NU 661 Exam 2 V1 | NU 661 Primary Care
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 2) | Regis
1. A pregnant client at 36 weeks gestation is being screened for Group B Streptococcus (GBS).
Which of the following statements by the nurse practitioner reflects the standard of care for
GBS screening?
A. ‘GBS screening is only necessary if you have a history of a previous infant with GBS
infection.’
B. ‘We will perform a vaginal and rectal swab today to screen for GBS colonization.’
C. ‘We will perform a vaginal and rectal swab today to screen for GBS colonization.’
D. ‘If you test positive for GBS, you will need to begin oral antibiotics immediately.’
E. ‘GBS screening is conducted via a clean-catch urine specimen at every prenatal visit.’
Correct Answer: C
GBS screening is routinely performed between 35 and 37 weeks of gestation using a
combined vaginal and rectal swab. Positive results indicate colonization rather than active
infection, and treatment is reserved for the intrapartum period to prevent neonatal
transmission. This protocol is a standard of care to reduce the risk of early-onset neonatal
sepsis.
,2. A nurse practitioner is assessing a client at 32 weeks gestation who presents with elevated
blood pressure. Which of the following clinical findings would support a diagnosis of
preeclampsia with severe features? (Select all that apply)
A. ‘Blood pressure of 165/112 mmHg on two occasions at least 4 hours apart’
B. ‘Platelet count of 90,000/mcL’
C. ‘Mild edema in the lower extremities’
D. ‘New-onset persistent headache unresponsive to medication’
E. ‘Serum creatinine greater than 1.1 mg/dL’
F. ‘Fetal heart rate of 140 beats per minute’
Correct Answer: ABDE
Preeclampsia with severe features is characterized by a systolic blood pressure over 160
mmHg or diastolic over 110 mmHg, alongside evidence of organ dysfunction such as
thrombocytopenia or renal insufficiency. Neurological symptoms like persistent headaches
or visual disturbances are also key diagnostic criteria for severe classification. Recognizing
these features is essential for determining the appropriate level of monitoring and timing
of delivery.
3. A client at 28 weeks gestation is undergoing a 1-hour glucose challenge test (GCT). Which
result would necessitate further diagnostic testing with a 3-hour glucose tolerance test (GTT)?
A. ‘A blood glucose level of 145 mg/dL’
B. ‘A blood glucose level of 125 mg/dL’
,C. ‘A blood glucose level of 110 mg/dL’
D. ‘A blood glucose level of 95 mg/dL’
Correct Answer: A
The 1-hour glucose challenge test is a screening tool, and a value of 130-140 mg/dL or
higher is generally considered positive, depending on the specific institutional threshold.
Clients who exceed this threshold must undergo the 3-hour GTT, which is the gold standard
for diagnosing gestational diabetes. Early identification and management of gestational
diabetes are crucial for preventing macrosomia and other neonatal complications.
4. During a routine prenatal visit at 20 weeks gestation, where should the nurse practitioner
expect to palpate the fundus?
A. ‘At the level of the symphysis pubis’
B. ‘At the level of the umbilicus’
C. ‘Halfway between the symphysis pubis and the umbilicus’
D. ‘Two fingerbreadths above the umbilicus’
Correct Answer: B
At approximately 20 weeks of gestation, the uterine fundus is typically located at the level
of the umbilicus. This landmark is used as a clinical correlation for fetal growth and
gestational age during the second and third trimesters. Significant deviations from this
expected height may indicate issues such as oligohydramnios, polyhydramnios, or
intrauterine growth restriction.
, 5. A pregnant woman with an O-negative blood type is at 28 weeks gestation. Her indirect
Coombs test is negative. Which action is most appropriate?
A. ‘Administer Rho(D) immune globulin only after delivery if the baby is Rh-positive.’
B. ‘Schedule a repeat Coombs test in 4 weeks and delay RhoGAM.’
C. ‘No intervention is needed since the indirect Coombs test is negative.’
D. ‘Administer Rho(D) immune globulin (RhoGAM) now.’
Correct Answer: D
Rho(D) immune globulin is administered prophylactically at 28 weeks to Rh-negative
women who are unsensitized, which is confirmed by a negative indirect Coombs test. This
prevents the mother from developing antibodies against Rh-positive fetal blood cells that
may enter maternal circulation. Failure to provide this prophylaxis can lead to hemolytic
disease of the newborn in subsequent pregnancies.
6. Which of the following instructions should the nurse practitioner provide to a pregnant
client regarding the intake of folic acid?
A. ‘You only need to take folic acid during the third trimester.’
B. ‘Daily intake of at least 400 to 800 mcg of folic acid helps prevent neural tube defects.’
C. ‘Folic acid is primarily used to prevent gestational diabetes.’
D. ‘Folic acid should be avoided if you are taking a prenatal vitamin.’
Correct Answer: B
of Childbearing Woman | Actual Q&A with
Rationale (NU661 Exam 2) | Regis
1. A pregnant client at 36 weeks gestation is being screened for Group B Streptococcus (GBS).
Which of the following statements by the nurse practitioner reflects the standard of care for
GBS screening?
A. ‘GBS screening is only necessary if you have a history of a previous infant with GBS
infection.’
B. ‘We will perform a vaginal and rectal swab today to screen for GBS colonization.’
C. ‘We will perform a vaginal and rectal swab today to screen for GBS colonization.’
D. ‘If you test positive for GBS, you will need to begin oral antibiotics immediately.’
E. ‘GBS screening is conducted via a clean-catch urine specimen at every prenatal visit.’
Correct Answer: C
GBS screening is routinely performed between 35 and 37 weeks of gestation using a
combined vaginal and rectal swab. Positive results indicate colonization rather than active
infection, and treatment is reserved for the intrapartum period to prevent neonatal
transmission. This protocol is a standard of care to reduce the risk of early-onset neonatal
sepsis.
,2. A nurse practitioner is assessing a client at 32 weeks gestation who presents with elevated
blood pressure. Which of the following clinical findings would support a diagnosis of
preeclampsia with severe features? (Select all that apply)
A. ‘Blood pressure of 165/112 mmHg on two occasions at least 4 hours apart’
B. ‘Platelet count of 90,000/mcL’
C. ‘Mild edema in the lower extremities’
D. ‘New-onset persistent headache unresponsive to medication’
E. ‘Serum creatinine greater than 1.1 mg/dL’
F. ‘Fetal heart rate of 140 beats per minute’
Correct Answer: ABDE
Preeclampsia with severe features is characterized by a systolic blood pressure over 160
mmHg or diastolic over 110 mmHg, alongside evidence of organ dysfunction such as
thrombocytopenia or renal insufficiency. Neurological symptoms like persistent headaches
or visual disturbances are also key diagnostic criteria for severe classification. Recognizing
these features is essential for determining the appropriate level of monitoring and timing
of delivery.
3. A client at 28 weeks gestation is undergoing a 1-hour glucose challenge test (GCT). Which
result would necessitate further diagnostic testing with a 3-hour glucose tolerance test (GTT)?
A. ‘A blood glucose level of 145 mg/dL’
B. ‘A blood glucose level of 125 mg/dL’
,C. ‘A blood glucose level of 110 mg/dL’
D. ‘A blood glucose level of 95 mg/dL’
Correct Answer: A
The 1-hour glucose challenge test is a screening tool, and a value of 130-140 mg/dL or
higher is generally considered positive, depending on the specific institutional threshold.
Clients who exceed this threshold must undergo the 3-hour GTT, which is the gold standard
for diagnosing gestational diabetes. Early identification and management of gestational
diabetes are crucial for preventing macrosomia and other neonatal complications.
4. During a routine prenatal visit at 20 weeks gestation, where should the nurse practitioner
expect to palpate the fundus?
A. ‘At the level of the symphysis pubis’
B. ‘At the level of the umbilicus’
C. ‘Halfway between the symphysis pubis and the umbilicus’
D. ‘Two fingerbreadths above the umbilicus’
Correct Answer: B
At approximately 20 weeks of gestation, the uterine fundus is typically located at the level
of the umbilicus. This landmark is used as a clinical correlation for fetal growth and
gestational age during the second and third trimesters. Significant deviations from this
expected height may indicate issues such as oligohydramnios, polyhydramnios, or
intrauterine growth restriction.
, 5. A pregnant woman with an O-negative blood type is at 28 weeks gestation. Her indirect
Coombs test is negative. Which action is most appropriate?
A. ‘Administer Rho(D) immune globulin only after delivery if the baby is Rh-positive.’
B. ‘Schedule a repeat Coombs test in 4 weeks and delay RhoGAM.’
C. ‘No intervention is needed since the indirect Coombs test is negative.’
D. ‘Administer Rho(D) immune globulin (RhoGAM) now.’
Correct Answer: D
Rho(D) immune globulin is administered prophylactically at 28 weeks to Rh-negative
women who are unsensitized, which is confirmed by a negative indirect Coombs test. This
prevents the mother from developing antibodies against Rh-positive fetal blood cells that
may enter maternal circulation. Failure to provide this prophylaxis can lead to hemolytic
disease of the newborn in subsequent pregnancies.
6. Which of the following instructions should the nurse practitioner provide to a pregnant
client regarding the intake of folic acid?
A. ‘You only need to take folic acid during the third trimester.’
B. ‘Daily intake of at least 400 to 800 mcg of folic acid helps prevent neural tube defects.’
C. ‘Folic acid is primarily used to prevent gestational diabetes.’
D. ‘Folic acid should be avoided if you are taking a prenatal vitamin.’
Correct Answer: B
