior to and during pregnancy is recommended for women with a history of previous infant with neural tube defect.

Question 84

A post-term pregnancy is best diagnosed by:

A) certain LMP.
B) third-trimester ultrasound.
C) fundal growth.
D) quickening.

Answer 84

A) certain LMP.

Dating a pregnancy is most accurate with a certain LMP.

Question 85

The screening test for GBS requires that the specimen be obtained from the:

A) ectocervix and vaginal sidewalls.
B) ectocervix and endocervical os.
C) endocervical os and rectum.
D) vaginal introitus and rectum.

Answer 85

D) vaginal introitus and rectum.

GBS screening is performed at 35–37 weeks by swabbing the vaginal introitus and rectal specimens.

Question 86

Blood in the chorionic villi pertains to the circulation of the:

A) pregnant person.
B) pregnant person and fetus.
C) placenta.
D) fetus.

Answer 86

D) fetus.

The chorionic villi develop from the outer wall of the blastocyst, which establishes an intimate connection with the endometrium and gives rise to the placenta.

Question 87

Determining an accurate EDB is critical because:

A) it is the basis for making decisions toward the end of the pregnancy.
B) mothers want to know the exact date the baby will be born.
C) it is all that is needed to plan a 37-week elective cesarean section.
D) families want to make plans around the baby’s birth.

Answer 87

A) it is the basis for making decisions toward the end of the pregnancy.

Determining an accurate EDB is critical because an accurate estimation of the date of birth is the basis for making decisions toward the end of the pregnancy.

Question 88

At the 36-week visit, a pregnant patient tells you that she is having nightmares that include labor as well as fears of having an abnormal baby. Your best response is to:

A) tell the patient there is nothing to worry about because most babies are fine.
B) encourage the patient to tell you more about the nightmares and fears.
C) make an appointment for the patient with a mental health nurse practitioner.
D) reassure the patient that there are dangers about which we all have to worry.

Answer 88

B) encourage the patient to tell you more about the nightmares and fears.

It is the healthcare provider’s role to listen and facilitate a patient’s expression of feelings and to provide a nonjudgmental environment.

Question 89

The triple screen tests for:

A) AFP, progesterone, and hCG.
B) AFP, estriol, and hCG.
C) estriol, progesterone, and hPL.
D) estradiol, progesterone, and AFP.

Answer 89

B) AFP, estriol, and hCG.

Second-trimester screening (also known as multiple marker screening) is performed between 15 and 20 weeks to detect neural tube defects and trisomies 18 and 21. Serologic testing measuring MSAFP, estriol, and hCG is called a triple screen; with the addition of inhibin A, this becomes a quad screen.

Question 90

Pregnancy tests detect:

A) estrogen.
B) hCG.
C) hPL.
D) progesterone.

Answer 90

B) hCG.

The placenta secretes hCG hormone to help maintain corpus luteum function and production of progesterone; levels found in serum and urine assays of pregnant women are detected in pregnancy tests.

Question 91

Drugs from which one of the following categories may be given to pregnant patients when the potential benefit justifies the potential fetal risk?

A) Category A
B) Category B
C) Category C
D) Category X

Answer 91

C) Category C

For drugs in Category C, animal studies have shown an adverse effect or no animal studies have been conducted, and there are no adequate and well-controlled studies in pregnant patients.

Question 92

When speaking with a primigravida about the way a baby develops, you would describe the embryonic stage as the:

A) period between the second and eighth weeks.
B) time from implantation to 12 weeks into pregnancy.
C) period when drugs are least likely to affect development.
D) period from fertilization to 4 weeks.

Answer 92

A) period between the second and eighth weeks.

Embryonic development is the period of organogenesis, which begins in the third week after fertilization, and spans 8 weeks; around the time, a woman may miss her next menstrual period and pregnancy tests will turn positive by detecting hCG.

Question 93

A patient comes to the office indicating her menstrual period is 1 month overdue. The level of pregnancy diagnosis is:

A) positive.
B) presumptive.
C) possible.
D) probable.

Answer 93

B) presumptive.

Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy refer to signs and symptoms that may be caused by something else. Amenorrhea may be caused by sickness or stress.

Question 94

Polyhydramnios is defined as:

A) AFI greater than 10 cm.
B) a single pocket greater than 5 cm.
C) AFI greater than 15 cm.
D) a single pocket greater than 8 cm.

Answer 94

D) a single pocket greater than 8 cm.

Polyhydramnios is an excess of amniotic fluid diagnosed as an AFI greater than or equal to 24 cm or a maximum deepest vertical pocket of equal to or greater than 8 cm.

Question 95

Recommended routine screening tests at an initial antenatal visit during the first trimester include:

A) GBS culture.
B) syphilis serology.
C) triple marker screen.
D) ultrasound.

Answer 95

B) syphilis serology.

Obtaining syphilis serology is a recommended routine screening for the first initial antenatal visit during the first trimester.

Question 96

During the last 8 weeks of pregnancy, the fetus:

A) finishes the final formation of the renal system.
B) completes the development of reproductive organs.
C) experiences the closure of the foramen ovale.
D) increases weight through fat accumulation.

Answer 96

D) increases weight through fat accumulation.

During 32–36 weeks of the gestation, the fetus continues to increase weight as more subcutaneous fat accumulates.

Question 97

A pregnant patient who is 5 ft 3 in tall has a pre-pregnancy weight of 115 lb. Which of the following represents the most appropriate weight for this patient by the end of her pregnancy?

A) 120 lb
B) 125 lb
C) 145 lb
D) 165 lb

Answer 97

C) 145 lb

Weight gain recommendations in pregnancy: for underweight women (BMI < 18.5), 1.0–1.3 lb per week in the second and third trimesters, for a total of 28–40 lb; for normal-weight patients (BMI 18.5–24.9), 0.8–1.0 lb per week during the second and third trimesters, for a total of 25–35 lb; for overweight patients (BMI 25.0–29.9), 0.5–0.7 lb per week in the second and third trimesters, for a total of 15–25 lb; for obese women (BMI > 30.0), 0.4–0.6 lb per week in the second and third trimesters, for a total of 11–20 lb.

Question 98

A patient comes for her 36-week visit, during which she mentions that her hands and feet are somewhat swollen. The patient has gained 2 lb since the last visit 2 weeks ago; her blood pressure is 128/76 mm Hg and she has no protein in her urine. What is your plan?

A) Refer the patient to a perinatologist for impending preeclampsia.
B) Explain that the edema at this stage is normal and see the patient in a week.
C) Order bed rest with a return visit in a week.
D) Restrict salt and fluid intake.

Answer 98

B) Explain that the edema at this stage is normal and see the patient in a week.

The patient is gaining appropriate weight and is normotensive, without protein in her urine, and without any severe features of preeclampsia. She can be reassured that edema at this stage in the pregnancy is normal. If she exhibits any other symptoms, however, she would need to be evaluated by a healthcare provider.

Question 99

A patient comes for a first visit at 11 weeks’ gestation. Her history reveals her concern about sore gums that sometimes bleed. You think that:

A) the patient most likely needs to see a periodontist.
B) gingivitis is common in pregnancy with increased vascularity of connective tissue.
C) the patient should be started on antibiotics to prevent systemic infection.
D) the patient should be placed on a soft diet until the problem is resolved.

Answer 99

B) gingivitis is common in pregnancy with increased vascularity of connective tissue.

Gingivitis often occurs during pregnancy and may result in bleeding of gums.

Question 100

Of the four pelvic types, which is more likely to lead to a posterior position with higher possibility of dystocia?

A) Android
B) Platypelloid
C) Anthropoid
D) Gynecoid

Answer 100

A) Android

An android pelvic type is commonly known as a male pelvis. Approximately 32.5% of white women and 15.7% of nonwhite women have this type of heavy, heart-shaped pelvis, which leads to increased posterior positions, dystocia, and operative births.

Question 101

Implantation occurs ________ after fertilization.

A) 24–48 hours
B) 3–4 days
C) 6–7 days
D) 9–10 days

Answer 101

C) 6–7 days

Implantation occurs 6–7 days after fertilization and usually in the upper, posterior wall of the uterus.

Question 102

Which of the following is considered a risk factor for psychological well-being in pregnancy?

A) Limited support network
B) Introversion at any point
C) Ambivalence any time
D) Concern about the danger signs

Answer 102

A) Limited support network

Risk factors for psychological well-being include having a limited support network, high levels of stress, psychological/mental health issues, and problem pregnancies.

Question 103

Placental transport of oxygen and glucose occurs by:

A) simple perfusion.
B) facilitated diffusion.
C) active osmosis.
D) active perfusion.

Answer 103

B) facilitated diffusion.

Both oxygen and glucose are transported across the placenta via facilitated diffusion.

Question 104

A pregnant patient comes in for her first antepartal visit. She is 5 ft 4 in and weighs 190 lb (BMI = 33). Her weight goal for the pregnancy should be to:

A) maintain current weight.
B) gain 11–20 lb.
C) gain 25–35 lb.
D) lose 10–15 lb.

Answer 104

B) gain 11–20 lb.

For obese women who have a pre-pregnancy BMI > 30, the recommended weight gain is 0.4–0.6 lb per week in the second and third trimesters, for a total of 11 to 20 lb.