NU 661 Exam 3 V1 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 3) | Regis
1. A 28-year-old multigravida at 28 weeks’ gestation presents for her routine prenatal visit.
Which of the following screenings and assessments are indicated at this specific gestational
age? (Select all that apply)
A. 1-hour glucose challenge test (GCT)
B. Antibody screen for Rh-negative patients
C. Group B Streptococcus (GBS) vaginal-rectal culture
D. Assessment of fetal kick counts
E. Cystic Fibrosis carrier screening
F. Repeat Hemoglobin and Hematocrit (H&H)
Correct Answer: A, B, D, F
At the 28-week milestone, clinicians focus on screening for gestational diabetes and
checking for physiological anemia of pregnancy. Rh-negative mothers require an antibody
screen before the administration of Rho(D) immune globulin. Fetal kick counts are typically
initiated around this time to monitor fetal well-being, whereas GBS screening is reserved
for 36 0/7 to 37 6/7 weeks.
,2. A patient at 32 weeks’ gestation reports a sudden gush of clear fluid from the vagina.
Which diagnostic finding most strongly supports a diagnosis of Preterm Premature Rupture of
Membranes (PPROM)?
A. Presence of clue cells on a wet mount
B. Ferning pattern on a dried slide of vaginal fluid
C. A vaginal pH of 4.5
D. Negative nitrazine test (yellow color)
Correct Answer: B
Microscopic examination of amniotic fluid typically reveals a ferning pattern when dried
on a slide due to salt crystallization. Amniotic fluid is alkaline, which would result in a
nitrazine test turning blue rather than remaining yellow. Clue cells are diagnostic of
bacterial vaginosis and are unrelated to the status of the amniotic membranes.
3. Which of the following is considered a ‘positive’ sign of pregnancy, confirming the
diagnosis beyond doubt?
A. Positive urine hCG test
B. Chadwick’s sign
C. Auscultation of fetal heart tones by a provider
D. Amenorrhea and morning sickness
Correct Answer: C
, Positive signs of pregnancy are those that can only be attributed to the presence of a fetus,
such as fetal heart tones or visualization by ultrasound. Probable signs like Chadwick’s sign
or a positive hCG test can sometimes be caused by other conditions like pelvic congestion
or molar pregnancies. Presumptive signs are subjective experiences of the mother, such as
nausea or breast tenderness.
4. A woman at 36 weeks’ gestation presents with painless, bright red vaginal bleeding. What
is the most appropriate initial management step?
A. Perform a digital cervical exam to check for dilation
B. Administer oxytocin to stabilize the uterus
C. Induce labor immediately
D. Perform an ultrasound to determine placental location
Correct Answer: D
Painless vaginal bleeding in the third trimester is highly suggestive of placenta previa. A
digital cervical examination is strictly contraindicated until the position of the placenta is
confirmed, as it can cause catastrophic hemorrhage. Ultrasound is the diagnostic tool of
choice to safely visualize the relationship between the placenta and the internal cervical os.
5. A postpartum woman who is breastfeeding reports a painful, reddened area on her right
breast and a fever of 101.4°F. What is the first-line antibiotic treatment for this condition?
A. Metronidazole
B. Ciprofloxacin
, C. Dicloxacillin
D. Doxycycline
Correct Answer: C
The patient’s symptoms are classic for lactational mastitis, often caused by Staphylococcus
aureus. Dicloxacillin or cephalexin are the preferred first-line treatments due to their
effectiveness against penicillinase-producing staph. Patients should be encouraged to
continue breastfeeding or pumping to ensure the affected breast is frequently emptied.
6. Which of the following describes the correct measurement of fundal height in a singleton
pregnancy?
A. Measurement from the umbilicus to the fundus
B. Measurement from the iliac crest to the fundus
C. Measurement from the xiphoid process to the fundus
D. Measurement from the symphysis pubis to the top of the fundus
Correct Answer: D
McDonald’s rule states that fundal height in centimeters should roughly correlate with the
weeks of gestation between 20 and 36 weeks. The measurement is taken along the midline
of the abdomen from the upper edge of the symphysis pubis to the highest point of the
uterine fundus. Variations of more than 2-3 cm from the expected gestational age require
further investigation via ultrasound.
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 3) | Regis
1. A 28-year-old multigravida at 28 weeks’ gestation presents for her routine prenatal visit.
Which of the following screenings and assessments are indicated at this specific gestational
age? (Select all that apply)
A. 1-hour glucose challenge test (GCT)
B. Antibody screen for Rh-negative patients
C. Group B Streptococcus (GBS) vaginal-rectal culture
D. Assessment of fetal kick counts
E. Cystic Fibrosis carrier screening
F. Repeat Hemoglobin and Hematocrit (H&H)
Correct Answer: A, B, D, F
At the 28-week milestone, clinicians focus on screening for gestational diabetes and
checking for physiological anemia of pregnancy. Rh-negative mothers require an antibody
screen before the administration of Rho(D) immune globulin. Fetal kick counts are typically
initiated around this time to monitor fetal well-being, whereas GBS screening is reserved
for 36 0/7 to 37 6/7 weeks.
,2. A patient at 32 weeks’ gestation reports a sudden gush of clear fluid from the vagina.
Which diagnostic finding most strongly supports a diagnosis of Preterm Premature Rupture of
Membranes (PPROM)?
A. Presence of clue cells on a wet mount
B. Ferning pattern on a dried slide of vaginal fluid
C. A vaginal pH of 4.5
D. Negative nitrazine test (yellow color)
Correct Answer: B
Microscopic examination of amniotic fluid typically reveals a ferning pattern when dried
on a slide due to salt crystallization. Amniotic fluid is alkaline, which would result in a
nitrazine test turning blue rather than remaining yellow. Clue cells are diagnostic of
bacterial vaginosis and are unrelated to the status of the amniotic membranes.
3. Which of the following is considered a ‘positive’ sign of pregnancy, confirming the
diagnosis beyond doubt?
A. Positive urine hCG test
B. Chadwick’s sign
C. Auscultation of fetal heart tones by a provider
D. Amenorrhea and morning sickness
Correct Answer: C
, Positive signs of pregnancy are those that can only be attributed to the presence of a fetus,
such as fetal heart tones or visualization by ultrasound. Probable signs like Chadwick’s sign
or a positive hCG test can sometimes be caused by other conditions like pelvic congestion
or molar pregnancies. Presumptive signs are subjective experiences of the mother, such as
nausea or breast tenderness.
4. A woman at 36 weeks’ gestation presents with painless, bright red vaginal bleeding. What
is the most appropriate initial management step?
A. Perform a digital cervical exam to check for dilation
B. Administer oxytocin to stabilize the uterus
C. Induce labor immediately
D. Perform an ultrasound to determine placental location
Correct Answer: D
Painless vaginal bleeding in the third trimester is highly suggestive of placenta previa. A
digital cervical examination is strictly contraindicated until the position of the placenta is
confirmed, as it can cause catastrophic hemorrhage. Ultrasound is the diagnostic tool of
choice to safely visualize the relationship between the placenta and the internal cervical os.
5. A postpartum woman who is breastfeeding reports a painful, reddened area on her right
breast and a fever of 101.4°F. What is the first-line antibiotic treatment for this condition?
A. Metronidazole
B. Ciprofloxacin
, C. Dicloxacillin
D. Doxycycline
Correct Answer: C
The patient’s symptoms are classic for lactational mastitis, often caused by Staphylococcus
aureus. Dicloxacillin or cephalexin are the preferred first-line treatments due to their
effectiveness against penicillinase-producing staph. Patients should be encouraged to
continue breastfeeding or pumping to ensure the affected breast is frequently emptied.
6. Which of the following describes the correct measurement of fundal height in a singleton
pregnancy?
A. Measurement from the umbilicus to the fundus
B. Measurement from the iliac crest to the fundus
C. Measurement from the xiphoid process to the fundus
D. Measurement from the symphysis pubis to the top of the fundus
Correct Answer: D
McDonald’s rule states that fundal height in centimeters should roughly correlate with the
weeks of gestation between 20 and 36 weeks. The measurement is taken along the midline
of the abdomen from the upper edge of the symphysis pubis to the highest point of the
uterine fundus. Variations of more than 2-3 cm from the expected gestational age require
further investigation via ultrasound.
